In "Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Headaches," David Buchholz, a neurologist at Johns Hopkins University School of Medicine, shares his simple and practical system to prevent painful headaches. Here's an excerpt:
The 1-2-3 Program Works
This book is not just for those who have struggled with the extremes of migraine pain for years. It can help you even if you suffer from headaches only occasionally. Do you experience “sinus” headaches when the weather changes or “tension” headaches with stress? Is your neck often stiff, or are you frequently congested? Maybe your child has complained that his head hurts in school, and you haven’t known what to do. Does your teenager have headaches with her periods, month after month? And how about your friend who gets dizzy spells? (Or is it you who’s dizzy all the time?)
The foundation of the 1-2-3 Program is a clear understanding of the migraine mechanism and the broad spectrum of headaches and other symptoms it generates. Once you’ve read all the chapters in this book, you’ll be prepared to take the right steps to prevent its activation—and thereby prevent the symptoms that result. Step 1 puts painkillers in their proper place: infrequent use only. Quick fixes for headaches aren’t your friends; if anything, they’re the enemy. They cause you to lose control, and you won’t get it back until you achieve independence from them. Step 2 is eliminating headache triggers that you can readily control—mainly those that you put in your mouth and swallow. If you can keep your total trigger level below your threshold for activation of migraine, the mechanism will not become activated and you’ll be symptom-free.
If you respond well enough to the first two steps, Step 3 may not be needed. If it does prove necessary, preventive medication (taken on a daily basis) can be added to block activation of migraine and thereby prevent the headaches and other symptoms it generates. Used properly, one or more of several preventive medication options can safely and effectively control your headaches.
But before we begin, let’s be clear about a few things. Most of the ideas expressed in this book did not originate with me. Many other headache specialists, past and present, have contributed to the understanding of headaches that I’m about to lay out for you. My contribution is to take some of these ideas a step further, blend the correct mix and present it so that it makes perfect sense. What I offer is a conceptual model of migraine, based in part on scientific data generated by others and in part on my own experience successfully helping thousands of patients to control their headaches over a period of two decades.
In scientific terms, my beliefs are hypotheses: potential explanations of certain cause-and-effect relationships. In this case, the migraine mechanism is one cause. When activated by sufficient triggers, the effects produced by this mechanism include all types of headaches and a host of other symptoms. Another cause is rebound, which results from dependence on quick-fix painkillers. Its effects are increased headaches and resistance to preventive treatment of migraine.
Scientists may wish to test these hypotheses formally, using randomized controlled trials. Memo to colleagues who undertake this challenge: Good luck, and I hope you do it right. If that’s possible. Helping people control their headaches by guiding them to do the right things demands art, and science in the form of a clinical trial might just interfere. Simply telling people what to do—without adequately explaining why, without forcefully countering resistance to what people don’t want to hear and without offering confident, optimistic encouragement—won’t work. Don’t forget: the process of science inevitably disturbs whatever it studies and therefore never really studies what it means to.
And setting aside the 20 years it’s taken me to refine my skills in teaching people to control their headaches, I know that my passionate faith in the 1-2-3 Program could not possibly be possessed, let alone conveyed, by dispassionate investigators conducting a controlled trial of my approach. I would not even participate in such a trial, because I know that the 1-2-3 Program works and I would not want any patient of mine to be randomized to alternative (and less effective) “control” treatment.
The final and most important hypothesis I offer is that by dealing properly with migraine and rebound you can control their effects: the headaches and other symptoms that result. In my extensive experience with headache patients, this hypothesis has been put to the test repeatedly and has passed time and again. The test is: by using the 1-2-3 Program, can headaches and other symptoms of migraine be controlled? Emphatically, the answer is yes. No “scientific” data to the contrary, from a randomized controlled trial or any other source, would ever convince me otherwise.
Don’t get me wrong: science can be a valuable tool. But sometimes you can recognize truth on your own, without needing scientists to certify it for you, because when you open your eyes and look at things the right way, the truth becomes obvious. Decide for yourself whether or not what I have to say rings true—in fact, makes perfect sense.
The details of my model of migraine may not be completely accurate--after all, the details remain largely unknown to anyone—but for our purposes that’s not so important. What is important is that this model is effective in guiding you to control your headaches. It provides a framework that helps you understand why you have to do what you have to do. With faith in yourself and a clear plan—the 1-2-3 Program—you can control your headaches.
Eliminating Dietary TriggersEveryone’s different, and it may be that not every one of the foods and beverages that most commonly cause headaches is a trigger for you, but the items that appear in Table 6 (pages 74-75) are the common culprits. You can begin to take control of your headaches by eliminating each and every one of these potential triggers from your diet. (Later, you may be able to reintroduce some of these foods and beverages, as I’ll explain, but for now strict compliance is required.)
The better you follow the diet, the more likely you are to achieve headache control, and the less likely it is that you will require preventive medication—or the less preventive medication you will require—in order to achieve headache control. No one can follow the diet perfectly, but do your best. Each dietary trigger you avoid, thereby removing it from your stack of triggers, reduces your total trigger level and increases the likelihood that you can keep the level below your threshold. Remember, since there are so many triggers that are unavoidable, or difficult or undesirable to avoid (see Table 5, page 62), it is all the more important to eliminate the potent but generally unrecognized triggers that you can avoid readily: the dietary items (and medications) detailed in this chapter.
The diet is a tool. The more skillfully you use any tool, the better it will function. The better you use this tool, the diet, the more effective it will be in controlling your headaches. If your goal is to control your headaches—and take as little medication as possible—the diet is the most valuable tool you have.
You might criticize the diet for its “negative” approach, and it’s true that it focuses on what you cannot eat and drink rather than on what you can. But the number of items you are allowed to eat and drink is much greater than what you’re not, and listing them would require too much space. And just in case you need some help, you’ll find some sample menus and recipes and other dietary tips in the Appendix. (Don’t be constrained by these suggestions; they’re just examples to get you started.)
The diet can be tough to follow initially, especially for vegetarians and others on already restricted diets, but it is not a life sentence of culinary deprivation. Cheer up: you can look forward to a time when your headaches have been controlled well enough, long enough that you can afford to rock the boat by carefully experimenting with dietary liberalization. It’s likely that eventually you can tolerate some of the initially restricted items, at least in limited quantities. But at the start you must strictly avoid all potential dietary triggers. Dietary liberalization comes only after you have achieved headache control and maintained it for four months or more. The details of how you can attempt to reintroduce items will be spelled out later in this chapter.Excerpted from “ by David Buchholz. Copyright 2007 David Buchholz. Reprinted with permission of Workman Publishing. All rights reserved.