The following is excerpted with permission from a book written by Dr. RichardPodell, M.D. This information has been helpful to thousands of people in the past, but is not meant to replace your physician. Be sure to check with your physician before undergoing any change in diet. ©1993 The Podell Medical Center, all rights reserved. May not be reproduced in any form without prior written permission. (see Podell Medical Center);   http://www.DrPodell.org

HEADACHE

(After 37 years or more) of suffering at least one migraine weekly, a food allergy elimination diet reduced Estelle's headaches by 98%. She was thrilled and astounded to say the least. Such dramatic benefit from nutritional treatment isn't common, but it's not really rare. More often optimum nutrition is one of several approaches that together strengthen one's resistance to headache.

Headache specialists spend considerable effort distinguishing between migraine headache--a severe, throbbing, usually one-sided headache often accompanied by nausea and sensitivity to light--and muscle tension headache--a duller, more achy and persistent pain.

There is a reason for this: Certain medicines, which are especially good for migraines don't do much for tension headaches. People with tension headaches are more apt to have mechanical or postural stresses underlying their headache vulnerability.

However, many have a mixture of different kinds of headaches with some features of migraine and some features of muscle tension. The most successful nutritional approaches can be applied to both.

DIET/LIFE STYLE

Recognizing and treating biomechanical and postural stress via change in work conditions, chiropractic adjustment, connective tissue therapy/deep muscle massage, and/or podiatric evaluation of feet and gait.

Caffeine reduction (working toward elimination).

Eliminating foods that commonly cause headaches such as nitrite-containing foods, alcohol (especially red wine), aged cheese, marinated foods.

Elimination diet: to detect individual sensitivity or allergy to foods.

Examining estrogen hormone supplements--reducing or eliminating them.

Reducing stress and anxiety.

Recognizing and treating arthritis or muscle imbalance in the jaw (Temperomandibular Joint Syndrome-TMJ).

Probably Effective:

An anti-hypoglycemia type diet, of small frequent meals with low simple carbohydrates and adequate fat. (See For Greater Detail section)
Moderate Regular Exercise
Salt--reduce high intake
Sleep --adequate duration and quality including detection of specific sleep disorders

FOR GREATER DETAIL

Anti-hypoglycemia diet: As of this writing there have not been double-blind studies but most nutritionally-oriented physicians believe that a diet designed to stabilize blood sugar-surges often reduces headache vulnerability. I would say it makes an important difference in about one-third of my headache patients.

Recognizing and treating biomechanical and postural stress: An enormous number of headaches could be prevented if we paid more attention to these factors. In this, medical specialists can learn a lot from the chiropractor, physical therapist, massage therapist, and podiatrist--all of whom typically pay closer attention to muscular stress and strain than do most physicians.

Caffeine is a stimulant which acutely helps reduce headache pain. That's why it's added to many headache medicines, e.g. Excedrin, Fiorinal. But, if the body gets used to a regular caffeine dose and then doesn't get quite enough, headache, fatigue and muscle aches are common "withdrawal symptoms." At least twice a year I find a patient whose headaches disappear completely after tapering off caffeine.

For those who drink 5 or more cups of coffee a day, probably about half are addicted. However, I have seen caffeine withdrawal headaches at even one cup of coffee, one tea, one cola drink or one an aspirin a day.

Every person who has chronic headaches--migraine or tension--if they have not already done so should try a caffeine-free holiday for at least 3 weeks. See Elimination Diet Section for step-by-step instructions.

Eliminating foods which commonly cause headache:
These foods cause headache in most vulnerable people because nitrites are added (as a preservative or to impart a red color): bacon, hot dogs, salami, sausage, bologna, lox.

These foods often cause headache because of their high content of the amino acids tyramine and phenyethyamine: aged cheese, avocado, banana, cabbage, chicken liver, chocolate, eggplant, pickled herring, marinated foods, fermented sausage, sour cream, red wine (especially Chianti).

About 50% of people with migraines report that alcohol of any kind triggers headaches in them--although many people find that red wines make their headaches even worse.

Aspartame (Nutrasweet), artificial sweeteners, and MSG (the flavoring additive) may cause headaches in certain vulnerable individuals.

Elimination diet to detect individual food sensitivity:

Several good double blind studies show that elimination of sensitive foods can dramatically lower the recurrence rate of migraine. Reasonable anecdotal evidence supports the search for food sensitivities in tension headaches also. What is controversial is whether food sensitivities in migraine affect a minority or majority of headache sufferers. My perception is that it's a minority, but common enough that food sensitivities should be investigated for most people who have headaches twice monthly or more often.

The foods that trigger Tom's headaches may be totally different from the ones that affect Harriet. A careful diet diary may help, but diet diaries work best when the culprit is a rarely eaten food, e.g., lobster. But if headaches are frequent, e.g. weekly or more often, foods or food additives that are eaten every day are more likely triggers. For example: milk, wheat, egg, yeast, citrus, tomato, sugar.

Standard allergy blood or skin tests are sometimes helpful in identifying suspects, but more often they are not. The best approach is an elimination diet--where we put you only on certain infrequently eaten foods to see if we can reduce the frequency of your headaches. (See elimination diet section for how best to do this.)

