Health & Fitness

Fighting migraines often trial and error for women

Dr. Patricia Feito performs a neurologic exam on Crystal Harris at Baptist Health Primary Care in Miami. Harris used to suffer from multiple, severe migraines each month. Harris adopted a new diet and exercise routine recommended by Feito and said she now experiences migraines only once per month.
Dr. Patricia Feito performs a neurologic exam on Crystal Harris at Baptist Health Primary Care in Miami. Harris used to suffer from multiple, severe migraines each month. Harris adopted a new diet and exercise routine recommended by Feito and said she now experiences migraines only once per month. MIAMI HERALD STAFF

Crystal Harris has suffered with migraines since she was 10.

At first, she got the debilitating headaches, which lasted several days, twice a month. That progressed to four times a month as a teen and once a week as an adult. She underwent MRIs, but doctors couldn’t find anything.

Last November, she went to see Dr. Patricia Feito, a primary care physician at Baptist Health South Florida, who immediately had her visit a dietitian. Harris, who weighed 245 pounds at the time, began to follow a diet that cut out caffeine, reduced carbs and increased vegetables. She lowered her doses of medication and started exercising.

She began by briskly walking a mile three to four times a week. She then started jogging, working her way up to running three times a week. By the fourth month, she was jogging 11 miles in 2 1/2 hours.

Harris, 29, has lost 35 pounds and now rarely has migraines. And she’s no longer pre-hypertensive or pre-diabetic.

“Before I was tired and didn’t have energy,” Harris said. “Everything has changed. It is like night and day.”

About one out of eight U.S. adults suffers from migraines, and migraines are three times more common in women than men. Women, ages 35-55, usually suffer most from chronic migraines, Feito said. Symptoms include pulsating, moderate to severe nausea, vomiting, sensitivity to light and noise as well as speech impairment.

While hormones such as estrogen and progesterone play a huge role in migraines for women, Feito said, so do lifestyle factors. Recognizing and avoiding triggers is the first step. Migraine triggers include caffeine, obesity, acute stress, snoring, sleep apnea and overuse of headache medication.

Harris, for example, would take her medication with caffeinated soda, not realizing it was a trigger.

Feito suggests a patient be monitored by a doctor, keep a three-month log of migraine history and then, together, come up with a treatment plan.

“Medication is not necessarily the first-line option," Feito said. "We would prefer to treat a patient conservatively without medication."

Treatment could include having a set time to go to sleep, diet changes, exercise and relaxation therapy. Modifying triggers through meal scheduling, exercise and stress management can often help. A trigger that can be more challenging and is rarer is a patient's genetic makeup, where family members also suffer from migraines. Other challenging triggers can be due to age, injuries to the head and neck and stressful life events.

Lily Rubin is hoping to experience a similar relief like Harris. For 2 1/2 years, the 43-year-old woman from Boca Raton has suffered from chronic migraines. She sometimes experiences dizziness and nausea and has trouble concentrating and remembering things. She has migraines 20 days of the month with one migraine lasting for two weeks.

The mother of three children, ages 10, 14 and 16, said she is able to run errands and drive her children around town, but she says, “I just want to be in my bed.”

She has found some comfort in the Cefaly device, a nerve stimulation device that is the only FDA-approved device for migraines in the United States, according to Dr. Teshamae Monteith, chief of the headache division in the department of neurology at UHealth — University of Miami Health System. The Cefaly device, which looks like a headband, is intended to prevent migraines when used daily for 20 minutes, Monteith said. Patients who prefer not to take medications or are on too many medications may benefit from the device. It is not clear how effective it is in patients with chronic migraines.

Rubin said the device relaxes her and provides relief for those 20 minutes. “It doesn’t prevent the migraines,’’ Rubin said. “It is kind of a cranial massage.’’

She also takes medication and uses ice packs to relieve the pain. She has cut out caffeinated drinks. She used to drink two Diet Cokes a day and now drinks only water. She also cut out other triggers such as birth control pills, aged cheese, chocolate, alcohol and yogurt.

Rubin continues to try other treatments to relieve her pain. On June 2, she received Botox injections, which are approved by the FDA for the treatment of chronic migraines, Monteith said.

Doctors don’t know how how Botox works, but one theory is that Botox inhibits certain types of specialized sensory neurons that detect mechanical stimulation.

Later this month, Rubin is scheduled to undergo intravenous dihydroergotamine, a five-day procedure, in which she will receive injections through an IV every eight hours during the five days she is in the hospital. The procedure constricts blood vessels, though, and can’t be given to people with cardiovascular disease.

“I hope it will help me,” Rubin said. "I really do."

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