What Doctors Don't Tell YouQ:My son, aged 22, has to take beta blockers plus Anadin for migraine. I am worried about him as I know he shouldn’t be taking so much medication. Can you tell me of an alternative treatment? He says it is all stress related. S H, Leeds.
A:The anti-estrogen drug danazol and beta blockers are among a growing list of drugs being tried out on migraine sufferers. Studies have shown that beta blockers (atenolol, labetalol, metolazone, metoprolol, propranolol and timolol) taken continuously will reduce the frequency of attacks.
As with sumatriptan, medicine doesn’t really understand why beta blockers, which essentially block the heart from stimulation (the action which causes it to race during effort, anxiety and excitement), would have any effect in aborting migraines.
However, as with sumatriptan, the cure is often worse than the disease. The most well known side effect with this class of drugs is, ironically, heart failure. The drugs also cause sexual dysfunction and impotence, dizziness, depression, sudden drop in blood pressure, emotional see-sawing, a lowering of blood sugar level and liver and kidney function impairment.
However, a more recent study, which appeared in the 20 October 1994 edition of Nature, confirmed earlier reports that beta blockers may affect certain kinds of memory.
A team at the University of California at Irvine divided a healthy group of volunteers in half, giving half propranolol and the other half a placebo, an hour before they were shown slides which told two stories. Tests taken just before the stories were shown demonstrated that all the drug takers were fully beta-blocked.
The first story factually told in pictures of a child visiting his father’s workplace with his mother. The second, however, was designed to arouse strong emotions; on the way to the visit, the child was hit by a car and badly injured.
A week later, when all the subjects were given a surprise memory test, both groups had similar results when recording the first story. However, the propranolol group had significantly worse recall of the second, emotionally charged story.
Although the study only examined the effect of a single dose of beta blocker on healthy subjects, rather than heart or migraine patients, animal studies have demonstrated that memory of emotionally charged events requires activating the beta-adrenergic systems, which of course are blocked by beta-blocking drugs.
In the view of WDDTY panel member Dr John Mansfield, author of The Migraine Revolution (Thorsons, 1986), the first port of call for any migraine sufferer should be food allergy. A study conducted by Ellen Grant (The Lancet, 1979; i: 966-8) on adults demonstrated that 85 per cent migraine was due to food allergy. A similar double-blind trial in 1983 at Great Ormond St Hospital for Children showed that 93 per cent of the migraines in children were due to allergies (The Lancet,15 October 1983).
However, Dr Mansfield differs from other migraine specialists in which foods he considers the most common allergic triggers. His view, he says, is supported by the evidence that only 2 per cent of migraine patients get better after eliminating those trigger factors commonly thought to precipitate the disease (cheese, chocolate, citrus fruits, and red wine).
In his experience, the biggest culprit, by far, is wheat. Allergies to milk and other dairy products, corn, yeast, cane and beet sugar, oranges and potatoes are other common causes.
The reason people don’t usually recognize their allergy has to do with the phenomenon of “masking”. Patients often feel better when they eat what they’re allergic to; when they refrain from it, they undergo what amounts to withdrawal symptoms, which often trigger migraine.
Those people who do get better when eliminating the classically defined triggers do so because they don’t eat the foods every day and tend to notice when they feel better. With foods like wheat it’s more difficult to notice a reaction because it is being consumed all the time.
Besides food allergies, Dr Mansfield finds some patients have candida albicans infections. Nevertheless, he finds that some 80 per cent of his patients can get rid of migraines on elimination diets alone, locating and eliminating the offending foods.
When he is less successful, the patient tends to be allergic to many substances, including chemicals like paint, perfume and petrol. In these cases, desensitizing the patient may get them 95 per cent better, if not completely well.
Another common cause of migraine is the birth control Pill. In a study published in the Lancet in May 1979 (The Lancet, 1979; i: 581-2) Dr Grant found that if she took patients off the Pill, cigarettes and ergotamine tartrate (a major migraine drug derived from rye), a good percentage of patients got better. Nevertheless, these substances seemed only part of the problem.
For those patients who are allergic to a large number of substances and for whom a simple elimination diet is impossible, Dr Mansfield and many
others advocate enzyme potentiated desensitization (EPD), in which the right neutralizing doses of the offending substance are given by injection or orally is found and which “switches” off symptoms (see WDDTY vol 1 no 5).
Hyla Cass MD
Tom Ferguson MD