Thursday, February 11, 2016

Gut Problems Feed Headache

The Fall

Both in terms of season and headaches.  In late September, early October, I was doing well.  I had some weeks of 4 headache-free days in a row, and I was feeling pretty good. Then something happened to my belly, and I've never been quite sure what caused it.
Rocky descent 

I went to the symphony with friends.  In the middle of the performance high in the nosebleed section of the balcony, my stomach began to hurt and I was suddenly tired and sleepy.  It was all I could do to keep my eyes open.  After the performance, I went home and crashed and didn't get off the couch for days.  I couldn't eat much.  I was nauseated, my stomach hurt and I had persistent diarrhea.  My digestive tract was in full scale revolt.  I assumed I just had a stomach bug and waited for it to go away.  Days turned into weeks which turned into months of nibbling at a bland diet and going to doctors.  I lost 15 pounds.  My headaches spiked to near daily events.  Not being able to eat normally was a knock-out punch.  I felt so lousy, weak and anxious that we had to cancel our December trip to Mexico.  My creative brain tanked.  I couldn't bring myself to write, draw or weave.

I had no fever, nor had I taken antibiotics recently, two diagnostic clues that might have indicated a serious infection.  All lab tests came back normal.

Winter heading towards spring

On December 1st, I went for my first visit with a new acupuncturist.  Slowly time, diet and her treatments helped me turn this thing around.  It bears mentioning here that I never let my acupuncturist put needles in my head.  I learned the hard way that it triggers a migraine.  Finally within the last 2-3 weeks, the severity level and the number of days between headaches have stretched out enough that I am out of rebound range in my use of abortives and rescue meds.  Now almost 3 months after this malady set in, my stomach and gut have decided to behave themselves, my anxiety is down, and my energy level up.

My family was together for Christmas when my son confirmed that he and his girlfriend were truly getting married soon (although they didn't yet know quite when) .  By the end of Jan., I was feeling good enough to go ahead and rebook our winter vacation to Mexico for mid Feb.  Of course, soon afterward, they sent out the evite for a May wedding in ........ Mexico.  Two trips is not a bad thing!  

Digestion and headache

So what happened?  It may have begun with a virus and what my gastroenterologist called post viral syndrome.  But I also had some stomach trouble off and on last summer, which leads me to consider other possibilities.  I am extremely sensitive or frankly intolerant to many medications.  One theory is that I can no longer tolerate one of my headache prevention meds.  My stomach was signaling me to reduce the dosage.  I do know that when my gut is happy, I have fewer headaches.  Conversely, when my digestion is messed up, my headaches become more frequent.

There's a lot of interest and research in western medicine right now on the subject of the gut micro biome.  It turns out that what goes on at the microscopic level, the bacteria we carry around in our intestinal tract, is implicated not only in diseases like diabetes, obesity, heart disease and inflammatory bowel disease, but also in rheumatoid arthritis, autism, alcoholism, multiple sclerosis and, yes, migraine.
http://journal.frontiersin.org/article/10.3389/fneur.2014.00241/full
http://www.ncbi.nlm.nih.gov/pubmed/25402818
 
The gut and your migraine brain communicate via the vagus nerve, endocrine and immune pathways. And the communication travels both ways, gut to brain as well as brain to gut.

What does all this mean in terms of what we put in our mouths to nourish ourselves and cure our ills?  Can we use this information to improve our health and reduce our headaches?  Well, the jury is obviously still out on this score, but here's what I do and why.

  • First I'm keeping my eye out for more information via current scientific studies and research.
  • I have quit taking isometheptene and I'm slowly weening myself off another of my meds under my doctor's watchful eye.
  • Whenever possible I avoid taking antibiotics, which strip your gut of helpful bacteria as well as the bad bugs they're designed to take out.  I have a primary care provider I like (an MD), as well as a naturopath who has prescriptive power in Washington State.  He often knows effective alternatives to antibiotics.  
  • Years ago, I had food allergy testing and the one and only thing that popped up was a clear intolerance to eggs borne out by the fact that they make me very constipated when I eat them.  So I don't.   
  • I take L-glutamine which also seems to help my gut.
  • I take probiotics and eat foods that supply prebiotics which, evidence suggests, help digestion and protect you from harmful bacteria.  http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/probiotics/faq-20058065
  • I take a tablespoon of ground flax seed daily.
  • I don't eat much prepared or packaged food, and when I do buy the odd bag of chips, package of crackers or boxed soup broth, I shop for the one that has the shortest list of ingredients, the one that leaves out the sugar, salt, thickening agents or preservatives.
  • I eat a lot of vegetables which, fortunately, I like.  My latest easy, tasty veggie is stir fried or steamed greens including kale, cabbage, beat greens, chard and spinach and more.  When my gut is behaving itself, I eat a lot of uncooked greens in salad too.

