health & wellness

Mastering Migraines

Specialists help patients find treatments that work.

Ruthan Brodsky

Special to the Jewish News

M

ost of us have some kind of
over-the-counter pain reliever
on hand to stave off the occa-
sional headache, but some of us regularly
suffer headaches that require medical
attention.
In fact, according to a 2013 abstract
from the American Headache Society, the
results of an ongoing study by four U.S.
public health groups showed that between
16-23 percent of adults 18 or older report-
ed having migraine or other severe head-
aches in the last three months.
Enter Dr. Joel Saper,
an Ann Arbor neurolo-
gist, who is an expert on
headaches and pain.
Founder and director of
the Michigan Head-Pain
& Neurological Institute
(MHNI), he was pre-
Dr. Joel Saper sented with the Lifetime
Achievement Award in
July by the American Headache Society at
the International Headache Society meet-
ing in Boston. The award honors Saper's
work for nearly 45 years in research, medi-
cal education and treatment for patients
with head and neck pain.
Saper, together with U.S. Rep. Mike
Rogers (R-Lansing), wrote the initial draft
of what became the National Pain Care
Policy Law that passed in 2010. Many
provisions of the law are included in
the Health Care Reform Bill to promote
improved pain care, such as enhancing
the pain research agenda for the National
Institutes of Health (NIH).
Early in his career as a neurologist,
Saper was assistant professor of neurology
at University of Michigan.
"I learned much during those years, and
wrote my first book about headaches while
at the university:' he says. At the same
time, I became convinced that a more
comprehensive approach to the treatment
of headaches was necessary. My in-laws at
the time, Holocaust survivors, inspired me

to build my own center and practice treat-
ing patients the way I thought best"
In 1978, Saper developed the MHNI,
the nation's first comprehensive head pain
treatment program. That year, he also
launched the first hospital specialty unit
to treat the most severe head pain patients
at Chelsea Community Hospital. MHNI
gradually gained a world-class reputation
as patients from the U.S. and a growing
number of countries sought treatment at
MHNI.
"We use multidisciplinary teams of
specially trained physicians, including
specialists in neurology, internal medicine
and anesthesiology as well as physical
therapists, Ph.D. psychologists, physician
assistants, registered nurses and medical
technicians to help patients:' says Saper,
currently a clinical professor of neurology
at Michigan State University.
"I've been Dr. Saper's patient for close to
40 years for headache pain:' says Suzanne
Tyner of Bloomfield Hills. "The other doc-
tors I had gone to said there was nothing
wrong with me and it must be mental.
In the meantime, there were days when
I literally couldn't function. Dr. Saper
explained that there were many different
reasons for headaches and every individu-
al is different, which means treatments for
individuals are also different"
Saper explains, "More women suffer
from headache pain than men and, not
that long ago, women with headaches were
automatically labeled as neurotic. For the
last 40 years, we've learned differently,
recognizing that a headache is often a
brain-biological disturbance intensified in
women by the adverse influence of estro-
gen."
Patients at the MHNI include those
who suffer from head pain, closed head
injuries, face and neck pain, and related
disorders.
"A current patient is an Iraqi War veter-
an involved in bomb blasts, while another
is an adolescent unable to attend school
because of headaches:' Saper says. "We
also treat a middle-aged man who lost his
business because of headaches and a pro-

fessional athlete who can't return to sports
because of headaches following an injury."
The MHNI campus includes 20 clinical
examination rooms, acute care accommo-
dations, procedure rooms for infusion and
interventional treatment, physical therapy,
laboratory, behavioral medicine and neu-
rodiagnostic facilities. Staffing has been
as high as 80.
An outpatient infusion program, gener-
ally requiring three or four days of con-
secutive treatment, provides administered
multiple medications for patients whose
headaches aren't generally controlled by
standard oral treatment.
"Triggers for headaches vary with
patients:' Saper says. "For some, it could
develop from a certain food, for others
the way they slept, not getting enough
sleep or getting too much sleep or from a
medication. Most people experience head-
aches from internal brain disturbances or
from excessive medication. We do not use
narcotics in our treatment because, when
taken regularly, they worsen the problem
due to brain changes. Today, there is no
universal cure and no easy generalization
to be made to prevent headaches.
"Fortunately, however, today we have a
better understanding of the physiology of
the brain and the complex mechanisms
of headache and other painful disorders:'
Saper says. "The role of neurotransmit-
ters and activating brain substances,
inflammation mechanisms and other
brain disturbances are being researched
aggressively. A newer concept for treat-
ment involves brain and nerve stimula-
tion, deep injections and some surgical
procedures."
Saper emphasized the need to pur-
sue all diagnostics. One young man, for
example, who suffered with headaches for
many years, was found to have a treatable
brain tumor.
"We are committed to learning more
about headaches and pain and are cur-
rently working on more than 25 clinical
research projects:' Saper says. "Exciting
new treatments, medications and other
methods are just around the corner:'

Migraine headache alone costs the United
States more than $20 billion each year,
according to the American Migraine
Foundation. These are attributed to direct
medical expenses (doctor visits, medica-
tions) and indirect expenses (missed
work, lost productivity).
"Migraines are more than just a head-
ache; they're a neurological disorder:'
says Dr. Rhonna Shatz, a neurologist at
Henry Ford Hospital, West Bloomfield.
"We now know there is a diverse set of
genetic influences that contributes to
migraines. However, we don't know yet
what these genes are.
"The good news
is that there are new
treatments related to a
mutated gene, MTHFR
(methylenetetrahydro-
folate reductase), which
is associated with an
increased risk in indi-
viduals
carrying these
Dr. Rhonna
mutations
for migraine
Shatz
with aura, stroke, heart
attack and dementia; she says.
"We all have this gene that plays a role
in processing amino acids, the building
blocks of proteins. Vitamin B supplements
may help reduce migraine in some of the
mutations but not in others. Migraine
with aura is the type of migraine associ-
ated with loss of vision or flashing lights,
numbness of the hand and face, confusion,
trouble talking as well as a headache dur-
ing a migraine episode:'
Saper points out that 80 percent of
patients with recurring migraine head-
aches have a family member who also suf-
fers from headaches.
"Just as in other illnesses that were once
thought to be psychological, migraine
headaches are caused by biochemical
abnormalities in the brain:' Shatz says.
"Hereditary factors often play a major role
in the physiological vulnerability."
Dr. Esther Young, a
neurologist at Beaumont
Hospital, Royal Oak,
says, "Treatment of
headaches has changed
during the last decade.
Now treatments are
trending to prevent
headaches so that
Dr. Esther
patients aren't taking too
Young
much over-the-counter
medications. We do this by figuring out
the headache trigger, although some peo-
ple have more than one trigger. Treatment
includes avoiding those triggers, whether
it is muscle tension or a bright light.
"The point is people don't have to live
with headaches:' Young says. "There are
good treatments and the sooner a person
gets engaged with the treatment the soon-
er they'll find relief."

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September 26 • 2013

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