DRUGS THAT CAN PREVENT MIGRAINE ATTACKS
There are various drugs that, taken regularly, can prevent migraine attacks, or at least reduce their frequency. Beneficial effects may not be apparent until they have been taken for several weeks.
In conventional migraine treatment, these are not generally prescribed unless migraines are fairly frequent and severe, and other measures have been tried without significant success. Those ‘other
measures’ might include reducing stress, avoiding situations that trigger migraines, and avoiding foods such as chocolate, cheese, red wine and citrus fruits. By extension, it would seem reasonable to investigate food intolerance, using an elimination diet, before starting on (or continuing with) these drugs.
12A Serotonin antagonists
Serotonin, or 5HT, is a chemical messenger produced by the blood platelets that is known to play a part in migraine. Drugs that block the receptors for serotonin seem to help prevent migraine. Some of these drugs also act as antihistamines. The main drug used is pizotifen (Sanomigran) which is generally safe but can cause weight-gain and drowsiness in some people. Methysergide (Deseril) is equally effective, but it can, very rarely, cause serious side-effects with lasting damage. Anyone taking it should have close medical supervision. It is advisable to stop taking the drug for 1-2 months twice a year, to check that all is well.
These drugs block (3-receptors for adrenaline, the hormone that produces the ‘flight or fight’ reaction. Their main use is in other diseases, principally heart disease, and it is not entirely clear how they help to prevent migraine.
Some of these drugs block the effects of adrenaline generally and they should not be taken by asthmatics, since they have the opposite effect to (32 bronchodilators (see section 4A). The ones in question are nadolol (Corgard), propanolol (Angilol, Apsolol, Berkolol, Inderal LA) and timolol (Betim, Blocadren). Others are more selective, only affecting (3-receptors in the heart, and they can be taken by asthmatics, although good medical supervision is needed. The principal drug of this type is metoprolol (Betaloc, Lopresor).
All these drugs have certain side-effects, including cold hands and feet, disturbed sleep, stomach upset and wheezing. If dry eyes or skin rash develop this should be reported td the doctor immediately as it can indicate a severe reaction to the drug. The drugs should not be stopped abruptly, but gradually withdrawn.
Clonidine
Clonidine is used to lower blood pressure and when taken at low dosage (Dixarit) it can prevent migraine in some patients. It is a relatively safe drug, but some patients may suffer from drowsiness, dizziness, dry mouth or insomnia.
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UNEXPECTION ALLERGIC CROSS-REACTION: CROSS-REACTIONS BETWEEN PLANT PRODUCTS
Many of those who are allergic to birch pollen cannot eat hazelnuts. This is not particularly surprising, since birch and hazel belong to the same plant family. What is unexpected is the cross-reaction seen between birch pollen and apple – a very high proportion of those with birch hay-fever are allergic to apples. It is thought that this is due to small molecules called phenols that are widely distributed in plant products. The suggestion is that apple and birch just happen to have the same sort of phenol, despite their unrelatedness. There are other odd cross-reactions between different fruits and vegetables which may be explained in the same way.
Shellfish
Some people seem to be sensitive to both crustacean shellfish and molluscan shellfish. Why this should be is a mystery – it is unlikely to be a cross-reaction, in the conventional sense, since the two groups are not at all closely related. Biologically speaking, they are as similar to humans or birds as they are to each other. Again, the use of an imprecise name for both groups -’shellfish’ – is a confusing factor.
For certain people, it may be something other than the shellfish themselves causing the problem. Toxins acquired from their food, or the preservatives that are liberally added to shellfish might be to blame.
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PREPARING FOR THE ELIMINATION DIET: SORT OUT OTHER PROBLEMS
The idea of the elimination diet is to create a period of ‘silence’ in which you can listen to your body answering specific questions. Any sort of background noise is going to confuse you, so you need to eliminate other things that cause symptoms before you start. The three main items to consider are airborne allergens, hyperventilation and chemical sensitivity.
You should suspect airborne allergens if your symptoms include asthma, hay-fever, a year-round runny nose or congested nose (rhinitis), red, watery or itchy eyes, sinusitis, or recurrent ‘colds’. Eczema and urticaria may indicate allergens in the air that land on the skin – or things that touch the skin directly. Consult pp64-5 for likely sources of trouble. Avoidance measures are described on pp66-8. Put these into effect for a few months before starting the diet.