Here are a few tips from Dr. Christiane Northrup, a good source of information on ways to take care of yourself.  http://www.drnorthrup.com/how-to-improve-your-gut-microbiome-in-a-day/

And from Michael Pollan in his book, "In Defense of Food."  Pollan looks at American eating habits and what he calls the culture of eating in this country.  He comes up with some great, well-researched  guidelines that deserve our attention.

Thankfully, I can finally eat again with the best of them, including tacos and enchiladas, rice and beans as well as #3 spicy Thai.  I'm looking forward to eating whatever I feel like when we touch down next week in Melaque, Mexico.  My strategy for staying healthy in Mexico?  Lots of limes, garlic and mineral water as well as my regular dose of probiotics.  Avoid the street food, and choose restaurants that are busy turning over a lot of meals every day.

Hasta luego y buen provecho!


    

Saturday, February 6, 2016

Family News and migraine

What's goin' on 

Andrew and Jenny are doing a kitchen remodel.  There is lots of discussion around paint colors, what it will feel like to tear that wall out and open up the kitchen to the living room and just when this is all going to happen.  Since for us, this is a vacation to Santa Cruz, we ride our bikes, walk on the beach and talk about which route to take this time driving our van north towards home.  Book and movie recommendations are always a topic.  Friends Jacob and Sally are getting married and we're all invited to the wedding in Poulsbo, Washington.  Andrew and Jenny are getting married in May in Sayulita, Mexico.  The foundation of Ben and Leslie's new house has been poured.  The kids are coming over on Sunday.


Notice there is no discussion about headaches, neither my son Ben's nor mine.  This is almost always the case.  I don't usually talk much about all my head pain because while my life seems virtually consumed by it, I feel as if it's probably a bore for everyone else.  And in fact I'm bored with the topic myself.  This in spite of the fact that my headaches have become near daily events and Ben's have spiked recently.  He functions as a nurse with dull daily head pain which sometimes spikes to severe pain by the time he clocks out.  For both of us the pain pattern and frequency fluctuates with the season, stress level, ambient noise, whether or not we get a good night's sleep and more.  Of course sleep is at a premium for my son with a pre schooler and a toddler at home and a new house under construction.

When Ben and I are together with the kids busy playing, that's when we usually check in to see how the other guy is doing and offer up any new or interesting information we've come across.  Here's what's happening for me right now.

Mood

I'm in a pretty good place emotionally right now.  My mood usually tracks with my headache frequency and season of the year.  My headaches are currently less frequent thanks to recovery from recent illness and relatively new treatment options.  And while the February winter weather is oppressive, we're finally headed out for 10 days in Mexico starting next week. 

When my headaches are out of control and I can't do the things I like to do, I am downhearted and at least a little depressed.  It's hard for me to maintain a positive attitude, and against all logic, I struggle not to blame myself.  Self blame is quite common among those with chronic illness.  Articles abound on the internet about how frequent and counterproductive this is.  One of my favorite authors on the subject, Toni Bernhard writes about this negative emotion and how to get beyond it.  Find her blog, Turning Straw into Gold, at the address below. 
https://www.psychologytoday.com/blog/turning-straw-gold

Mid winter in the Pacific Northwest is wet, cold and gray.  The "monsoons" start in mid to late October.  The weather warms up in the spring, but the rain and gray skies often continue through June.  I usually do ok until after holidays.  Then I run out of patience, and my mood slides into the gutter like the rain on a wet day.  If I can stay active and engaged with friends and family, I do better.  But if I am flattened by headaches, my mood deteriorates.  I can tolerate one or the other, headaches or Northwest winter, but putting up with both is a killer.

Current Meds 

Preventatives:  Baclofen, klonopin, mirtazapine, zyprexa and CBD cannabis capsules
Abortives:  SpringTMS and naratriptan
Rescue:  Fioricet w/ codeine,  cannabis via vaporizer for pain, nausea and sleep
Sleep:  Zolpidem

I'm very fortunate that medical marijuana is legal in Washington, because nothing else except narcotics touches it for conquering pain and nausea while waiting for the abortives to work.  The downside is you can't travel legally out of the State with it, and I certainly can't take it to Mexico, our February escape destination.  In anticipation of traveling, I have spent the last two weeks weening myself off marijuana to see how I do.  Not bad, just less comfortable.  Poor sleep is actually the worst of it.

