Breaking the Headache Cycle: A Proven Program for Treating and Preventing Recurring Headaches

PART I

Headaches, Stress, and the Nervous System

Introduction

A Neurologist’s Quest to Treat His Own Migraine: Dr. Livingstone’s Story

I remember my first migraine as vividly as if it occurred yesterday. I was a second-year medical student. The morning following an important anatomy test, I woke up at 4 A.M. with a pounding headache. Light, even from the bedside lamp, was blinding. Sound from the rustling of the sheets was irritating. I could find no comfort as waves of nausea swept through my body. I couldn’t decide whether the nausea arose from my stomach or my head. I held my head in my hands, placed a cold cloth on my forehead, and took a painkiller without relief. Any movement worsened the pain. After hours of misery I eventually fell asleep and later awoke with some relief and the feeling that I would survive. It’s just stress, I thought, and this analysis was confirmed by my fellow medical students, family, and family doctor.

Only years later, during my neurology residency, did I realize that these headaches were migraines, and only recently have I come to understand their relationship to stress.

Several years ago, my headaches became more frequent and more frustrating. Although I love my work, it is stressful. I often skipped meals, kept irregular hours, had interrupted nights, and did not tend to my own well-being. In short, I did not practice what I preached to my patients.

I felt angry and frustrated by my inability to prevent these headaches and increasingly resented the need to take medication in order to function. I also felt cheated because the headaches would often occur on weekends when I was most relaxed. I found myself nursing a headache when I could have been enjoying time with friends and family, and my lack of control over these headaches frustrated me. I knew I needed to look at my own life, to take stock, but I felt enormous resistance to doing so.

I consulted a colleague who suggested I take preventive daily medications. I resisted, thinking that there had to be a more natural way to control these headaches.

I began studying the early medical writings on headache as well as the current scientific literature, looking for a thread that explains our sensitivity to headache and why we are prone to different and diverse headache triggers. I attended seminars. I kept a headache diary. I began listening more closely to my patients. I read Oliver Sacks’s Migraine, with its poetic description of migraine sufferers. I then came across a monograph written by a Victorian neurologist named Edward Liveing in 1873 entitled On Megrim, Sick-Headache and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms. He wrote this book at a time when there was very little scientific information on headache—at a time when most headaches were considered neurotic in origin. It was a groundbreaking work describing in detail the case histories of numerous migraine sufferers with common patterns. He was the first person to describe the heightened reactivity of the nervous system as part of the migraine trait. We headache sufferers react vigorously to change. This includes sensitivity to stress, sensory overload, odors, certain foods, weather changes, changes in routine, and insufficient sleep or even too much sleep.

Liveing also recognized that migraine is not just a headache but a whole constellation of symptoms of which the head pain is only part. He referred to these as nerve storms. He had no scientific way to understand that he was observing the effects of fluctuating brain chemistry that occurs with migraine. He was aware of the fact that the tendency of headaches often runs in families, yet he lived more than a hundred years before the discovery of the DNA genetic coding of the first migraine genes.

As I followed this theory of sensitivity through old and modern medical writings I was led back to one of my main passions in studying neurology—the relationship of mind and body.

The Natural Way to Reduce Headache

I wondered if there were natural and scientifically based ways to calm and protect the sensitivity of the nervous system. And if so, do these techniques improve the quality of life of those who suffer recurring headache?

The answers came when I attended one of Dr. Herbert Benson’s seminars. Dr. Benson, the discoverer of the relaxation response, is founding president of the Mind/Body Medical Institute at the Beth Israel Deaconess Medical Center. I began to look for ways to tailor relaxation techniques to headache prevention and treatment. Relaxation provided the antidote to the enhanced responsiveness of the nervous system, the sensitivity that is part of the migraine trait.

I first began practicing relaxation techniques myself—and the results were astonishing. Not only did my headaches decrease, but my sense of self-control, self-esteem, and general energy level improved. I also became aware that the source of health and restoration exists within each one of us. I wanted to extend this understanding to others and to use these techniques in my neurological practice. I saw this as a natural way to enhance medical treatment and improve well-being. I joined forces with nurse practitioner Donna Novak, a fellow migraine sufferer, and through our collaboration we found a way to integrate mind and body in the medical treatment of headache. This is the core of our practice at the Princeton Headache Clinic, and the essence of this book.