Hyperventilation is suggested by dizziness, faintness, tingling in the hands and feet, numbness, spaced-out or confused feelings, shortness of breath and a variety of other symptoms. A full list is given on pl56. It appears that hyperventilation often accompanies food intolerance, but it can sometimes be the sole cause of symptoms.
There are no typical symptoms reported for chemical sensitivity, but most people who react generally know that they do because certain things always make them feel ill – travelling by car, smelling perfume or swimming in chlorinated water, for example. Complete avoidance is difficult, but try to clean up your environment as much as possible, and wait for about two weeks before starting the elimination diet, so that you can assess the effects of doing this.
If you respond to any of these avoidance measures, however slightly, they should be continued throughout Stages 1, 2 and 3 of the diet.
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WHAT CAUSES FOOD INTOLERANCE? REBECCA’S STORY
Rebecca began to have problems with severe sore throats when she was in her teens. At the same time she suffered ‘swollen glands’ (swelling of the lymph nodes) producing painful lumps in her groin, armpits and neck. The pain was often so bad that she had difficulty in walking. She also felt bloated, with a noticeable puffiness around her face and neck, and she suffered spells of dizziness when she would sometimes pass out. Eventually her tonsils were removed, but this did not bring much improvement: her throat was less sore, but it was still painful and swollen. In her early twenties, Rebecca married, and although she was very happy with her new husband, her symptoms began to get worse. She frequently felt as if she had flu
coming on, with aches and pains, headaches and swollen glands. Severe catarrh, recurrent mouth ulcers and stomach pains were also making life difficult.
All these problems came to a head when she was 25 and they moved house. Looking back, Rebecca thinks it was the stress of moving which precipitated a crisis in her state of health. All her symptoms became more frequent and more severe, and she felt as if her body was ‘totally out of control’. She also developed some new problems, including aching joints and bouts of severe depression. She had to give up her part-time job and even simple tasks around the house became impossible.
Rebecca had seen many different specialists over the years, and none had been able to do much for her. But at this point she heard something about ‘food allergy’ from a friend, and asked her family doctor if he thought this might be worth investigating. The doctor was sceptical but made an appointment for her to see a specialist, who put her on a strict diet, starting with a three-day fast. Then she went on to a diet of lamb, pears and mineral water. Within a week she felt so much better that she could scarcely believe it. Almost all her symptoms had gone, except for a few aches in her joints. ‘I had been ill for so long, I’d forgotten what it was like to be well – it was an amazing feeling,’ she recalls.
The long process of testing foods then began. Eventually Rebecca identified the following culprits: most types of additives, wheat, oranges, lemons, butter, strawberries and alcohol. Eating any of these would produce swollen glands, depression, headache, stomach pains, aching joints and general flu-like symptoms within a few hours. It took her a long time to test all foods and establish a workable diet, but she now enjoys very good health and can eat a variety of foods. She can even tolerate small amounts of wheat and her other culprit foods occasionally, but has to avoid additives.
Cases like Rebecca’s are rare but they raise some interesting questions about what causes food intolerance. The swollen lymph nodes suggest that her immune system was affected by her reactions to foods, even though her symptoms were not those one would associate with allergy.
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THE CLASSICAL ALLERGIC DISEASES: HAY-FEVER
Pollen, produced by plants and carried on the wind, is the most notorious of the airborne allergens – it causes the symptoms known to doctors as seasonal rhinitis and conjunctivitis and to the rest of the world as hay-fever. Not all
hay-fever sufferers respond to the same pollen, and the timing of the symptoms will depend on which pollen is the culprit.
Mast cells in the nose and eyes respond to the proteins in the outer coat of the pollen grain. The mediators that are released cause inflammation of the delicate membranes, which the hay-fever sufferer experiences as red, itchy, watery eyes, and a runny or congested nose. Some people also suffer from itching in the mouth or ears. Irritability and fatigue may accompany these physical symptoms, although whether these occur as a direct effect of the allergens on the nervous system, or simply a secondary effect of the unpleasant physical symptoms, is debatable.
Food can probably contribute to hay-fever, though pollen is always the major allergen. Some people find that by avoiding particular foods they reduce their sensitivity to pollen, and a lucky few lose their hay-fever symptoms altogether. Sensitivity to foods can also mimic hay-fever, if the foods concerned cause rhinitis and are only eaten in the summer, or in much larger amounts then.
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