It’s all in your head

After nearly 20 years of prescribing the same medications to severe headache sufferers and hearing the same, seemingly incurable complaints—The pain! Throbbing! Nausea! Fatigue!—doctors finally have good news for patients. Relief may be on the way through a slew of medical breakthroughs—from new drugs to magnetic stimulation, and maybe even a version of yogic breathing.

As long as humans have endured headaches, which affect all but one per cent of women and seven per cent of men, the prevailing remedies have included aspirin, ice packs or a dark, quiet room. For your garden-variety headache, a hit of an over-the-counter painkiller usually works. But for more severe or frequent headaches, there has been a dearth of miraculous elixirs. “They’re always a failure,” says Dr. Eric Magnoux of the Montreal Migraine Clinic, of drugs currently available that prove ineffective in some people, or are inappropriate because they conflict with other medical conditions.

The new headache treatments, for both the tension type and migraines, couldn’t come at a better time. Headaches were the most common head and neck symptom reported by more than 10,400 people who took the online Q-GAP test since last May. It was developed by Toronto’s Scienta Health and is posted on the Maclean’s website to help readers evaluate their physical and emotional health. Participants ages 26 to 35 were especially affected, which is consistent with statistics showing that young and middle-aged adults are most prone to headaches. “These patients suffer during the prime of their life, between the ages of 20 and 50, when they’re supposed to be at their most productive,” says Dr. David Dodick, a leading neurologist at the Mayo Clinic in Scottsdale, Ariz.

Now there is a growing understanding of how headaches work and what to do about them, which has the medical community paying more attention. One of the most exciting developments is a new group of drugs referred to as calcitonin gene-related peptide antagonists. These work as “abortive” medications, which stop a headache attack, especially migraines. (The other class of headache drugs are preventative.) CGRP-antagonists, which are still in clinical trials but may be on the market as early as 2011, are as effective as the current leading medication, known as triptans. The difference is that unlike triptans, CGRP-antagonists do not cause the blood vessels to constrict. That means patients who couldn’t take triptans because they have risk factors for heart disease—such as high blood pressure, diabetes or high cholesterol—or who have suffered a stroke or heart attack may now have a powerful headache remedy.

Magnoux calls CGRP-antagonists “a breakthrough” and says 30 per cent of his patients will benefit from the new drugs. And it’s been a while since a new headache medication has been developed. The first triptan became available in Canada in 1992, says Dr. Werner Becker, a pre-eminent neurologist in Calgary. “So it takes a long time for these breakthroughs to be repeated.”

Perhaps even more rare than new drugs are non-medicinal treatments. That’s why an innovative therapy called transcranial magnetic stimulation is a “hot topic,” says Dodick, who is heading this research. Patients hold a device to the lower back of their heads, which delivers a one-millisecond pulse of magnetic stimulation. They don’t feel anything, but that pulsing stops the neurons in the brain from abnormally discharging, thereby interrupting part of the process that causes a migraine attack, hypothesizes Dodick. TMS has already been effective in treating depression and aiding stroke recovery, and there appear to be no side effects. Magnoux suspects it won’t be widely offered in Canada for a while yet, but Dodick predicts it will be commercially available in the States within a year.

As high-tech and scientific as these treatments sound, there may be one more option for patients that could provide significant headache prevention: slow breathing. Magnoux is informally studying patients at his clinic to determine whether reducing the rate at which they breathe can actually inhibit headaches. The concept, which is derived from prana yoga, is referred to as heart rate variation biofeedback, or HRV—and can be as effective as a preventative drug and has benefited patients with depression and fibromyalgia. Patients practise breathing six times per minute, rather than the usual 12 to 15, which changes their cardiac frequency. That, in turn, helps stabilize their nervous system, which promotes relaxation—and hopefully prevents headaches. Magnoux says people can try this while driving or watching TV. The challenge, he warns, will be keeping up the exercises. “You must do it every day,” Magnoux advises. “And this is the problem. We don’t have the time, or we don’t take the time.”

In fact, our lifestyle habits—eating too much, exercising too little—may actually be contributing to our headaches. Mounting scientific evidence reveals that the more overweight or obese we are—even just 10 lb. too heavy—the higher our risk of having more and more headaches. Researchers think that excess fat leads to an increased number of inflammatory proteins in the blood that circulate and potentially excite pain nerve endings, says Dodick. It’s unclear whether shedding pounds will reduce headaches. No matter, “there are a lot of reasons why patients should lose weight, and now we have another,” he adds.

Another concern among physicians is medication overuse headaches, or MOH. When patients take painkillers, including non-prescription, more than 10 or 15 days a month to alleviate headaches, it can actually provoke more of them because they change our brain chemistry. Becker likens it to caffeine withdrawal that coffee drinkers experience when they curb their consumption. Many medications actually contain caffeine. The bottom line, he says, is for patients to talk to their doctor about their headaches. “Most patients just get a lot of headaches and they go on for years like this unless they learn about it,” says Becker, “and how to stop it.”