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David Baxter

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The Migraine Diet
by Judith Warner, New York Times
October 25, 2007

Fortunately, no one seems to have noticed that I wrote last week?s column with one eye closed. I also had the lights in my office off, the shades drawn and the thermostat turned up to about 85 degrees.

All this because I had a migraine. In fact, I was on day six of a migraine that would, by day seven, have me dissolving into tears in between the taped segments of my radio show. (Think Holly Hunter. Think ?Broadcast News.? The show went on, seamlessly.)

I was suffering like this because I was Taking Control of my life. I?d recently read Heal Your Headache, by the Johns Hopkins University neurologist David Buchholz. And now I was following his 1-2-3 Program for Taking Charge of Your Pain.

In Dr. Buchholz?s view, chronic migraine sufferers like me ? I average around seven to twelve headaches a month ? are, very often, victims of their own past treatment successes. Triptans, the new-ish class of drugs that bind to serotonin receptors and can work wonders when taken early in migraine attacks, cause rebound headaches, he says, if you take them more than two days a month. So do over-the-counter painkillers and stronger stuff like codeine and oxycodone.

Step 1 in his plan, then, involves removing such ?quick fix? drugs from your life. Step 2 is about recognizing your migraine ?triggers? and removing the ones ? like certain foods, alcohol and caffeine ? that you can do something about. (As opposed to the ones ? like changes in barometric pressure, work deadlines and mothers-in-law ? that you can?t do anything about.) Step 3 is daily preventive medicine ? but the idea, in Buchholz?s book, is that if you do well enough at Steps 1 and 2, you might not have to go to Step 3.
I am already there. And I have been trying to get out.

I?ve had migraine headaches since the age of 8. When I was younger, they were severe, but infrequent. When I turned 35, they turned chronic. They were ? at best, when the triptans were working ? fatiguing. At worst, they sent me to the emergency room. A few years ago, they got much better for a while when I started taking amitriptyline, a tricyclic antidepressant (formerly known as Elavil) that is now given, in low doses, as a migraine preventative.

I didn?t like the amitriptyline. It made me gain weight. It made me sleepy. It made me think of mental patients shuffling down the corridors of state hospitals in the 1950s.

I wasn?t willing to take the higher doses of amitriptyline that came to be needed, over time, to allow the drug to really work. I liked the idea that, through supreme force of will, I could free myself from the iron grip of Big Pharma.

So I followed Buchholz?s prescriptions. I stopped taking my Relpax, a triptan, and put away my Prontalgine, the codeine- and caffeine-containing, French over-the-counter headache remedy that I use when the Relpax doesn?t work.
I stopped drinking caffeine and alcohol and stopped eating chocolate, cheese, M.S.G., nuts, vinegar, citrus fruits, bananas, raspberries, avocados, onions, fresh bagels and donuts, pizza, yogurt, sour cream, ice cream, aspartame and all aged, cured, fermented, marinated, smoked, tenderized or nitrate-preserved meats.

For a couple of weeks, I was ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. But I felt, headache-wise, somewhat improved. I had six or nine migraines, but they were less severe. And, once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.

And then the headaches returned, with a vengeance.

Earlier this week, I went to see my neurologist, who for months has been trying to get me to increase my dosage of amitriptyline or go on topamax, an anti-seizure drug that also prevents migraines.

?Are you enjoying your suffering?? he asked me.

Eagerly pocketing my topamax script, I asked him if he thought that food elimination could hold out any last hope.

Maybe, he said, smirking down into his notes; you never know. ?You could always go up to Baltimore and ask Dr. Buchholz.?

Many people who take daily medications come at some point to hate them. Teenagers with ADHD routinely rebel against their meds. Long-term users of anti-depressants risk relapse because they can no longer stand the way the drugs make them feel.

Some people do manage, through diet and exercise, or by protecting themselves from their worst ?triggers,? to free themselves from their drugs. But many can?t do it. Many find they can?t accept living in the compromised condition that drug-free existence requires.

A smart high school girl I know switched a few years ago from a mainstream school, where she was struggling with dyslexia and ADHD, to a school that specializes in teaching kids with severe learning disabilities. Being there has permitted her to function without her ADHD meds. But now she?s bored. She?s dispirited by the lack of academic challenge and she wants out, because she?s afraid that, without academic challenges, she won?t be able to get into a mainstream college.

That?s the tradeoff: taking daily drugs, or living a life that feels not quite worth living.

Halloween is coming, and Emilie and I have a ritual: While trick or treating, we eat exactly one piece of candy after every house. She gives me the Snickers bars. She keeps the Hershey?s Kisses and the M&Ms. We split the caramel creams and the Starbursts and pawn the dark chocolate off on her sister, Julia.

It?s from routines such as this, I am convinced, that the childhood roots of adult happiness are formed.

This year she?s anxious. I?m not eating chocolate. Or peanuts. This week, with her babysitter, she baked me a cake, white with white frosting, sprinkles, multi-colored flowers and candy corn. But, she asked me, what will happen on Halloween?

I told her not to worry; I?d eat my Snickers bars.

In fact, I think that I?ll sanctify Halloween by eating every single forbidden food on the migraine diet, all in the space of a couple of hours.

Somehow, I doubt that I?ll end up in the emergency room.
 

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As a person who dodges migraine every day, trying to avoid known triggers, I also rely on triptans as a backup as well as Anaprox (Naproxen) which is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and swelling (inflammation). Anaprox has been found to sometimes be effective in relieveing migraine at a prescribed dose, and in a recent published study appears to have a synergistic effect when used with triptans.

I feel there is a sensible balance between
free myself from the iron grip of Big Pharma.
and total abstinence from medication in treating migraine.

There is no cure at present, and treatments need to be tried to find what works best for each person, but I don't feel anyone should have to endure the suffering of a migraine.
 

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