Our Big Headache

Knoxville’s a top migraine hotspot. Why all the misery? And what can you do about it?

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Photo by Lauren Ray Wagner

I’m a human barometer. A storm front is moving in, and I can feel it from head to toe—I’m achy, tired; my toes and fingers have a distinctive burning/cold sensation, and I can literally feel the pressure building in my head.

When it gets here, it’s dramatic—gales of rain, bright cracks of lightning across the predawn sky, and rumbling thunder growing inexorably louder, shaking the house. But as intense as things are getting on the outside, this storm has got nothing on the one within me. My muscles are tensing, my field of vision dimming and blurring even as my senses of hearing and smell are becoming hyper-acute. I feel myself telescoping inward, dizzy and nauseous, as the entirety of my consciousness shrinks violently into a hot dot that takes up residence behind my right eye for what will inevitably be the next 72 hours. Migraine.

Panicking, I make my way to my kitchen, where there’s an entire drawer filled with prescription medications aimed at preventing, aborting, or simply easing the pain of these full-body headaches, which have been raging out of control for well over two years now—since I moved home to Knoxville from the West coast. The best of everything Western medicine has to offer is right here: Imitrex, Zomig, Axert, Maxalt, Topamax, Depakote, Zanaflex, Phenergan, Ultram. (And that’s not to mention my small stash of desperation narcotics.)

It’s shocking, really, considering how much of my life and career I’ve devoted to helping people avoid this fate. Just a couple of years ago, I was the editor of a magazine called Natural Health, advocating for alternative therapies and writing about my success in keeping these migraines under control with a combination of magnesium, feverfew, and vitamin B2. Then I had a baby, moved home, and the headaches took a real turn for the worse—transforming from occasional nuisance to a near-constant source of blinding, incapacitating pain. Now, I’m practically a junkie.

As the storm and the pain in my head lash out, I view my options with despair. The truth is, these drugs don’t really work all that well. But the more failure I face, the more medication I’m willing to take—new types, higher doses, new combinations. I’ve been willingly climbing the slippery slope of allopathic treatment, hoping for some miraculous relief, but it never comes.

I reach for an Imitrex STATdose, and give myself a forceful injection that will—if nothing else—take my mind off the pain in my head for a second. And in that moment of clarity, I ask myself this life-changing question: How much longer can I keep doubling down on my health? And just as clearly, I receive the answer: No more.

GROWING PAINS

There are 29.5 million diagnosed migraineurs in this country, and each and every one of us has a different story to tell. Migraines are like snowflakes—no two are quite alike in the ways they are triggered, manifested, and experienced.

It’s true that the pain tends to occur on one side of the head, but beyond that, the headaches can come on fast or slow, last hours or days, be preceded by an aura or not, cause nausea and vomiting…or not. And as for the triggers, they might include sunshine, loud noises, perfume, discordant music, excessive heat, stressful situations, overexertion, chemical odors, icy drinks, orgasm, sleep variations, hormonal fluctuations, shifting weather patterns, and a wide variety of foods.

Life, in other words, and all of its glorious sensory stimulation, is one big headache-maker.

That’s especially true here in Knoxville. Our fair city recently ranked number four on a list of America’s Top Migraine Hot Spots, compiled by Sperling’s Best Places in conjunction with Ortho-McNeil Neurologics. (Nearby burgs Johnson City and Chattanooga ranked seven and eight, respectively.) The study—a massive per-capita demographic number-crunching—considered the number of migraine-related prescriptions written, environmental characteristics conducive to migraines, lifestyle, and stress factors known to aggravate to migraines, and consumption of known migraine trigger foods.

“Knoxville had a very, very, very high prevalence of migraine-related prescriptions,” notes Bert Sperling, the data analyst who created the study. “When you look at the number of prescriptions for triptan drugs, like Imitrex and Zomig, and migraine preventives, like Topamax, Knoxville falls into the 97th percentile in the nation.”

We also scored high—in the 86th percentile, according to Sperling—in consumption of trigger foods, which include aged or imported cheeses, red wine, beer, hot dogs, peanut butter, nuts, pickles, sour cream, pizza, sausages and other cured meats, coffee, chocolate, grapefruit juice, and other alcoholic beverages.