Estrogen hormones: Often increase a woman's vulnerability to headaches, especially migraine.

Exercise: Like adequate sleep and generally taking care of yourself, a program of sensible, moderate exercise often improves resistance to headaches.

Recognizing and treating TMJ (tempormandibular joint): Headaches that affect the temple area are most often due to strain in or around the angle of the jaw, the tempormandibular joint area. Dentists are the most qualified to help.

Reducing stress and anxiety: Headaches are rarely "all in your head," but there's no question that stress, anxiety and other emotional distress can increase your headache vulnerability.

Salt: High salt intake appears to promote migraine. Eliminating added salt can often be helpful.

Sleep: Too little (and also too much) sleep can increase your vulnerability to headaches. Sleep apnea--where people stop breathing for 10 seconds or more while they sleep--can cause headaches in the morning as a result.

SUPPLEMENTS FOR HEADACHE

Probably Effective:Fish Oil 3 to 9 grams Beware of this side effect, people often belch "fishy"
Feverfew don't stop suddenly
Magnesium 500-1000 mg: beware of loose stool
Possibly Effective:
Capsaicin apply 3 times: may burn; may take several days to work when taken intra-nasally
Ginger 500 mg: up to this amount every 4 hrs for acute migraine.

For Greater Detail

Capsaicin is the spicy factor in jalapeno pepper. When rubbed on the skin over an area of chronic pain, e.g., a tender joint, for a few days to weeks, it reduces pain, probably by depleting the nerve endings of a major inflammatory chemical called Substance P. Several studies report that applying capsaicin into the nostril can shorten the course of a severe, episodic form of migraine called cluster headache. I've not used it much because of one major drawback: it stings like the dickens when applied to sensitive membranes of the nostril.

Feverfew: Two double-blind studies suggest that on-going preventive treatment with this herbal preparation can reduce the frequency of migraine headache in a substantial proportion of people.

Fish Oil: Fish oil is an excellent source of omega 3 fatty acids. These essential oils have an anti-inflammatory effect on the body. They also make cell membranes throughout the body less stiff and more flexible. Two small double blind studies found that high dose fish oil supplements reduced the frequency of headaches in people who chronically suffer. Requires a six week trial.

Ginger: May help the nausea and vomiting that occurs with acute migraines, since it helps the nausea of motion sickness. Several cases where it helps have been reported, but as of this writing, no double-blind studies.

Magnesium: Magnesium helps muscles relax. About 40% of migraine headache victims have low magnesium as measured by a sophisticated magnesium test developed by Dr. Burton Altura of New York's Downstate Medical School. These individuals, but not those with normal magnesium, improve dramatically when given intravenous magnesium during a migraine attack.

Indirect evidence suggests that ongoing supplements with oral magnesium may also have a preventive anti-headache effect, but as of this writing we do not have double blind studies to prove this. One study conducted without double-blind controls* claimed that 80% of a group of 3,000 migrainers improved with magnesium supplement. Personally, I doubt that the success rate is that high, but I do recommend magnesium for at least a two month trial for nearly all of my migraine patients.

*In a double blind study two groups are selected. One group is given a placebo while the other is given the medication being studied.

• Try to identify triggers which might have been missed, e.g., tension in jaw muscles (TMJ Syndrome), tense or tender muscles in the neck or shoulder, inadequate sleep, sleep apnea or related sleep disorders (see sleep section), sinus infection, poor vision, estrogen hormones, stress, poor posture or mechanical strains.

• If you take in caffeine every day without a break (even if you take small amounts) definitely consider a caffeine free holiday for at least 3 weeks. Sometimes the results are nothing short of miraculous. If you drink 5 or more cups of coffee a day, the odds are at least 50% that you are addicted to caffeine.

• If you have headaches weekly or more often, then definitely work with your doctor to do an elimination diet to search for food sensitivities. See section on Elimination diet. My guess is that at least 10% of people with chronic headaches can benefit substantially.

• Whether or not you have food sensitivities, you may benefit from a trial of an anti-hypoglycemic type diet. (See therapeutic diet section.) Give it a 3-4 week trial, along with proper rest, and regular moderate exercise. If you habitually salt your foods, try also a period of no salt being added.

• In addition to an "insurance level" multivitamin I recommend that most headache patients work up to 500-600 mg a day of magnesium supplement and give it a 6 week trial. Take with food and in divided doses (not all at one meal) . Watch out for loose bowel movements: if they occur try divided doses. (See magnesium section.)

• For people who have difficult chronic headaches, consider a 6 week trial of fish oil at a dose of about 3 grams of omega 3 fatty acid (up to 9 grams a day if tolerated). Also consider feverfew in the dose range of 80mg daily for migraine prevention. Use a brand that is standardized for the presumed active component parthenolide. It should have 0.4-0.66% of parthenolide.

This information has been helpful to thousands of people in the past, but is not meant to replace your physician. Be sure to check with your physician before undergoing any change in diet.

We recommend taking the anti-oxidants PowerVites, PowerSleep and Signal369. For stress try Sunnie.

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