We invite you to join us to learn natural ways to prevent and treat headaches. If you can answer yes to any of the following questions, this book will help you find relief.

Do you experience recurring headache?

Do you wish to improve the effectiveness of your current medical treatment?

Do you want to use less medication?

Do you sense a loss of balance in your life?

Do you wish to have more control of your headache triggers?

Do you want to feel less stressed in your daily life?

Do you want to regain optimism?

This book is based on the success of the Princeton Headache Clinic Headache Reduction Program (HARP). HARP will teach you natural, drug-free ways to prevent headaches and to relieve the misery of recurring headache. These methods reduce stress, protect the nervous system, and restore harmony. They are timeless but scientifically principled techniques that can be adapted to everyday life.

As physician and nurse practitioner, our mission is to lessen the burden of the headache sufferer. As fellow migraine sufferers, we also have a personal interest in this work. Many of the patients that come to our clinic with headaches have also suffered from being misunderstood, misdiagnosed, and mistreated. Headaches are often not taken seriously once underlying pathology has been ruled out. The public and the medical community fail to recognize that although chronic headaches are not life-threatening, they are disruptive and disabling. Data published by the World Health Organization lists migraine in the top rung of diseases that severely impact quality of life. Clearly, people need more than an effective painkiller to gain control of recurrent headaches.

Our experience has shown that the people who gain the greatest control of their headaches understand what they can—and cannot—do about them. They learn to accept the part that is not in their control—that migraine is a biologic disorder of the brain and nervous system that predisposes them to having headaches. They have also accepted responsibility for the part of migraine treatment that is in their control. They keep a headache diary to track their headache triggers (such as foods, missed meals, and irregular sleep), and make whatever lifestyle changes are necessary. They stay in tune with their stress response and to the signals of an impending headache, and take steps to prevent the headache with techniques such as focused breathing, muscle relaxation, and positive self-talk. They also protect their nervous system and become more resilient to headaches with regular periods of relaxation, using such techniques as meditation, yoga, and mindfulness. They see health-care practitioners as partners in helping them achieve optimum health and well-being.

Part I of Breaking the Headache Cycle contains information about migraines, the nervous system, and stress. Part II teaches specific relaxation techniques and stress management strategies that will help you gain control of your headaches and live a healthier, happier life.

1

Origin of the HARP

Hi Donna!

I have not seen you in a while, but I just wanted to let you know how I am doing. For the first time in about three years I can actually say that my head does not hurt. My daily headaches are virtually gone. Now I only get the occasional full-blown migraine. Usually about once or twice a month I have to stay in bed all day, but I can deal with this much better. I am able to do normal things now! I can do homework without pain and I even have extra time to have fun and relax. It’s great—I can make plans now without worrying about how I will feel later on. I never imagined I could feel this great!

I want to thank you and Dr. Livingstone for your help and attention. I don’t think I can possibly express what a difference you have made in my life.

Sincerely,

Betty

Betty, age twenty, suffered from migraines and daily headaches for several years. She recently sent us this e-mail from college, a few months after completing our headache reduction program.

Edward, a fifty-four-year-old business executive, entered the program out of frustration. I may as well try this—I have tried everything else, he said. He experienced severe headaches several times a week. Although he was able to control each headache with medication, he felt that he had no way to prevent them and sensed that he was always on the verge of the next one. He began practicing a relaxation exercise each morning before leaving for work. Within two months his need for medication dropped from several times a week to about twice a month—a dramatic improvement.

Evelyn, a thirty-five-year-old schoolteacher, found that her frequent headaches made her irritable and short-tempered with the children at school. She came to understand that this was part of her migraine trait that gave her nervous system the quality of enhanced responsiveness. She successfully found a way to use simple breathing exercises. As she became aware of rising tension in her neck and shoulders, Evelyn responded by shifting the movement of her breathing to the abdomen (which reduces the tension held in the chest) and breathing rhythmically to a 1 … 2 … 3 … 4 count (this harmonizes the nervous system with natural body rhythm). In only a few minutes, Evelyn could restore her level of calm and prevent the rise of tension that may have culminated in a headache.

