My aching head - interview with headache specialist Dr. Seymour Diamond - Interview

Vibrant Life, July-August, 1993 by Gary Bousman

What did Ulysses S. Grant, Edgar Allan Poe, Karl Marx, Sigmund Freud, and Charles Darwin have in common? Migraine headaches. If you belong to this distinguished group, you're not alone. An estimated 21 million Americans share your misery.

Like many other "migraineurs," you may first see flashing lights in front of your eyes before the throbbing pain begins. During the painful attacks you are often nauseated, and may feel dizzy, have cold hands, and be sensitive to light or sound. You have probably tried over-the-counter drugs, which brought little or no relief.

As a fellow sufferer, I have another trait common to many migraineurs--curiosity. I wanted to know why I have this affliction, what I can do to ease the pain, and if there's a cure. To get the answers, I put these and other questions to Dr. Seymour Diamond, director of the Diamond Headache Clinic in Chicago, and executive director of the National Headache Foundation.

Q: Are there different kinds of migraine headaches?

Dr. Diamond: Most specialists divide migraine headaches into two broad categories: the classic migraine and the common migraine. With the classic migraine, the person experiences an aura--vision of bright lights of wavy lines. Some have blind spots or a distortion of the vision field. With the common migraine, the aura is missing and, as the name implies, this type of migraine headache is more common.

Q: Is there a heredity factor?

Dr. Diamond: Yes. We see some patients who have no family history of migraines, but the number of cases in which there is a family connection is striking.

Q: It has been said that migraine headaches are more common among women than men. Is this true?

Dr. Diamond: Specialists estimate that 60 to 80 percent of migraine patients they see are women. women. But we are not sure whether women are more susceptible to migraines or whether men simply do not report that they have migraines, thinking it's "unmanly" to go to a doctor because of a headache.

Q: Is there such a thing as a migraine personality?

Dr. Diamond: Many migraine patients are perfectionists. They tend to be intelligent, doers, and achievers. However, many specialists reject the idea of a migraine personality because the psychological makeup of migraine sufferers tends to be similar to that of nonmigraine sufferers.

Q: What actually goes wrong in the system when a person has a migraine headache?

Dr. Diamond: In all cases there is a swelling, or dilation, of blood vessels in the scalp and covering of the brain. Many specialists now believe that the blood vessels also become inflamed during an attack, and we think this accounts for a good deal of the prolonged pain in migraine.

Q: Are there things that touch off a migraine attack?

Dr. Diamond: Yes, many things. Hunger, because it lowers the blood sugar, may set off an attack. But eating after an attack begins will not stop the headache. Stress can also be a factor. Changes in barometric pressure have been blamed, but the jury is still out on this point. Eating certain foods is high on the list of triggering factors. In women an influx of certain female hormones, especially estrogen, is believed to play a part.

We do not know why these factors trigger migraines or why they bring on attacks one time and not the next.

Q: If foods are a triggering factor, which foods should I avoid?

Dr. Diamond: Before I begin, let me say that there is some variation among migraineurs as to which foods touch off an attack. Also, a food that triggers a headache one time may have no effect the next time it is eaten.

Foods that are believed to trigger migraine attacks include freshly baked bread, pork, cheese (except cottage cheese), herring, navy beans, lima beans, most citrus fruits, vinegar (except white vinegar), onions, nuts, and chocolate. Add to the list alcohol.

Q: What do you, as a physician, do to help a migraine victim?

Dr. Diamond: First we attack the pain, to reduce the severity and the frequency of the attacks. This is usually accomplished by prescribing one of a variety of medicines. If one does not work, we try another.

Second, we try to find the underlying cause, and this is not as easy. The causes are sometimes subtle.

Q: How do you go about attacking the pain of migraine?

Dr. Diamond: We begin by trying to abort or interrupt the pain with medication. Then we attempt to prevent future attacks.

By giving carefully prescribed medicines at the first sign of a migraine, we are usually able to abort the headache. A medicine often prescribed is egotamine tartrate. Usually combined with caffeine (a combination called Cafergot), it tends to constrict the blood vessels, thus reducing the swelling of the vessels that cause the pain. Midrin, a milder constrictor, is also useful.

It is very important that egotamine tartrate be taken at the first hint of a migraine.

Q: Can anyone take ergotamine compounds?

Dr. Diamond: It should not be used by women during pregnancy, nor by anyone with certain kinds of heart conditions or circulatory problems and the elderly. Also, it should not be used on a daily basis.