Boston Book Club: The Migraine Brain
Thankfully, we don’t suffer from migraines. While we never dismissed people who do, we never realized how horrific the experience can be until we read Dr. Carolyn Bernstein’s The Migraine Brain.
Bernstein, who is an assistant professor of neurology at Harvard and is a staff neurologist for the Cambridge Health Alliance, describes how the brains of migraine sufferers differ from others. Her book also gives ways in which those who do can learn to prevent and control their pain.
We talked to Bernstein about the latest research into migraines, how the economy is affecting her practice and patients, and how far is too far to travel for her services.
Boston Daily: I’ve never had a migraine, so your book was quite eye-opening for me. In it, you mention that some people go years without being diagnosed. How could they function?
Carolyn Bernstein: I was talking to a patient this morning who’d driven here from New York State about how hard it is for a lot of people who are not working in this field and don’t have these headaches to understand how completely disabling they are. I think that there is a culture that says that a migraine is just a headache. I’m really hoping the book will educate people and validate them. This is a whole constellation of symptoms. Pain is one part of it.
BD: How does the brain of a migraine sufferer differ from a non-sufferer’s brain?
CB: We are just starting to look at whether there are changes in the brain that are really chronic. There was a study that measured brains of people who have migraines against people who don’t, and there was a difference. Sometimes there are changes that are seen on MRI scans. We don’t know what they mean at this point. If you come back and ask me that question, in five years I’ll have a lot more answers for you.
BD: What are some of the treatments available for migraineurs?
CB: Medications are one option. In terms of non-drug treatments, we recommend biofeedback at the Women’s Headache Center for a lot of patients. There is a piece about that in the book. I recognize that when people from different locations look at that, they might not have that available as a resource, but it can be a wonderful technique. What it is is learning how to change how your body responds to pain, and how to stop things that will trigger or worsen a headache.
We found that changing how you eat—not just avoiding food triggers, but being the person who has a snack in their handbag to keep the glycemic index steady—can really help. Acupuncture, yoga, meditation are some other non-drug treatments.
BD: Do a lot of people come in and say they don’t care what you do as long as the pain stops?
CB: I think everyone is looking for a wonder pill, which I totally understand. But it’s the physician’s job to set the expectations accurately. We also talk about the disability scale—how much are migraines impacting your life. We look at that number and check it again after someone’s had some kind of treatment for a few months. Oftentimes, the number will go down and that’s really, really helpful. Even though they’re still getting migraines, you can point to improvement. It isn’t going to cure you, but you might feel better. If it doesn’t work, we’ll keep going.
BD: You mention Jonathan Papelbon and Johnny Damon suffer from migraines. Did you ever treat them?
CB: I haven’t treated them. People say, “Can I send a man to the Women’s Headache Center?” And we only treat women. But I do have a general practice, and I do treat some men there.
BD: How come you decided to focus on women’s headaches in your practice?
CB: I really like treating men. It’s rewarding to help anybody feel better. But if you look at how women prioritize healthcare in the family, they’re often at the bottom of the list. So I was really trying to think of how to create a place that would focus on specific issues related to women’s health.
We do some education about calcium and Vitamin D needs, we’ve been able to help some women who’ve been battered in a home relationship. It’s OK with us if women need to bring their kids with them. Do you have to separate care to provide good care? No. But it felt like there was a need for something that would get women to come in and seek care for this.
BD: How do you think it would affect a baseball player’s ability to perform if they have a migraine?
CB: Not a good feeling, that’s for sure. A baseball field is probably right up there with an emergency room as one of the places you don’t want to go with a migraine. You have to become really hyper-vigilant if you have migraines because if you let your guard down, they’re going to sneak up on you.
If I were a Major League baseball player, I’d be sure to eat really well. I’d do some kind of relaxation before I went on the field. Eating, getting decent sleep, and the other steps outlined in The Migraine Brain will help. I would not want to play baseball with a migraine headache, I tell you.
BD: It must be hard for you to manage your own migraines with the stress of running the Women’s Health Center and doing promotions for The Migraine Brain.
CB: I am lucky—I get one every couple of months. The motivation for the book wasn’t so much “gee, I get migraines,” but it was more about the patients that I was seeing. Mine have been under pretty good control, and I actually do follow a lot of my own advice. Doing a lot of exercise and getting rid of stress helps, especially right now.
One of the other interviews I did, they asked me what advice I had for migraine sufferers during this economic climate. It would be the same advice—do whatever you can to find some time to relax. Don’t check your stock returns.
BD: The Cambridge Health Alliance might be facing some significant budget cuts. Will this affect the Women’s Headache Center?
CB: I think the place is really wonderful. They’ve been very supportive to the Headache Center. We’re always busy—we’re booked so far out—and I think they see that. The people who work here are so dedicated and bring a lot to taking care of patients from all walks of life. It’s very painful to see difficult times, but the administration is very committed to making things work.
BD: How was the reader feedback been about The Migraine Brain?
CB: It’s been really interesting. One thing I’ve done is a lot of public radio broadcasts around the country. After I discuss the book a little bit, they’ll have people call in and a lot of them have read it. I’ve had new patients coming in in the past month who bring the book in. I don’t hear negative things from people, but they’re really positive about it. I think it’s validating for a lot of people, which makes me really happy. People like the tone of the book. There are other headache books out there (and I’m certainly not going to name specifics) that kind of blame the patient. As a person and a physician, I don’t really like that.
BD: How far have people come to visit the Women’s Headache Center?
CB: We got a call from somebody from Alaska.
BD: Could she see Russia from her house?
CB: Exactly. I’m not making any political comments about what resources might be there, but we had to tell her it probably wasn’t appropriate for her to make that kind of a trip.
BD: Are there people like you who are adopting this philosophy in other areas of the country now?
CB: There are other headache centers around the country. To my knowledge, we’re the only ones who had the patients really design and make recommendations for the center. But there are probably not enough headache centers. If you’re in a part of the country where there’s only one family practice doctor taking care of many many patients, there’s not going to be someone who does migraine work specifically. That’s where I think whatever you can do to educate yourself and your doctor is going to be really helpful for you.
The Migraine Brain is in bookstores now.
