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From the Townsend Letter
November 2007


A Primer for Managing Migraines
book review by Katherine Duff

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Low magnesium levels in the blood have long been connected to headaches and migraines. However, studies attempting to correlate magnesium levels and the various types of headaches have shown inconsistencies. The puzzle was solved when new laboratory techniques were able to separate the levels of bonded magnesium from the serum ionized, or free, magnesium. Subsequent studies showed the magnesium level relevant to headaches and migraine treatment was the serum ionized magnesium.

What Your Doctor May Not Tell You About Migraines: The Breakthrough Program that Can Help End Your Pain
by Alexander Mauskop, MD and Barry Fox, PhD
Warner Wellness, Time Warner Book Group, 1271 Avenue of the Americas, New York, New York 10020
Softcover; c. 2001; $14.95; 260 pp.

The incidence of migraine headaches in this country is no small matter. According to What Your Doctor May Not Tell You About Migraines, 25 million Americans suffer from this problem and spend over $20 million a year seeking relief. In the 1980s, the number of people suffering from migraines increased 34% for men and 56% for women. The authors of this book, Alexander Mauskop, MD and Barry Fox, PhD, may have answers that could not only reduce the incidence of migraines, but reduce the overall expenditures as well. It all begins with education.

The education starts with a proper diagnosis from a physician. We learn there are many different types of headaches, and even when the specific diagnosis of migraine is made, there are several types of those. If migraine is diagnosed, the physician determines if it is migraine with or without aura, the visual disturbances that occur in 15% of the cases. Other types of migraines would be considered, such as basilar, which produces dizziness, double vision, and poor coordination. Another type is the hemiplegic migraine, which makes moving one side of the body difficult during an attack. No matter what type of migraine a person may have, migraines should be regarded as a whole-body syndrome.

The full picture of what causes migraines is not yet known, but the authors offer the latest working theories. Though a migraine may feel it is caused by the blood vessels in the brain, it is actually the blood vessels in the head, near the brain, that are the culprits. The Vascular Theory, which describes the contraction and dilation of the vessels and the resulting inflammatory response, was once the most popular theory, but has become secondary. Now there is the Serotonin Theory, the Neural Theory, and the Unifying Theory, which are described.

More than any other reason, however, people will read this book for advice about relief from their migraines. The authors offer a seven-step strategy called the Banishing Migraines Program, which combines treatment and lifestyle changes that can prevent or reduce the severity of migraines. The seven steps of the program are as follows:

1. Get a proper diagnosis from a medical doctor.
2. Use the triple therapy.
3. Identify and avoid your migraine triggers.
4. Eat to avoid migraines.
5. Take the edge off.
6. Walk it off.
7. Use medicines as necessary.

The "triple therapy" advised in the second step is integral to this program and was developed by Dr. Mauskop at his New York Headache Center. When he was not getting very good results from standard medications, he first turned to magnesium and found through established research and his own research, that magnesium indeed could play an important role in preventing migraines and reducing their severity. The herb feverfew, which has been known as a successful headache treatment for hundreds of years, was added to the regimen to strengthen the therapy. Then, recent research showed riboflavin was able to prevent migraines, and it was added as well.

The three components – magnesium, feverfew, and riboflavin – are combined to form the triple therapy, which is to be taken daily in oral supplement form and likely for years. The triple therapy is discussed in great detail with emphasis on the important role of magnesium. Dr. Mauskop found in his studies that those patients lowest in magnesium benefited the most from magnesium infusion. He also found that the standard measure of total magnesium was not adequate. After new laboratory techniques were developed, it was possible to separate the bonded magnesium levels from serum ionized magnesium, or free magnesium, levels. Mauskop's studies were then able to confirm that the free magnesium levels were more relevant to migraine treatment than the total magnesium level. It also became possible to look at the ratio of the serum ionized magnesium and serum ionized calcium, which must maintain a proper balance for appropriate muscle contraction.

The other steps in the program are discussed and offer an education that should give people suffering migraines greater control in their lives. The authors start by teaching the reader to identify the triggers that are unique to each person. The triggers can include environmental triggers such as pollution or perfumes, or stress and food triggers. For all of these, the authors provide steps to accurately identify them, such as using an elimination diet to uncover food triggers. A person whose trigger is exertion and exercise is taught to use isometrics as warm-up, and those with environmental triggers can learn to clean the environment of offenders.

As a specialist in the area of migraine headaches, Dr. Mauskop is also a realist. He knows that reduction in the number of migraines and lessening of severity still leaves a treatment gap that can be – and is often – filled with medications. He provides a thorough list of the medications used for stopping a migraine in-progress and for preventing a migraine altogether. This section should provide a much-needed reference for anyone working their way through the numerous drugs available to treat migraines. For each medicine, he lists the other names of the drug, the type of medicine it is, the usual dose, the maximum dose, the consequences of overdose, any side effects, a profile of the type of patient who should not take the drug, and a list of the drugs that should not be taken while using the particular drug.

As director of the New York Headache Center, Dr. Mauskop has obviously dedicated himself to the problem of headaches and migraines. It is apparent that he has also dedi­cated himself to the care of his patients and all who suffer migraines. In this book, he is sharing a wealth of information for all.


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November 27, 2007

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