I spend hours nearly every week staying on top of any and all headache news that hits the national media, reading any peer reviewed scientific articles I can get my hands on, checking in on the blogs to make sure I'm not missing any new possibilities, learning more about diets that seem to be working for others, seeing specialists including, right now, my headache guy, an acupuncturist, and a mental health provider.  I log in hours every month or two haggling with my insurance company over medication coverage. While I share some of this information with my husband, much if it is filed away or filtered for personal use inside my own skull.  It's a world of feeling and information that tends to live within me alone.  Here's just a little bit of the latest 

Current and future possibilities

Spring TMS


This device involves transcranial magnetic stimulation to abort a headache.  It rents for $ 250.00/ month and will likely not be covered by the vast majority of insurance companies.  It just became available in late December.  I got mine 3 weeks ago.  It's early days, but the frequency of my harsher headaches is down, and I'm not using quite so much abortive medication.  www.eneura.com/tms.html

GammaCore

A device that delivers electrical stimulation to the vagus nerve in the neck - to abort or prevent a headache.  Available in Canada but not in the US even though this multinational company is headquartered in the US and FDA drug trials have taken place here.  It's a pricey little devil at approximately $ 475.00 (Canadian) for a limited number of doses.  Then you have to send it in for a recharge of the device, which no doubt will be accompanied by a monetary recharge as well.  There is no information on when this baby will be available in the U.S.     
http://seakaproducts.ca/product/gammacore-150-doses-cw-gel/

GammaCore

Migraine vaccine, CGRP Antagonists

This pharmaceutical is not really a vaccine but acts kind of like one.  There is a lot of excitement about the drug in medical circles.  For me, it's hard to get excited about a "solution" that is still undergoing FDA trials and is, at the very least, 3 years from market.  On the other hand, my son is holding onto the possibility that this new approach will solve his migraine problems.  Truthfully, at age 69, I just don't have that many years left, while he does.  Aging changes your perspective and the quality of your hope.

When it becomes available, either monthly or every 3 months or so your doctor will inject humanized antibody CGRP to prevent headaches.  So far, research looks promising, but it's a long wait if you're having near daily headaches.  There are FDA drug trials I'm looking into, but chances are that I won't meet the requirements.  For the most part, those over 65 don't qualify for a drug trials.
http://www.pacificrimheadache.com/news/2015/05/news-from-the-international-headache-congress/

Cefaly


The Cefaly is a (tens) transcutaneous electrical stimulation mini machine that targets the trigeminal nerve.  I bought my Cefaly in Canada where it is approved as both a preventative and abortive device.  Settings may be different for one prescribed and purchased in the U.S.
One push on the button of my Cephaly activates a 20 minute session that is designed to abort a migraine.  Push the button twice for a preventative session, three times for a relaxation session.  This device worked for me for a while, and then it was no longer effective as an abortive.  I gave it to my son who thinks it is helping to reduce intensity and frequency of his headaches.  Purchase price:  $349.00.  http://www.cefaly.us/en

Emsam transdermal patch

This medication is an MAO inhibitor, a drug for depression that has a long record of successful (for some) off-label use to prevent migraine.  It comes in pill form with an extensive list of dietary restrictions that are necessary to prevent serious drug/ food interactions.  The new patch doesn't have these restrictions.  Available now.  Pricey at $1200.00 per month.  My insurance would pay half, so at 
$ 600.00 per month, I haven't leaped up to try this.  Neither have I crossed it off my list entirely.  When I told my family about the patch and the price, my sons offered to help with the payments.

Sphenocath 

This procedure involves threading a catheter (no needle) up your nose (waaaay up) to access a ganglion leading to the trigeminal nerve.  When on target, the doctor injects the anesthetic marcaine.  Repeat 2 or 3 times and you may get some lasting relief.  I tried this, and it made things worse giving me a nasty sinus-like headache which was minimally responsive to my usual abortive medication.  No repeats for me.

Medication

I am really at the end of the long list of medications that act to prevent migraines.  Due to age and genetics, I tend to have exaggerated side effects and poor response to many pharmaceuticals.

Alternative treatments

While I'm always open to new ideas, the most common so called alternative treatments have had no impact on the frequency and severity of my headaches.  These include massage, physical therapy, acupuncture and Chinese medicine, chiropractic and naturopathic treatment, biofeedback, cognitive behavioral therapy, herbs and supplements, essential oils and the migraine diet.  Massage feels good;  acupuncture helped with carpal tunnel and digestive issues; biofeedback has helped with relaxation and gut problems; physical therapy exercises are healing long-term achilles tendonitis and yoga helps me to feel better overall.  None has touched the headaches.  I continue to see a mental health counselor to help me cope with chronic pain and stay open and curious about new ideas and approaches.

Last spring I began meditating, which does seem to reduce the severity of pain on some days.  This little chink in the brick wall of head pain is significant, so I continue to explore this path.  In the 1970's Jon Kabat-Zinn, a Buddhist monk working with others at the University of Massachusetts Medical Center, developed  an 8-week course for those with chronic pain.  Since then it has morphed from one class to a mindfulness movement.  Last summer I took the class, Mindfulness-based Stress Reduction, which borrows from the traditions and practices of Buddhism, yoga and progressive relaxation using meditation, breathing, movement and stretching.  http://www.umassmed.edu/cfm/stress-reduction/history-of-mbsr/