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One of Utah's foremost headache experts says most people who suffer from headaches can be helped, but for those who need medicine, "it takes a little manipulation of types and doses."

Dr. Robert M. Miska, a neurologist on the staff of LDS Hospital who also is in private practice, added that one thing doctors must be wary about is patients who complain about headaches so they can be prescribed drugs. A doctor should try to know patients over time, in order to prescribe the best course of action.During this Saturday's monthly session of the Deseret News/

Intermountain Health Care pro-gram, Health Care Hotline, Miska and his colleague, Dr. Denise Skuster, will be available to answer all sorts of questions about headaches. Skuster is a neurologist on the staff of the IHC Salt Lake Clinic and at LDS Hospital.

Chronic daily headaches are often what neurologists term "analgesic-rebound" headaches. Some underlying problem causes a headache and then a person uses analgesics - that is, pain-killers - usually, but not always, obtained over-the-counter.

"It helps a little for a short time, but then the headache comes back," Miska said. That's because the problem is actually compounded by the analgesic. Thinking it's helping, the sufferer takes more and more of the analgesic. Not only can the patient become addicted to painkillers, but the headache never completely leaves.

The answer, Miska believes, involves education. "One of the things that they have to do is to stop using the very medications" that seemed to give relief. Instead, the patient might require medication not aimed at relieving pain, plus specific therapy centered on the symptoms.

One of the worst headache problems is the vascular headache; that is, involving the blood vessels. These are migraines and such variants as cluster headaches.

"Migraine headaches are much more common than cluster" headaches, he said. Migraines can be on one or both sides of the head. Typically, they are "throbbing in character and often accompanied by nausea, sometimes vomiting, some-times visual blurring."

Some people with migraines have special neurological symptoms, such as becoming manic before the attack or developing a craving for special foods. "They want to eat a lot of pickles, and here comes the headache the next day," Miska said.

A prescription medication, sumatriptan, can stop migraines. "It's been available now in this country for about five years, and an oral form of it became available about two years ago."

Miska said an oral dose can stop the migraine, "but it seems to have a little bit slower onset of action." Also, it is not appropriate for people whose migraines make them sick to the stomach, because it won't be absorbed if thrown up.

"Estimates of the commonness (of migraines) vary a lot on who collects the data, going from 10 percent to 25 percent of the population." Miska thinks 25 percent is too high, but agrees that about one person in every 10 may get a migraine or one of its variants.

Cluster headaches usually strike men. "They tend to be seasonal in spring or autumn," he said.

A cluster headache, which is related to a migraine, is usually an intense pain, often severe, often behind one eye. In contrast to classic migraines, which cause people to wish to lie still, "the person with a cluster headache is rather activated and will pace back and forth," he said.

Some have been known to bang holes in the wall with their heads.

Migraines may be triggered by sensitivity to bright lights, certain food or drinks, or a fall in air pressure. The latter can happen "when the weather turns from nice to stormy," Miska said.

Other known causes include sleep depravation or even sleeping too much. Fasting can be a cause, as it causes a drop in blood sugar.

Another common trigger for classic migraines, but not for cluster headaches, is called "stress offset." It will happen when a person is under stress and then suddenly the stress is relieved.

"People often get their migraines on weekends or on vacations" because of stress offset, he said.

"For cluster headaches, the triggering factors are far less evident," Miska added. One of the triggers that is known to be involved is the change to fall or spring, and it seems to be related to one's internal clock. During that period, drinking alcohol may give a person a cluster headache when he wouldn't get it during the summer or winter.



Talk to the experts

Tormented by headaches? Here's your chance to talk to two of Utah's top experts.

Dr. Denise Skuster and Dr. Robert M. Miska, both neurologists, will answer questions from the public on migraines, cluster headaches, pain-killers and related subjects, Saturday during the monthly service Health Care Hotline.

The hotline is sponsored by the Deseret News and Intermountain Health Care. IHC is a nonprofit and charitable organization based in Salt Lake City.

Callers can reach the hotline toll-free from anywhere in the region, from 11 a.m. to 1 p.m. Saturday, by dialing 1-800-925-8177.