Written by Linda Yau, M.D., F.A.C.P.
October 25, 2014
Have you ever had such a terrible headache that you had to lie down? Are you one of the millions of people that suffer from headaches that affect your work, play, life? Then this book has many insights and a plan to alleviate that suffering. Dr. Buchholz was the Director of the Neurological Consultation Clinic at the Johns Hopkins Hospital for 14 years. He also served as Director of the Division of General Neurology at Hopkins. He focuses his clinical practice on headache.
Dr. Buchholz focuses the book on headache sufferers being able to gain control over the pain. He introduces the mechanism behind migraines and then outlines a 3 step approach to decreasing headache pain. He explains that each person has a migraine threshold and also triggers that may activate headaches. The migraine threshold is likely genetic. Triggers are individual but can be environmental, stress, medications, and food. When a person is exposed to multiple triggers at the same time, they cross the migraine threshold and the pain begins. He explains the complicated biochemical and nerve pathways that eventually lead to swelling of the blood vessels that affect the brain, which then trigger nerves that cause pain. The goal of his treatment is to keep the triggers below the threshold level where a migraine develops.
Step 1: Avoiding the Quick Fix
Dr. Buchholz states in his book, “Eliminating rebound is potentially the hardest but also the most important step toward controlling your headaches.” He explains that chronic headache sufferers often fall into a cycle of taking painkillers to get rid of headache pain. Because the pain is severe, the patient will take a medication that eliminates the pain. Often these medications will work for a while, but the headache returns worse afterwards. As the medication is taken more often, the pain often starts not to respond to the medication but the medication is responsible for rebound, the process by which the blood vessel swells more after the painkiller has worn off. Dr. Buchholz recommends limiting potentially rebound inducing medications to two times per month. Examples of rebound inducing medications are: caffeine containing medications such as Excedrin, Butalbital compounds such as Fiorinal, Decongestants such as Sudafed, Triptans such as Imitrex and Isometheptene compounds such as Midrin. He recommends that the first step toward prevention of headaches be to get rid of painkillers.
Step 2: Reducing Your Triggers
If a person can reduce headache triggers, he or she will definitely reduce pain. He explains that there are many migraine triggers that are unavoidable such as barometric pressure and weather changes, hormonal fluctuations due to menses, pregnancy and menopause, physical exertion such as bending over, aerobic exercise, weight lifting, sex and dehydration. Sleep deprivation and stress are also triggers. So how can someone control their triggers? The main controllable trigger is diet. Even if someone does not notice a direct link between a particular food and a headache, it is likely that the lag time and the presence of other triggers can make the link less obvious. As Dr. Buchholz explains, depending of the other triggers that are present at the same time as the food, someone may notice the link one time and not the next. Therefore it is very important to try to eliminate all potential food causes immediately and then add back one food at a time. This book has a nice appendix which gives examples of a diet that would help eliminate headaches. The diet he recommends cuts out all chocolate, all caffeine, monosodium glutamate (MSG), processed meats and fish (e.g. hot dogs, sausage, pepperoni, etc.), cheese and other dairy products, nuts, alcohol and vinegar, citrus fruits, bananas, raisins and other dried fruits, and onions, pea pods and certain beans, Aspartame, and less than one day old fresh yeast-risen baked goods. The book goes into more details about each food group. Dr. Buchholz also explains a list of medications that could potentially cause headaches. These medications include hormonal medications such oral contraceptives and hormone replacement therapy. As always, each person should discuss the diet as well as medication with his or her personal physician.
Once the elimination diet is achieved for 2 months, the patient could add back one food at a time each week.
Step 3: Raising Your Threshold
If Step 1 and Step 2 are successful, many people do not need to try Step 3. Besides recommending aerobic exercise daily to try to raise the headache threshold, this section explains the many medications that can raise the headache threshold. In a succinct manner, Dr. Buchholz guides the reader through the proper usage of preventative medications. “Try one at a time. Start with a low dosage to avoid side effects. Keep increasing the dosage slowly but steadily over a period of two months until you either achieve satisfactory headache control or hit the dosage ceiling.” He writes about each category of preventative medications, such as beta blockers, calcium channel blockers, tricyclic antidepressants and antiseizure medications.
In the latter half of the book, Dr. Buchholz deals with “Migraine Myths and Misdiagnoses” and “Beyond Migraine”. He includes a question and answer section on Frequent Asked Questions. He also has the aforementioned section on a model diet and recipes. This book clearly describes a good approach to decreasing headaches that has been successful in many patients. It is a stepwise approach that may be very helpful to many headache sufferers.