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The Keeler Migraine Method: A Groundbreaking, Individualized Treatment Program from theRenownedHeadache Clin ic
     

The Keeler Migraine Method: A Groundbreaking, Individualized Treatment Program from theRenownedHeadache Clin ic

by Robert Cowan
 

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A revolutionary and scientifically backed prevention and rescue treatment plan for migraine attacks.

More than 30 million people suffer from debilitating headaches. Yet our understanding of the science behind migraines is still in its in-fancy. At the Keeler Center for the Study of Headache, Dr. Robert Cowan and his team of specialists conduct some of

Overview

A revolutionary and scientifically backed prevention and rescue treatment plan for migraine attacks.

More than 30 million people suffer from debilitating headaches. Yet our understanding of the science behind migraines is still in its in-fancy. At the Keeler Center for the Study of Headache, Dr. Robert Cowan and his team of specialists conduct some of the most cutting-edge research in the field. Their treatment program, which combines the latest alternative and conventional therapy strategies, has helped thousands of sufferers manage their symptoms effectively and regain control of their lives.

As Dr. Cowan explains, each patient presents unique sets of triggers and pain patterns and requires a customized treatment approach. The Keeler method helps migraine sufferers identify their own headache triggers and then create an individualized formula for dramatically decreasing the frequency and severity of these attacks. It also illustrates how to design a foolproof, reliable ?rescue? plan when necessary, and offers surprising information, such as:

· Why elimination diets and ?foods to avoid? lists may not work
· Why frequently prescribed medications can actually make a headache worse
· Why many headache treatments stop working over Time

With a step-by-step program and expert advice throughout, The Keeler Migraine Method will be the most comprehensive guide to migraine management in the bookstore.

Product Details

ISBN-13:
9781440653964
Publisher:
Penguin Publishing Group
Publication date:
11/13/2008
Sold by:
Penguin Group
Format:
NOOK Book
Pages:
416
Sales rank:
792,717
File size:
3 MB
Age Range:
18 Years

Related Subjects

Read an Excerpt

Introduction

The Keeler Method forMigraine Management

She sat across the desk from me, her arms and legs crossed, wearingan expression I could describe only as hostile. For more thanthirty of her forty- four years, she had dealt with a long line ofdoctors for her headaches, and I was just the latest. So far, all I had donewas introduce myself, and already I was in trouble. It didn’t help that shelooked a lot like my fourth- grade teacher. For a second, I thought abouthaving her change into a gown in case she was packing a weapon. “Doyou have a headache today?” I asked her, instead. “I can turn down thelights if you like.”

She glared a moment longer, sizing me up. “I have a headache everyday. But yes, that would be very nice.” Her expression softened a bit. “Ihate the fluorescents.”

“Me too,” I commented as I flicked the switch, “especially when Ihave a migraine.”

She uncrossed her arms.

“You get headaches?”

Her resistance melted away as I explained to her, apparently for thefirst time, why fluorescent lights bother migraine sufferers, even whenwe don’t have a headache. I told her that certain shades of sunglasseswork better than others for light sensitivity, and mentioned that somerecent research in Japan suggests that specific preventives are better forpeople with severe light sensitivity. She and I were developing what wedoctors call a therapeutic relationship, meaning we were finding a commonground where we could work together on her headaches.


At least for the moment, she suspended the defenses that she’d developed during a lifetime of trying to convince doctors, coworkers,and even family members that her headaches are real, serious, andimportant. Over the next several months, we reworked some aspects ofher lifestyle, changed her medication strategy, and gently educated heremployer and her family. While she had suffered daily headaches andmissed an average of four workdays per month, we reduced that to oneweekly headache that she treated early and effectively with a differentrescue medication.

Her case is pretty typical of the results we see at the Keeler Center, butevery treatment plan we create is unique, custom fitted to each individualpatient. That, in a nutshell, is why the Keeler plan is so successful.When I tell patients that I, too, get headaches, it is not a ploy to gaintheir trust or sympathy (though this is often a beneficial consequence).I mention it as a simple reality. The fact is, I get migraines. Some daysI may have to cancel their appointments because I have a headache.

Migraines are just part of my world, and I have had some really bad ones.I know how they feel, how they can ruin too many days and can dominateyour life. Like most migraine sufferers, I have tried on occasion towork through a migraine and ended up making a mess of things. Duringmigraines, I have made bad decisions, missed major family events, gotteninto fights with my wife, been short with my kids, and even thrownup in my host’s bathroom once or twice. Twenty- five years ago, I evenconsidered dropping out of medical school because of my headaches. Ipractice what I preach and, now, I doubt that I miss more than one or twodays a year because of a headache. Today, for the most part, I know whatcauses my headaches, how to avoid them, and how to treat them whenavoidance doesn’t work. With the help of my patients, my research, andthe many scientists and clinicians with whom I work, I have gotten a lotbetter at managing my own migraines, and most of these incidents arejust painful memories. Now my headaches are a footnote rather than thefocus of my life. And while the plan you develop with the Keeler Methodwill likely be different from mine, it should do the same for you as it hasfor me.

A Migraine Cure?

