Vail Daily health feature: Managing migraines
Migraine myths and misconceptions
Dr. Marius Birlea, medical director of the Headache Clinic at the University of Colorado Health in Denver, explains some common misconceptions about migraines:
1. Intense headaches are often a sign of something more serious: False
90 to 95 percent of headaches are primary, which means we don’t have a cause for them. Secondary headaches, which indicate things like stroke, tumors, infections or high or low spinal fluid pressure, only occur about five percent of the time, Birlea said.
2. Headaches are genetic: True
There are 30 to 40 different types of inherited genes that could predispose people to migraines. Now we know why family gatherings always tend to hurt our heads, and not just because of a nagging aunt or uncle.
3. To treat migraines, take over-the-counter pain and headache medications often: False
Pain relievers like Tylenol and Ibuprofen could make your migraines worse. Birlea said limit taking these no more than 15 days a month, and also don’t take narcotic medications more than eight days a month.
4. High altitude can affect migraines and headaches: Unsure
Birlea said he has patients who say their migraines get worse living in the mountains (compared to sea level), while others say their headaches get better at high altitude.
“I don’t think it’s a straight relationship with altitude,” Birlea said. “I don’t advise in general for a patient to change their life (and move) because of the mountains.”
We all get headaches, but for some it’s not as easy as popping two Advil and waiting for the pounding to stop.
Four years ago, Avon resident Rich Staats, now 34, started experiencing migraines every few weeks that were so bad he thought, “I was sure I was having a stroke.”
At one point he ended up in the emergency room, after a frightening incident in which he was about to drive to Denver, dropped his dog off at day care and then couldn’t remember where he was, what he was doing and didn’t recognize any of the names and numbers in his cell phone.
“When I lost my memory, that was pretty scary,” Staats said. “(I thought) ‘Something is clearly wrong. I need to figure out if this is something life threatening.”
Staats is one of the estimated 36 million Americans — about 12 percent of the population — who experience migraine headaches, according to the American Migraine Foundation. On top of this, another three percent experience chronic migraines.
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THE MYSTERIES OF MIGRAINES
Even though migraine headaches affect so many people, we still don’t quite know exactly what causes them. Dr. Marius Birlea, assistant professor of neurology at the University of Colorado Denver, said that in the past researchers believed that migraines were a disorder of the blood vessels inside the brain. Now, Birlea said scientists think that either something occurs on the surface of the brain, then spreads and leads to sterile inflammation (inflammation not caused by infection), or the cause begins in the deep structure of the brain, which spreads to the surface and involves the blood vessels.
Other factors can also influence the cause of migraines, such as genetics, “nerves around the brain, hormonal environment (and) mental processes,” Birlea said.
Despite the mysteries surrounding migraines, they can be treated. Birlea is the also the medical director of the Headache Clinic at the University of Colorado Health in Denver, which opened in 2013 and is designed to give specialized treatment to headache and migraine patients. Birlea said one of the first things the clinic does with a new patient is find out what other methods they’ve used to combat the hammering in their head.
“When they come in and say, ‘I have tried everything,’ we often find that they have not tried everything,” Birlea said. “They (drink) four cups of coffee every day or soda; even a little caffeine you drink everyday can worsen the headaches. They don’t sleep well, or there is a lot of light in their workspace, or there is a stressful work environment.”
When treating migraines, there isn’t a one-size-fits-all-approach. Even with medication, like anti-seizure drugs, Birlea said they work about 55 percent of the time. Botox injections are effective in 70 to 80 percent of patients, but typically more than one treatment is needed.
“We often have to put multiple tools together for the patient to get better,” Birlea said. “This is a discussion I’m trying to have with each patient, to be comprehensive.”
TREATING THE PAIN WITHOUT A PILL
For Staats, after consulting with a neurologist, he met with a nutritionist, sought out treatments with a holistic chiropractor and started doing yoga. A former athlete with a high metabolism, Staats said eating an unhealthy diet, drinking a lot of alcohol and work stress from running his own business likely contributed to his migraines. While Staats has used medication, he didn’t want this to be his go-to method.
“When I gave up alcohol, I gave it up because I had a problem with an addiction,” Staats said. “So I’m not really interested in treating (my migraines) with a narcotic. When you see a (doctor) and they present that to you, it’s kind of frustrating.”
Birlea said many of his patients are seeking a solution that doesn’t involve taking a pill every time they feel a pain in their brain. However, he stresses that migraines are a biological problem, not a psychogenic problem caused by a mental or emotional issue.
“Some people may not need medication,” Birlea said. “(But) some patients are telling us, ‘I really have to work,’ ‘I really have to focus,’ ‘I really have to take care of my kids.’ They need to take some medication then.”
‘TEACHING PEOPLE HOW TO ELIMINATE THEM’
Another method Staats tried was getting a special migraine massage from Tom Bacon, a massage therapist at the Vail Vitality Center. Bacon himself began experiencing chronic migraines in his mid-20s, and said they would last 72 hours, often so intense he started vomiting.
“At 24, I (was) a Vietnam vet,” Bacon said. “I was married and had a couple of kids. I was in college, I was stressed out and then they really started. I grew up in San Diego and then I transferred to a Colorado State (school). When I got here they really kicked in.”
After more than five years of debilitating headaches, Bacon decided to educate himself, researching migraines and treatments. He developed a method that uses a combination of relaxation, breathing, focusing and massage techniques.
“After three or four months, they went from being 72 hours to only lasting 24 hours,” Bacon said. “Awhile after that, they went to being an hour in length. When I would do this (pressure) point routine on my head … the migraine would end in 20 minutes and then they just stopped altogether.”
Now in his late 60s, Bacon is interested in teaching others his technique and offers a research study that locals with chronic migraines can participate in every summer.
“I’m not interested in making (migraines) a little bit better or easier to deal with,” Bacon said. “I’m teaching people how to eliminate them.”
Staats said he practices Bacon’s routine nightly as a way to prevent future migraines.
“What’s great about the session is he showed me how to do it on my own,” Staats said. “He showed me all the pressure points and how to think about approaching a headache. For people who suffer from headaches … it’s about how you handle the 30 minutes before you hit that peak.”
‘DEAL WITH THEM IN A POSITIVE WAY’
Staats said he still gets intense migraines about four times year, but having a change in mental attitude helps him manage them better.
“(It’s) about keeping myself in the mindset that they are going to happen and deal with them in a positive way,” Staats said.
Philosopher Friedrich Nietzsche was believed to have suffered intense migraines, so when he said, “That which does not kill us, makes us stronger,” maybe he was really just referring to the pounding in his skull.
However, just because Nietzsche philosophized through the pain doesn’t mean others must. The fact that there are multiple ways to reduce or eliminate migraines should be seen as a benefit, not yet another reason to get a headache.
“The good news is this is a treatable condition,” Birlea said. “It’s very rare that patients have no other option than go on narcotics.”
For more information on Tom Bacon’s migraine treatment method, contact him through the Vail Vitality Center at 970-426-0034.