Environmentally speaking, we’re just about average (though it should be noted that Sperling did not consider pollen counts in his formula). And when it comes to lifestyle aggravations, we’re actually low—in the 16th percentile, much less stressed, it turns out, than cities such as Milwaukee and St. Louis.

So why the high ranking? I can accept the idea that Knoxvillians eat a lot of processed meats and drink a lot of beer. After all, the spread of migraine trigger foods considered in the study sounds like the average tailgate party to me. But Sperling notes that there’s no smoking gun among these statistics—we eat more hot dogs, maybe, but only by a fraction of a percentage point. Surely, that’s not all there is.

When I ask Sperling for his assessment, he agrees that our food choices don’t tell the whole story—but can’t put his finger on what, exactly, does.

“We are urban demographers, not medical researchers,” Sperling says. “Our study was rigorous, and it does show where there seem to be migraine hot spots. We’re not suggesting that you’ll get migraines if you move to Knoxville, or that you’ll be cured if you move away. We’re just saying there’s something going on—some combination of lifestyle, food, genetic, or geographic factors—that might bear future study.”

In conclusion, Sperling offers only this: “Migraine is a very debilitating and powerful condition that afflicts millions, but it’s difficult to even identify what the triggers really are because they very so much from person to person. We know Knoxville is a hot spot; we don’t know exactly why.”

BRAINIACS ON THE LOOSE

In that, Sperling is in good company. Nobody even knows what actually causes this affliction, period—in Knoxville, or anywhere else. Until recently, the predominant theory was that the headaches were vascular in origin, caused by unstable artery walls creating pressure in the brain. “That’s antediluvian thinking now,” says Dr. John Claude Krusz, a neurologist and director of the Dallas-based Anodyne Headache Center and medical advisor to the National Migraine Association. “The blood vessels are involved, but they’re not the chicken—they’re more like the eggs.”

According to Dr. Jeffrey Nelson, the neurologist who runs the Knoxville Headache Clinic at Fort Sanders Hospital, “We think the trigger for migraine is an abnormal brain.” Once I recover from my Young Frankenstein flashback (“Abby who?”), he continues: “If you do an MRI of a migraineur, the brain will look normal, but at the molecular level, there is something wrong. There’s some kind of electrical abnormality that begins the whole headache process—it stimulates the blood vessels to act in the wrong manner, and you get the head pain, nausea, sensitivity to light and sound, and all the other symptoms you associate with migraine.”

Krusz calls this the “excitable brain”; that is to say, it’s an extreme sensitivity issue. “Migraine is a brain disorder in which there seems to be excessive electrical signaling in the brain, allowing too many painful signals to get through,” Krusz says. “We don’t have a good level of understanding as to why it happens. We are only just beginning to scratch the surface.”

Add that picture up and you get a person, like me, who is hypersensitive to life—working with a doctor, like him, who’s somewhat shooting in the dark.

That’s not to knock Krusz—he’s got a deep understanding of neuropharmacology. He knows what he’s doing. He’s a caring doctor, open to alternative therapies (in fact, he’s done some pioneering research on migraines and magnesium), and has reached out to thousands of migraineurs in his role as virtual clinician for MyMigraineConnection.com. But Krusz is a rare breed, and he knows it.

“Neurologists don’t want to see headache patients, because they consider them an nuisance,” Krusz confesses. “In private, they’ll roll their eyes. They consider headachers to be weaklings or misfits.”

Nelson confirms that diagnosis. “It’s true that migraineurs are needy patients,” he says. “They call often, take up a lot of staff-member time, and you really have to take your own time with them to educate them about their condition and about their options for treatment. It helps if you have the condition yourself.”

Nelson does. As a migraineur himself, and a transplant to the area (from Dallas, where he was acquainted with Kruscz), he’s observed a thing or two about Knoxvillians that he thinks may contribute to the headache epidemic here. “Caffeine is a huge trigger, and it’s big around here—people just down Mountain Dews and energy drinks all day,” he says. “Smoking is another big problem. But the thing that probably puts Knoxville in the number four spot is obesity. Obesity hasn’t been proven to be an absolute risk factor for migraine, but it’s a big factor in increasing frequency, and it makes the disease more intractable.”

