LIVING WELL: Headache triggers continue to baffle researchers

DR. MARK KESTNER, Post Columnist

Readers may recall an article I wrote last year about a young man who had been having headaches between three and four times per week since the second grade.

He had been to so many doctors over the years without success that he eventually became wary of trying another treatment.

To his surprise and delight, he began responding well to acupuncture as soon as he began treatment.

I met with this same young man last week as a follow up. I asked how long it had been since his last headache.

“I can’t even remember the last time I had a headache,” he replied.

It was obvious he spoke those words with a mixture of amazement and relief.

Even after practicing 25 years, I am still thrilled to see people find solutions for chronic pain, especially headaches.

I enjoy the opportunity to work with people who have been having chronic headaches primarily for two reasons.

First, my own experience of having been a chronic headache sufferer until I received successful chiropractic treatment in my 20s probably has a lot to do with that.

Knowing personally what headache patients are going through helps in being able to understand their symptoms and how the condition affects daily life.

Like the young man mentioned above, I had tried so many doctors that I had almost given up on finding a solution. I am still thankful today for the work of that chiropractor 30 years ago.

Another reason treating headaches is so satisfying is that working with a headache patient often has the same allure as solving a puzzle.

I have found there is no universally successful way to solve a headache problem. Every patient is unique. This is especially true of migraine patients.

Many people with migraine headaches are aware of specific stimulations that can trigger pain.

In this week’s edition of the medical journal Neurology, a new study demonstrated the difficulty in research attempts to determine how these triggers cause a migraine.

In a small study involving patients who had identified certain factors that were likely to cause a headache, specifically physical exertion or flickering lights, the results failed to recreate the triggering effect.

Of the 27 participants in the study, only three experienced a migraine with an aura, and three reported a migraine without one. Only physical exertion triggered any migraines in the study. No headaches were triggered by the experimental exposure to flickering lights.

The researchers were surprised by the findings. The authors of the study suggested the long-standing medical advice to identify and avoid migraine triggers may be wrong.

Although this study is believed to be the first that actually attempted to induce a headache by using triggering events, several larger studies have found that up to 95 percent of migraine patients report being susceptible to triggers.

In one large study published in 2010 in the medical headache journal Cephalagia, more than 50 percent of migraine patients identified at least one trigger that would stimulate a headache most or all the time.

Many migraine patients treated with traditional means are often provided with medications intended to prevent the headaches.

They are instructed to take these medications daily. Medication may also be prescribed to have on hand to treat the migraine if it occurs in spite of the preventive drug.

Patients are often justifiably concerned about the potential side effects of this type of drug-based treatment.

They are also often frustrated that the treatment does not resolve the  problem, it just seem to minimize the daily effects of the condition.

For patients who have found complete resolution from their migraine or other types of headache with chiropractic or acupuncture care, these alternative treatments may seem miraculous.

I wish I could say all headache sufferers would respond so well to these conservative options.

Unfortunately, some headache patients will respond beautifully to these alternative treatments and some will not respond at all.  

Most will see some benefit.

There are distinct advantages to chiropractic or acupuncture treatment for headaches, including the lack of side effects and the fact that resolution may be possible instead of having to continue to take medication for a lifetime.