The Mysteries of Migraine Management

Taken from the July/August 2012 issue of the Women's Health Activist Newsletter.

“What are you looking at?” Mary peered at me in the rearview mirror without turning her head.

“I’m trying to focus on this weird light.”

“Oh,” she said, “You’re having a migraine.”

“How do you know?”

“I only have vision in one eye, remember? I know about migraines.”

Okay, I thought. I guess you’d know. What she didn’t tell me what that, 45 minutes later, after returning to the lab, a searing pain would rip through my head, so sharp and potent I wanted to tear my eyes out of their sockets. Somehow I managed to ride my bike back to my apartment, endure this incredible pain, finally throw up, and pass out.

Within the next three months I suffered two more migraines. Something was wrong but I didn’t know what. Thus I found myself in my department office, filling out the papers for a leave of absence.

That was more than 30 years ago. Now, after decades of research, multiple neurologists, a behavioral therapist, food diaries, and four medications, I am able to say I can live with these migraines. I have found a system that works for me.

With all this behind me, I picked up and read C.M. Shifflett’s Migraine Brains and Bodies: A Comprehensive Guide to Solving the Mystery of Your Migraines (North Atlantic Books, 2011) with great interest. The book opens with some eerily familiar images: illustrations of daily life drawn as though through the eyes of someone experiencing the visual auras of a migraine. Shifflett describes the often paternalistic, frequently dismissive comments migraine sufferers receive — “It’s hormones”; “It’s just a really bad headache”; “It will go away after you get pregnant” — from those who have no idea what a migraine is. And so, she affirms the reality of this “headache” that moved into our lives, uninvited.

Shifflett discusses the many potential causes for migraines, from tension to vascular and neurological origins. Numerous detailed diagrams supplement the text and illustrate trigger points, methods to self-diagnose where tension points may lie, and how to treat them. The chapter “Triggers and Thresholds” is quite inclusive. Researchers have learned that certain triggers can set off migraine attacks. These triggers vary from person to person, and can include sleep disturbances, stress, weather changes, bright lights, and loud noises; in other words, many things. In my case, after all these years I have stopped trying to discover my triggers; when the lights appear, I kind of shrug my shoulders, figure out what was on my schedule for that day, and know I will have to reschedule.

Shifflett deals with these topics with an obviously personal, concerned passion and, in my opinion, a bit of odd humor. But, far be it for me to dismiss someone because our outlooks on life differ! I would be in terrible shape as a nutrition educator and consultant if I only worked with folks who laugh at the same jokes as I do. But I cannot, as a registered dietician, look past other assertions Shifflett makes. Until the chapter “Chemical Triggers,” I had taken for granted the reliability of her research. Yet, as I began this section, my concerns rose.

Dehydration is the cause of many health issues, including headaches. According to Shifflet, “If you squeeze your eyelids gently together and see sparkles, it isn’t aura; it is dehydration severe enough that the eyeball has begun to deform.” I had never heard this before, so I contacted my eye doctor. She informed me these sparkles appear when the retina is subjected to pressure and is called an “entopic phenomenon.” My optometrist had never heard of dehydration as a cause for these sparkles.

This was not Shifflett’s only curious claim. In her section on Vitamin C, she states that one side effect of certain painkillers like ibuprofen and aspirin is “active destruction of Vitamin C,” I looked through my resources to see how this mechanism could work. It is true that overdosing on these medications – and individuals who are in a lot of pain may find themselves taking too much – can cause kidney and liver disease; but I found nothing about Vitamin C destruction. My research actually described the opposite: too much Vitamin C reduces these painkillers’ effectiveness.

Shifflett also discusses B vitamin deficiencies as a cause of migraines. While a deficiency in one B vitamin, thiamin, has been known to occur among migraine sufferers, this primarily occurs in alcoholics. (This is because alcohol depletes thiamin as part of its metabolic detoxification.) In general, thiamin is found in just about each and every grain product we consume, and so its deficiency is rarely a source of migraines.

Shifflett’s last chapter, “Getting Help,” is the most effective. She offers a range of tools that migraine victims may use to combat their suffering. She recognizes that there is no single cause for migraine, and lists many resources, including organizations, websites, self help groups as resources. She does not dismiss Western medicine nor push alternative methods (such as acupuncture); she merely presents what is available; what has worked for her; and what other victims might want to try. She describes the roadblocks she experienced in her journey towards finding successful treatment, encourages patience when dealing with the medical system, and cautions against being overly optimistic when trying alternatives.

While I personally may not agree with some of her recommendations, I am grateful for her thoroughness because I know what it is like to be told, “There is nothing you can do.” What Ms. Shifflett does – with varying success – is to provide tools that empower the migraine sufferer to take back some of the control lost to devastating pain and uncertainty.

Leeann Simons, MS, RD, LDN is a registered dietitian with over 30 years of clinical and teaching experience. She has been involved with women’s health since her graduate days at the Women’s Resource Center in State College PA. She is the author of At Peace With Food. 

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