SPOONFUL OF MEDICINE

I could write on for pages about the whys of the disease, but when the pedal hits the metal and your head is exploding, the whys don’t really matter. The central question, the one that takes over every thought, becomes: How can I make this stop?

On that one, again, there are no easy answers. From a Western allopathic perspective, frontline treatment most often includes pharmaceuticals. For periodic migraines, a relatively new class of drugs called triptans—that is, Imitrex, Zomig, Maxalt, Axert, Frova, Relpax, and Amerge—work well to stop a migraine in its tracks (hence, they’re often called “abortives”). For migraineurs, these drugs have been a godsend—though, at about $20 a dose, an expensive one.

Once the headaches become increasingly frequent, or intractable—as mine now are—it’s on to prophylaxis. In this realm, the options are nearly limitless: sedatives, beta-blockers, calcium-channel blockers, anti-depressants, sleeping pills, muscle relaxers, anti-inflammatories, blood-pressure meds, anti-psychotics, allergy drugs, and even Botox are among the options. It’s a crapshoot to find the drug—or combination of drugs—that will work.

But most doctors rolling the dice will start with neuronal stabilizing agents—drugs originally developed for treating epilepsy. Chief among these are the only two officially approved to treat migraine disease: Topamax and Depakote.

“If you’re having more than three or four migraines a month, you really need to consider a preventive medication,” says Dr. Darrell Thomas, founder of Knoxville Neurology Specialists, and my own neurologist. “Topamax and Depakote do work in the majority of patients, and can really improve the quality of life and lifestyle. But they can be hard drugs to take, and a hard sell. You tell a young woman that Depakote can help, but it might cause weight gain and hair loss, and all she hears is fat and bald. With Topamax, side effects are cognitive impairment, numbness and tingling, perversion of taste. So it takes a while to counsel the patients.”

What’s most needed, Thomas says, is patience and perseverance. “It’s a long-term commitment,” he says. “You don’t take the drug and it’s all rosy tomorrow—what we’re doing is rearranging the brain chemistry. I say a migraine is like a bucking bronco, and the drug is the saddle and halter. If you put the saddle and halter on for two or three days and then take it off, the bronco will go back to being wild. To get that animal under control, you need to keep training it over a period of time.”

Under Thomas’ direction, I’ve taken both Topamax and Depakote, and suffered every side effect in the book. I can confirm that they are hard to take. But desperate times call for desperate measures. With his counseling (and that of his wise and wonderful nurse practitioner Harriet Starkey), I stuck it out until the migraines were better—whining all the way.

YOU ARE WHAT YOU EAT

Better, however, doesn’t mean gone. With the help of the drugs, I was able to prune my headaches back from every day to four or five times a month—an improvement, but hardly a cure. When I tell my story to nurse practitioner James Sensenig, he laughs—with me, not at me. Sensenig, who was the founding president of the American Association of Naturopathic Physicians in Connecticut, has heard a lot of stories just like mine in his 30 years of practice, and has an analogy for what he sees as the central flaw in the allopathic approach.

“Imagine that you have a fire in the building somewhere and the fire alarms are all going off, making a horrible noise, bothering everyone,” he says. “You call in a specialist, like a neurologist, and they turn off the alarm and tell you the problem is solved. Meanwhile, the fire is left to burn. That’s what you’re doing when you take an Imitrex, you’re just turning off the alarm.”

You can’t heal a migraine with drugs, he says. “To create health, you have to restore balance in the ecosystem of the body—it’s that simple,” he says. “But you can’t do it by sending in highly toxic substances. You can’t poison your way back to health.”

That’s naturopathic gospel, and it sounds right to me. The drugs I’ve taken, especially those aimed at prevention, have had serious and debilitating side effects—I’ve gained 15 pounds, my hair has fallen out, I’m sluggish, my memory is shot, I have to grasp for every word. I am toxic. Now that life feels less like one long emergency, I’m ready to mount a real return to natural healing.

