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Managing Your Headaches & Migraines

June 4, 2018 11:00 AM with Dr. Stuart Bergman-Bock

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Pulsating temples, sensitivity in the neck and shoulders and severe pain are just some of the many symptoms that can indicate a headache, which are a major problem for many. In addition, others experience migraines, which can be debilitating and majorly impact daily life. What can cause these pains? How can you deal with them? Ask Dr. Stuart Bergman-Bock, NorthShore Neurologist, during an online chat all about headaches and migraines. He’ll take questions on symptoms, causes and provide his expertise on the various treatment options and how specialists can help you address your headaches.

Colie (Moderator) - 11:00 AM:
Our chat on headaches and migraines is open. You can submit questions at any point during the hour.

  Karen - 11:02 AM:
What are some natural remedies/suggestions for alleviating a headache or migraine?
Stuart Bergman-Bock
This is a great question. A variety of natural supplements have been studied for migraine. Butterbur has the highest level of evidence in the most recent guidelines. There had been concerns regarding its potential for liver toxicity but this seems to have been ameliorated now that newer processing techniques remove the dangerous chemicals. Other supplements including magnesium, vitamin B2 (riboflavin), Coenzyme Q10, and feverfew also likely are helpful to reduce the severity and frequency of headaches.

Stuart Bergman-Bock - 11:06 AM:
Hi everyone, My name is Stuart Bergman-Bock and am a neurologist here at NorthShore with a special interest in headaches. I look forward to answering your questions!

  Natalie (Des Plaines, IL) - 11:06 AM:
How much of an influence does exercise have on preventing headaches/migraines?
Stuart Bergman-Bock
There have been multiple studies suggesting that regular exercise is a great way to reduce headaches. A large study from Sweden found that adolescents who engaged in regular cardio exercises had a significant reduction in headache frequency. Cardio exercise probably has the most evidence, I am honestly not sure offhand regarding evidence for weightlifting or anaerobic exercise. But as this can be helpful for anxiety, it would make sense that adding anaerobic exercise is important as well (not to mention its benefits for bone density). It is important to start a new exercise regime gradually. Headaches can temporarily worsen if it is too rigorous when you body is not yet used to regular exercise. The important thing is to find an activity you enjoy and can practice multiple times a week, gradually increasing in intensity and duration.

  Jenny (Wisconsin) - 11:13 AM:
I recently learned I have hypotension (low blood pressure) and have headaches as a result of it. I am being treated by a doctor but am curious about salt tablets. We heard tri-athletes take them to avoid low blood pressure. I am taking Topamax but are the salt pills better to take? Are there long term side effects from Topamax?
Stuart Bergman-Bock
I am not aware of salt tablets being used for the treatment of headaches. Though certainly correcting hypotension could be helpful for headache control (though probably unlikely to be the entire answer). Topamax has a very high level of evidence for its use as a migraine preventative. But of course, side effects are possible. In my experience, tingling in the fingers/toes is the most common complaint. Cognitive effects such as word-finding difficulties can occur as well. A variety of uncommon side effects such as kidney stones or a very rare but very serious type of glaucoma have been documented. And it is not safe to use this medication while pregnant. But for most patients, Topamax can be used as a long-term preventative safely and without significant side effects.

  Lisa - 11:23 AM:
I notice that I often get headaches when I wear my contacts instead of my glasses. Is it common for headaches to be linked to vision?
Stuart Bergman-Bock
Incompletely corrected vision leading to eyestrain can cause headaches. But I am not sure why the use of contacts versus glasses that are the same prescription would cause headaches. I am not entirely sure as to the prevalence of vision-related headaches. In my experience, there are usually other factors at play. But it is an area that requires further study.

  Paul - 11:29 AM:
I notice I get seasonal headaches. Even if it is raining outside, I feel the headache right when I wake up in the morning. Am I imagining that it's caused from the weather, or is this a possibility?
Stuart Bergman-Bock
I do not think you are just imagining it. I would say that the majority of my migraine patients note an association with weather patterns. It seems that falling barometric pressure may be the most common trigger. But I am not sure how the changes in weather patterns influence headaches, but it has long been a feature described in migraine.

  Evan - 11:36 AM:
I'll often try to cope and just deal with a headache without taking medication. I've even gone to sleep at the end of the day, and still had a headache the next morning. Do you recommend taking over the counter medication even if you are going to bed with a headache?
Stuart Bergman-Bock
Non-medicinal ways (such as visualization, meditation, distractions, cold/warm packs, massage, etc) of coping with headaches are sometimes necessary. Pain medication taken too frequently can make headaches worse. But that being said, letting headaches linger on can make it harder for them to go away. Over-the-counter medication is certainly a reasonable way to start. But if headaches are significant it should be brought up with your doctor so that better treatment methods can be explored.

  Ben - 11:42 AM:
Are there any foods that trigger headaches?
Stuart Bergman-Bock
There are! You could drive yourself crazy trying to avoid every possible trigger. Some of the most notable include chocolate, caffeine (strange as also used as a treatment for headaches), deli/cured meats (especially those containing nitrites/nitrates as preservatives), red wine (or other alcohol), aged cheese, almonds/nuts, citrus fruits, or MSG. And that is not even close to a complete list. But these are examples of potential triggers, that does not mean that EVERY person with migraine will be triggered by any of these foods. There are a variety of migraine diaries online that can help uncover potential triggers. The best (Though difficult) technique is to eliminate as many of the potential triggers as you can for a few weeks. Then add one back on at a time to see if any one in particular worsens headaches.

  Nicole (Chicago, IL) - 11:53 AM:
I get horrible headaches during menstruation - is this from hormones? Is this a particular kind of headache? And what can be done to alleviate this?
Stuart Bergman-Bock
The flucutation of hormones such as estrogen associated with the menstrual cycle has a very important influence over headaches such as migraine. We do not always give it a specific name. Migraine headaches that occur ONLY in relation to the menstrual cycle has been called "Pure menstrual migraine." There are a variety of treatments, some utilizing hormonal therapies, or simply using medications that are used for migraine or headaches in general. This is something that should be brought up to your primary doctor or gynecologist. A neurologist may assist if the headaches remain intractable.

Colie (Moderator) - 11:59 AM:
The chat is now over. Thank you Dr. Bergman-Bock for your help and expertise. Due to the high-volume of questions, not all were answered. Stay tuned for a follow-up blog post on Healthy You.
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