FAQ Episode 53: Are you Migraine Treatment Resistant?
FAQ Episode 53: Are you Migraine Treatment Resistant?
Frequently Asked Questions about Natural Migraine Relief for Women
Over the years I have met and treated many unfortunate souls who fall into the “Migraine Treatment Resistance” camp. The “resistance” is not on their part; heaven knows they’ve been heroic in their efforts to find relief. But when a condition is resistant to treatment the physical, emotional and real life situational costs pile up. Many of those without headache problems are often surprised to hear that migraine is the second most debilitating disease worldwide. If you’ve experienced a migraine, you also know about the definition of debilitating: a serious impairment of strength or ability to function.
In the U.S, around five to six million of us have chronic migraine*, and up to half of this group, approximately three million, are said to be “treatment resistant**.” A recent study by the National Headache Foundation1 found that more than 50% of chronic migraine patients are dissatisfied with their current therapy due to lack of symptom improvement and about 75% have stopped drug therapy options, or avoid using them due to side effects. Even among those who get some response to preventive therapy, 84% “wished there was a better treatment option.” And this is where we stand nearly 60 years since the first drugs for migraine prevention were introduced. Recent advances in migraine therapy are encouraging, but still incomplete.
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*characterized by 15 or more headache days a month with at least eight of those days marked by typical migraine symptoms.
** those for whom therapy options fail to deliver a consistent response or lasting relief.
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Chronic migraine affects…well, pretty much everything.
Respondents to this same National Headache Foundation survey also said that of those with chronic migraine:
-50% were extremely dissatisfied with their current ability to control their disease.
-64% had reduced energy levels.
-57% had reduced mental clarity.
-54% experienced reduced productivity.
-50% found it adversely affected their personal relationships.
-49% said it had reduced their professional success.
-65% of responders said that their migraine disease makes them feel like “life is passing them by.”
-66% feel they are a “guinea pig” as their healthcare provider tries to find the right preventive treatment for them.
-52% say they cannot make plans with friends, family, or colleagues because of their disease is so unpredictable.
-67% acknowledge their risk of anxiety and depression increases as the number of their migraine attacks increase.
If these sentiments resonate with you, let’s ask ourselves: “Going forward, what are you going to do differently to break out of this vicious cycle?” Its a fair question, because if you are reading this, its likely that what you’ve done so far has fallen short on both expectations and results.
I’d like to offer that progress that makes a difference comes down to three things:
Having the most accurate diagnosis of your headache disorder. An old axiom says that “half the cure is the right diagnosis.” I’d place it more like 30%, with the next 30% being our next point #2:
Understanding why YOU have THIS problem. After we get past the snag that “life in a naughty world just ain’t fair,” its useful to remember that its extremely rare to find a problem where one thing done right is the total solution. Headaches, including migraine headaches, and especially treatment resistant headaches have more than one root cause factor, specific to you, which promote the persistance and recurrence of your headache pain.
The final 40% lies in finding the right resources to assist in addressing and clearing as many root cause factors as possible. If you remember my “full glass theory of migraine expression” (to review this click here and go down ~5 paragraphs), we don’t have to solve all of them, we just need to manage enough of them to lower your predisposing factors below the clinical level of expression: i.e. having a headache.
Jeanette’s story: Finding root causes and clearing chronic and resistant migraines
Let me give you an example from real life, a patient of mine we’ll call Jeanette. When I first saw Jeanette, she was early 40s, had started having migraine headaches in her mid teens, and was experiencing 4-5 migraines per month with each of these costing her anywhere from one to three days of functional capacity. She had tried several medications, of which the triptan medication group did minimize the progression of about 30% of her migraines, when caught early. We took her through my Migraine Action Plan2 (part of my Natural Migraine Relief for Women course) and found four major root cause factors to address. I’ll be brief in describing the what and why:
a. we knew from her history that her hormone cycles played a major role in her headaches, and that she had long term progesterone deficits which worsened as she entered her peri-menopausal years. We started her on cycle specific bio-identical progeterone with a small amount of daily estrogen and female appropriate testosterone support. Because hormonal influence plays such a key role in many women’s migraines, we mention it in many FAQ episodes, and address it very specifically in four of the Natural Migraine Relief course’s lessons (#s 11-14.) This part of her therapy had the added benefit of clearing much of her cyclic PMS, and also allowing much deeper and restorative sleep, which was a real key to her overall recovery.