My first thought is of popping supplements instead of pills. Magnesium, feverfew, butterbur, vitamin B2, and coenzyme Q10 are the usual suspects, and all can be helpful in managing migraine, Sensenig confirms. But relying on them alone to fix the problem is magical thinking—especially for someone with intractable migraine disease (that’s me).

My best bet, he says, is to take a multidisciplinary approach that encompasses the structural, physiological, energetic, and emotional levels. “With migraine, there often is no one thing to point to—it’s more like a little bit of misalignment, a little bit of toxicity, a little digestive problem, a little food sensitivity,” he says. “Any of these alone would be no problem, but add them up in a sensitive person, and there’s a headache.”

Most of the nonmedical advice migraineurs get amounts to avoidance therapy, and most of it relates to food. A typical list of potential migraine trigger foods will include aged cheese, chocolate, nuts, cured meats, caffeine, broad beans, yeasted breads, ripe bananas and avocados, canned foods, artificial sweeteners, MSG, red wine, beer, and processed foods of all sorts. Broadly, dairy, wheat, and corn have been implicated as possible triggers. That’s a lot of food off the menu.

But it’s important to find and eliminate dietary triggers, since the connection of migraine to digestion is—from a naturopathic perspective, at any rate—profound. “There is a connection between the enteric nervous system—the nervous system in the gut—and the rest of the nervous system,” says Sensenig, citing seminal research in the emerging field of neurogastroenterology by Dr. Michael Gershon at Columbia University. “Classic naturopathy says everything starts with digestion and elimination, and I often get best results by working this way. You want to improve assimilation, decrease exposure to potential food allergens, and increase the body’s ability to eliminate waste through the liver. That’s where I’ve seen the best results.”

To that end, Sensenig has helped to formulate the aptly named Gut Brain Therapy, a two-step protocol that supports digestive function with a fish-based amino-acid peptide protein formula, and stimulates liver and kidney function with an herb-based detox formula. “When you assemble a group of 10 migraineurs, maybe three of them will be sensitive to light, three will have a misalignment, one or two will have magnesium deficiencies,” he says. “But what do they all have in common? The gut-brain connection. It’s the lowest common denominator.”

I’m taking this supplement now—not with the thought that it is the total cure for what ails me, but that by reducing some of the sensitivity in the digestive tract, I can keep it from being the alarm that’s constantly sounding.

ENERGY CONSERVATION

Energetic issues are also huge. In case I haven’t made it clear, the pain of migraine takes a lot out of a person. It sucks up your energy—and the less energy you have, the more vulnerable you are to migraine. It’s the very definition of a vicious cycle.

“Migraine is an energetic problem,” says Prasad Robert Hutter, who holds a masters degree in public health and is owner of the Knoxville Acupuncture and Yoga Center. “There is almost always tension held in the system due to an energy block in the meridians. Often it’s the stress and strain in the lifestyle that causes energy to get stuck in the head—or the energy is so depleted that it can’t get up to the head.”

Acupuncture is excellent at breaking through blockages and restoring lost energy, says Efrem Korngold, co-director of San Francisco’s Chinese Medicine Works and author of Between Heaven and Earth: A Guide to Chinese Medicine. I tell him my story—a major career change, a move, a late-life baby, a complicated C-section—and he makes his diagnosis: Kidney chi depletion.

In the view of traditional Chinese medicine, kidney chi is the source of life—that which animates and sustains us. “We all have two kind of kidney chi, the kind we’re born with and the kind we acquire, he explains. “But you will only have a fixed amount of your ancestral, inherited chi.” Major life events, traumas, too much stress—all these are withdrawals from your inherited chi account, Korngold says. Once it’s gone, it’s gone—you’ll never get it back.

“That’s what happens when you have a baby late in life,” he says of my own case, though it might as easily have happened because of a job loss, divorce, accident, serious illness, or death in the family. “Because you’re older, you’ve already spent a lot of your energy, and now you’re making tremendous demands on what’s already become a limited resource. You’ll start having headaches at the slightest nuance of stress. You don’t have a cushion anymore, you don’t have energy to keep you grounded.”

