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Migraine Headache—Diagnosis and
Treatment |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
The importance of diet to headache patients and how to avoid
weekend headaches were just a few of the clinical insights
shared by Dr. Seymour Diamond on February 18 during his opening
address to more than 200 physicians at a Headache Research
Summit presented by the Diamond Headache Clinic Research and
Educational Foundation.
Dr. Diamond is the director and founder of the Headache Clinic
and has a career that spans more than 50 years as a headache
specialist.
He reported that because of the important role diet plays in
headache patients whose pain is set off by exposure to
ingestible items, such as aged cheese, chocolate, alcoholic
beverages, and medicines, the Diamond Headache Clinic developed
a menu plan that helps about 30% of all headache patients by
eliminating those foods. He offered to send the menu plan/diet
to any physician who requested.
Dr. Diamond then shared what physicians can do to help their
patients remain headache-free on the weekends.
He explained that many headache patients have physiological
causes for headache, such as keeping late hours, oversleeping,
and skipping breakfast. There can also be psychological causes,
such as anxiety, depression, fear, and repressed anger.
“To avoid weekend headaches, my instructions to patients are to
get up the same time every day and to eat the same breakfast,”
said Dr. Diamond. “If it is a weekend and they are still sleepy,
they then can go back to bed. “If they do that, they will avoid
a lot of weekend headaches.”
According to Dr. Diamond, headache patients often have warnings
of approaching migraine that may include talkativeness, a
feeling of well-being and surge of energy, hunger, drowsiness,
depression, irritability, and tension.
He then traced the history of drug therapy for headache, making
the point that the perfect headache drug has yet to be
developed. Many classes of drugs have been tried with various
degrees of satisfaction, he said, but even the triptans don’t
work on every patient all the time.
Among the drugs that can provide some benefits to different
subpopulations of patients, Dr. Diamond continued, are
ergotamine with caffeine, aspirin, corticosteroids for prolonged
migraines, ergotamine with NSAIDS, NSAIDs such as indomethacin,
naproxen, ibuprofen, and ketoprofen. He added that other
sometimes useful drugs include the ß-blockers, propranolol and
timolol; the calcium channel blockers, verapamil and nimodipine;
antiepileptic agents, such as phenytoin, the triptans; and
tricyclics antidepressants.
Tricyclics are helpful to many migraine patients, continued Dr.
Diamond.
“If tricyclics antidepressants, such as amitriptyline, doxepin,
and protriptyline, went before the FDA today and we didn’t know
they had anti-depressant benefits, they would be approved as
painkillers,” said Dr. Diamond. “These are the first drugs you
should try.”
“If the patient has a sleep disorder, we at the Diamond Headache
Clinic use amitriptyline,” he said. “If sleep disorder is not
listed as a co-morbidity, we use a non-sedating tricyclic
antidepressant.
Monamine oxidase inhibitors (MAOIs) such as the hydrazine
derivatives pheneizine and isocarboxazid are very effective in
the treatment of the chronic daily headache, continued Dr.
Diamond.
“We use them at the Diamond Clinic, but you should not,” he
cautioned.
“As you all know, MAOIs have side effects such as postural
hypotension and weight gain, and dangerous interactions with
many classes of drugs, including antihypertensives,
decongestants, appetite suppressants, L-Dopa, and amphetamines,”
warned Dr. Diamond. He pointed out that all drugs have side
effects and that patients should be warned about those side
effects and possible drug interactions. For instance, with the
tricyclics antidepressants, patients often get dry mouth,
constipation, and blurred vision.
“Doctors should treat side effects before they occur by
explaining to the patients, for example, that they may get
tingling sensations in their hands, but not to worry because
this may disappear after a couple of days,” Dr. Diamond
explained later in an interview.
In closing, he stated the most important thing doctors can do
for their headache patients is to “give them continuity of
care.” The headache patient cannot be treated on a one-shot
basis, he said. “You have to be able to follow up and see how
they are doing.”
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| Copyright 2008 Elsevier Custom Conference Coverage. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification of diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the Publisher, the sponsor, or the editors. Elsevier assumes no liability for any material published herein. |
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