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A Migraine don’t

pkamens Icon Posted by Paula Kamen

May 1st, 2006

Last Thursday (April 27), NPR’s “Morning Edition” did an interview about controlling migraines through avoiding food triggers, as prescribed by author Dr. David Buccholz.

The good news is that this advice can help a lot of people, and is definitely worth mentioning. As the story explains, even when food triggers aren’t at the root of pain, they can add to some patients’ overall vulnerability to it, especially when combined with other weakening triggers, such as stress and weather changes. With many genetically-vulnerable patients, once a certain number and amount of triggers add up, they get a migraine. It’s like these patients have a shorter fuse than other people, and all these factors make the fuse shorter and shorter.

The bad news is that, like with other coverage of migraines (which are mainly experienced by women, a whopping one third of women of childbearing age), the media ignores the more severe cases and puts unrealistic pressure on many patients to manage a serious disease without drugs.

The story quotes Dr. Buccholz delivering some grandiose promises to all, as he does in his book:

I tell people to use the power they have in their own hands to control their headaches.

Like so many others on the topic writing a mass audience, this story hardly recognizes the wide variety of headaches (as well as other types of chronic pain) that exist out there, especially more severe cases. Often, no matter how a person eats, no matter how much she avoids MSG, she cannot “control” the pain. In fact, as neurologist Dr. Lawrence Robbins writes to other headache specialists, “the vast majority of migraines are not associated with any easily identifyable precipitating factor.” (See Robbins, Lawrence. Management of Headache and Headache Medications. New York: Springer-Verlag, 2000, p 7). And for every person who does have triggers, they can be wildly different.

Furthermore, many people with chronic headache, including those who have it constantly or daily (about 4 percent of the population, 10 percent of women of childbearing age), do not have any identifyable triggers, either internal (such as hormones) or external (such as foods and weather). And while some people may experience these factors (ie MSG or cheese) exacerbating pain, all the diet changes in the world won’t stop the pain.

Such stories indeed help sell millions of books to desperate patients, eager for a “quick fix” to a neurological disease, trusting a supposedly “scientific” source. Furthermore, they help to compound guilt of millions of headache sufferers (such as yours truly) who have spent years worrying that they are personally at fault if they can’t manage their pain through diet, ignoring some very powerful physiological forces.

Once again, the truth is that EVERY disease has excerbating influences, such as stress and certain foods, but that migraine (like other pain and fatigue disorders) carries a double standard, that it all should be in YOUR control. This advice that all people can control headache through food is like someone giving that advice to all diabetics (types 1 or 2), that they can control their problems just through foods. For some, this is the case. For others, that is dangerously unrealistic.

Please pass the cheddar….

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