b. her Vitamin D level was a very low 22 ng/dl.. Being fair skinned, she had tended to avoid regular sunshine. We aimed for a Vitamin D level closer to 60-80 ng/dl, which was easily achieved with safe and inexpensive daily oral dosing. See FAQ # 11 and FAQ #40 for more information on the role of optimal Vitamin D and its potential role in migraine relief.
c. she had a strong family history of migraine, and we checked her for MTHFR methylation gene activity using a serum homocysteine level. You can also do gene testing (FAQ #3.) Healthy levels of homocysteine are <10, hers was 15. We were able to correct for this pro-inflammatory factor with an inexpensive combination of pre-methylated Vitamins: B6, folate and B12. Not only did this help in the here-and-now with migraines, it also reduces her long term risk for heart attacks, strokes and dementia. See FAQ #3, FAQ #13 and FAQ #39 for more information on this important and oft neglected root cause factor.
d. Jeanette had a long history of irritable bowel syndrome (IBS). We found from blood testing for IgG food sensitivities that dairy and gluten were a factor in provoking ongoing inflammatory responses that could promote her migraines. Although she did not exclude these 100% from her diet, by making them a less common part of her diet along with healing the gut lining with probiotic therapy she was able to clear her IBS. See more about this in FAQ Episode 20: How do food sensitivities promote migraine headaches?
When we addressed these main issues, along with a few others, like having her take the Basic Four nutrient group (see FAQ # 40 for more info on this) which I advise for all my migraine patients, she started to see results in the first month. By three months along she was ~50% better on frequency and intensity of her headaches and by the fifth-sixth months was nearly headache free. No doubt we will need to tweak the hormonal therapy as she progresses toward menopause, but I feel confident that we can maintain her progress. We, and no doubt her family and friends, as well, are thrilled with her success.
Action considerations for you and your migraines
First and foremost, get an accurate diagnosis for your headaches. Start with your primary care physician, and you may benefit from seeing a neurologist, as well. The Natural Migraine Relief course’s “Lesson 4: Migraines vs. other kinds of headaches” can help you narrow this issue down some.
Second, please heed my warning not to accept that potential drug treatment from any physician is your one and only path to migraine therapy. Prescription drugs can be a very helpful adjunct, but 1) most do not address root cause factors for migraines, and 2) the newer drugs that do will almost always leave other root cause factors unaddressed. This is why drug therapy is often incomplete in managing migraine. On the other hand, the right medication can be a very useful part of an overall management plan, so work with your prescribing physician to access all the tools you may need.
Third, understand YOUR “specific to you” root cause factors for migraine. You may find a physician, N.D., D.C. or other allied practitioner who can give you knowledgable advice on this. You may find my Natural Migraine Relief course helpful, as well (see footnote 2 below.) Its “Lesson 24: Getting another opinion: finding an integrative or functional medicine minded practitioner” can be very helpful in finding local assistance.
Fourth, like Jeanette’s story, combine the key elements most specific to your story and root cause factors. When done right, and with enough time to reverse chronic inflammatory factors, our goal is to “reduce the ounces in your migraine cup” and minimize the clinical expression of migraine headaches in both frequency and intensity.
The Migraine Action Plan portion of the Natural Migraine Relief for Women course reviews 10 broad areas of root causes for migraines, including 60+ related medical disorders, and over 90 specific non-drug interventions that can be tailored and triaged to your self-individualized circumstances. You can see an outline of that course by going to the post Natural Migraine Relief for Women: Table of Contents or reviewing FAQ Episode 42: What can I learn from the Natural Migraine Relief course?