Acupuncture helps build energy in the system by restoring the proper flow of blood and chi throughout the body—often focusing on the kidney and liver meridians. But the real game is to fill up the tank through lifestyle measures. For migraine patients, Korngold considers the essentials to be a proper diet, eight hours of sleep a night minimum, lots of liquids (though not alcohol, which he calls poison), and an active stress-relieving practice, such as yoga, tai chi, or qi gong.

Hutter agrees that lifestyle, ultimately, is the thing. “I use acupuncture to help create a more comfortable energetic environment for my clients,” he says. “But then you have to make your own health the number one priority—not your job, or your home, or your husband, or even your baby. What good are these things when you’re laying in the bed in pain?”

IT'S ALL IN YOUR HEAD

Hutter asks his clients—as he asked me—to carefully examine the thoughts that might lead to imbalances. Pain begets pain, he says; what’s out of alignment in the inner world will always manifest in disease in the body.

“You need to learn to make choices that support the spirit and create a sense of inner peace to find relief,” he says. “It’s so easy to use drugs or herbs or acupuncture to feel better to mask the imbalances that are calling you to make new choices, one that are more in harmony with the basic rhythms of life.”

In the end, it all boils down to this fundamental truism of natural healing: Our thoughts create our reality. Genetics, environment, and lifestyle are undeniable factors—and it’s an oversimplification to believe you can think your migraines away. Still, there’s something there. “I can think of 100 different reasons why people get migraines,” Hutter says. “To make them go away, you always have to deal with the psychology.”

Could that be true in the case of my migraines? The idea is intriguing and off-putting in equal measures. But it resonates with me, largely because I’ve been told so often by so many different healers that I need to work with my own anger issues. I am angry, often—but whether my anger is the cause the migraines, or because of them, would be up to me to figure out.

To discover their source, I call L.S. King, a world-class hypnotherapist and HypnoCoach who practices in Maryville at N*Tranced. King is a lovely, soothing soul, who welcomes me and is glad to hear that I’m not just interested in learning a hand-warming technique or some other coping skill that will help me deal with migraines in the moment, but leave the more complex and fruitful emotional questions unasked.

“When I see migraines, I know there’s some emotional issue that needs to be looked at,” King tells me. “It might be about repression, or about needing a change, or wanting to avoid some part of your life. It might be very simple, but it might be the kind of thing that you intellectualize away. With hypnosis, I can help you learn the source of you problem and find the emotional release you need to heal.”

She puts me under, and during our 90-minute session I learn a lot. A whole heckuva lot—about my life, my past, even my past lives. I learn that my anger has roots in all of these, and in my hypnotized clarity, I see that it is neither cause nor effect, but something more along the lines of distraction.

The root of the matter is more complex—and hard to describe out of the enchanted state hypnosis creates. It’s something like an inner alienation—a disconnection from what the real me really wants. I realize I’m so busy fuming around all the time, I’m not really listening to my own self. More than that, though, I realize I have a headache every time I make a decision that’s not in alignment with this true self. Literally, whenever I do or say or eat or drink or write something that leads me on a path away from who I really am (or want to be), I suffer.

I can’t claim to be cured; I’m still having headaches. But with this information, I feel like I’ve got a fighting chance for improvement—for living life more fully, with fewer side effects. But I take my vitamins every day, diligently practice yoga, and always leave the house with an Imitrex tucked away in my purse. And just in case, I’m keeping Dr. Thomas on speed dial.

Hillari Dowdle writes about health and spirituality for magazines such as Yoga Journal, Natural Health, Body + Soul, Health, and Vegetarian Times. She’s also MARRIED TO THE EDITOR OF METRO PULSE!

© 2008 MetroPulse. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Comments » 1

octobergirl7 writes:

As a migrane sufferer, I have found that each of my headaches often require different remedies; both conventional and nonconventional. Until I read this article I did not realize that Knoxville ranked in the 97th percentile. Thank you for all of the information provided.

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