Betty and others benefited from four unique elements in our program:

1. Education and understanding of migraine is the essential first step in regaining control.

2. The clinic encourages self-care by respecting the body’s natural ability to heal and restore. Medications are often not enough. Natural relaxation methods improve the effectiveness of and reduce the need for medication.

3. The program addresses the heightened responsiveness of the nervous system that occurs in migraine sufferers.

4. The isolation of the headache sufferer is relieved by shared experience. You are not alone.

The Limits of Drug Treatment

The biological tendency to recurrent headache is not easily remedied. A new class of drugs, called triptans, has revolutionized the control of the migraine attack. For some migraine sufferers these drugs may be the only treatment needed—particularly for those whose migraines are not frequent. Preventive medications are also invaluable in reducing the migraine tendency. However, there are side effects to all medications and limits to their effectiveness. Studies have shown that relaxation techniques reduce headaches to approximately the same degree as preventive medications. Relaxation techniques also enhance the effectiveness of medication taken for relief of an existing headache.

Natural relaxation techniques and medications complement and enhance each other. Our program uses whatever tools are necessary and safe to improve the migraine sufferers’ quality of life.

The Role of the Nervous System

Many headache and migraine sufferers have a heightened responsiveness or reactivity of their nervous system. The sensitivity is part of the disorder of chronic and recurring headache. This trait is a double-edged sword, as it confers sensitivity to the good things of life but makes us more vulnerable to the damaging effects of stress. We are only now beginning to appreciate how much this hyperresponsiveness contributes to the misery and discomfort of headache. Medical treatment of recurrent headache is limited unless it addresses this heightened nervous system sensitivity. Relaxation techniques specifically tame this enhanced responsiveness of the nervous system and provide a vital aspect of treatment often ignored in medical practice.

You Are Not Alone

The people who enroll in the Princeton Headache Clinic’s Headache Reduction Program (HARP) feel that there is something wrong, something out of balance in their lives. They come to the clinic for evaluation and treatment of headache, but most complain of being stressed out or burned out, of feeling driven and unable to relax. Some also suffer from frequent illnesses or chronic disorders such as fibromyalgia, irritable bowel disorder, high blood pressure, insomnia, or depression. They are seeking ways to improve their medical conditions without greater reliance on prescription medication. Many are taking medication and have tried other relaxation techniques such as transcendental meditation and biofeedback with limited benefit.

At the first HARP session, we ask participants to introduce themselves and talk about why they decided to embark on the program. Here are some of the thoughts people have shared:

I want to regain some control. I feel I have lost control of my headaches.

I feel guilty in having so many headaches. I feel I am failing others.

Although the medications help me, I hate the side effects. Is there anything else I can do besides taking medication?

I feel stressed much of the time.

These headaches are interfering with my life. I want to get rid of them.

My preventive medications are making me gain weight. I want to find another way to control my headaches.

I always feel on the verge of headache. There must be something wrong with me.

You have probably experienced similar feelings and thoughts about your headaches. As headache specialists and fellow migraineurs, we are here to say you are not alone and that there is hope.

Through the stories and words of our group participants, we will try to transmit some of the wonderfully supportive energy that a group experience generates and tell you how you may gain the same benefits as an individual.

2

Understanding Your Headaches

Barbara, forty-three years old, is a busy homemaker. She went to her doctor because she had experienced an increase in what she thought were her sinus headaches. Her ENT physician referred her to us after her sinus X rays were normal. Barbara’s headaches, which she had been partially controlling with over-the-counter sinus medications, are now disabling. She can no longer function during a headache. She has to cancel appointments and find someone to help with her children’s activities. She feels bad. She becomes more irritable and short-tempered during an episode. Her headaches, which now occur three or four times each month, begin over the right forehead and are made worse with movement such as bending forward; they make her feel nauseated. She becomes extremely sensitive to light and sound during the headache, which lasts up to forty-eight hours. Barbara has suffered with these headaches for twenty years, never obtaining relief. Her mother had a similar headache history at her