I would love to have titled this book The Migraine Cure, but the realityis, we’re not there yet. Both patients and practitioners tend to look forand latch on to the notion of a cure, that one thing that will make it allgo away. That is why there is such a proliferation of books, articles, andwebsites claiming to offer “the cure”:

“Heal Your Headaches with Magnesium!”

“Magnets Cure Migraines!”

“Eat Away Your Headaches!”

“Pilates for Headache Health!”

The list is endless. Any one of these approaches may be perfect for agiven patient, but in twenty- five years of caring for headache patients (fiftyyears, counting caring for myself), I have studied— and tried— dozensupon dozens of miracle cures. But I still get headaches and, unfortunately,so will you. The reality is, there is still no cure. A cure would notstay a secret for long. If we had a one- size- fits- all solution to headaches,it wouldn’t be buried in a back- page ad in the National Enquirer, youwouldn’t need to search the Internet for it, and you wouldn’t hear it fromyour aunt in Omaha. Thirty million of us suffer from migraines, so a curewould be on the front page of The New York Times, Matt Lauer would betalking about it on the Today show, and the Internet would be lit up withreferences to major medical journals.

Brains are complicated, and so are the conditions that affect them. Ifevery headache sufferer had the same triggers, responded the same wayto every medication, and had readily predictable headaches, migrainemanagement would be easy. It isn’t. Still, I have yet to meet the headachesufferer who, with the help of the Keeler plan, does not experience asignificant improvement in quality of life, usually through a reductionin the number, severity, and duration of headaches. That’s why I wrotethis book— because all headache patients are unique, and so are their headaches. This book will help you identify your unique migraine characteristicsand teach you how to use this information to better manageyour headaches.

Procrustes, the son of Poseidon, invited weary travelers to restat his inn, and then broke their bones so that they would fit into abed too small for them. Many doctors have a very “Procrustean” approachto headache treatment. They generate lists of foods that give some peopleheadaches, asserting that avoiding those foods will prevent all headaches.They simply prescribe one drug after another, hoping one will work, andthey try the same therapies in the same order, on patient after patient.Sometimes these measures work, sometimes not, because, aside from thepain, my headaches are probably not exactly like yours. What works forme might not work for you, and vice versa.

Until very recently (about the last fifteen years), headache was the“poor relation” in neurology. Until the last ten years or so, we had nofellowship programs (special postresidency training) in headache and,even today, there are only a few programs. Indeed, through seven yearsof training in medical school and residency, headaches were covered in afew hours, with the emphasis on secondary headaches (those headachesthat are a symptom of something else, like brain tumors or rupturedblood vessels). Even today, federal funding for headache research is lessthan $15 million per year. Headache sufferers and their treating physiciansknow the frustration in treating a condition about which they knowlittle and for which there is minimal support, either from the medicalcommunity or from society at large. When the treating physician is also aheadache sufferer, this frustration is multiplied.

If migraine were like an infection, we could draw some blood, put itin a petri dish, see which infectious agent caused the problem, and pickthe right drug to knock it out. But migraine is not an infection. Migraineis a disorder of sensory processing. People with migraine often feel painafter stimuli that typically do not bother nonmigraineurs. Migrainesufferers have symptoms in common, starting with the pain (althoughsome forms of migraine do not have pain as a component). What triggersthe pain, however, varies from individual to individual. This is thefocus of clinical research. We endeavor to identify the unique features in migraineurs that will lend insight to the common underlying causes ofhead pain. For example, recent research suggests that people who experiencetheir headaches as “exploding” may have a different response tocertain treatments from the response of those whose headaches aredescribed as imploding. While this has yet to be verified, it is an excitingclinical observation that can teach us a great deal about the nature ofhead pain and its treatment.

Since all headache sufferers have their own unique triggers, theyeach need their own unique management plan to address those triggersas well as the pain and other symptoms that result. This means that oneof the biggest problems for migraine sufferers today is with our healthcare system. While the medical community is extraordinarily good atdealing with acute and life- threatening conditions (like major trauma,cancer, and pneumonia), it is not set up to treat chronic, episodic, progressivediseases— like asthma, depression, diabetes, obesity, heart disease,and migraine.

When a physician’s schedule only allots seven minutes to take a headachesufferer’s history, examine the patient, and design a treatment plan,it is impossible to provide ample customization to prevent and treat thatpatient’s migraines. But without that level of customization, the planis doomed from the outset. Instead, patients and their doctors performendless experiments with drug after drug, or get referrals to psychiatrists,neurologists, or pain specialists. The fortunate ones may find theirway to headache specialists, yet often even these superspecialists areoverworked and overwhelmed. In the end, patients often feel that theyhave not been heard, their questions have not been answered, and theyhave no plan. Still, they have a new prescription and a follow- up visit inthree months, when, one hopes, they will get some relief.

We shouldn’t blame the doctors, the emergency room staff, or anyoneelse who is honestly trying to help. Most of them weren’t trainedfor this and, almost always, these practitioners are doing the best theycan. Even so, the greatest challenge in implementing your treatmentplan can often be to enlist effective support from your doctor, your insurancecompany, your benefits counselor, and everyone else involved inyour health care.

The Keeler Center for the Study of Migraine

When I was the chief of the Headache and Facial Pain Section at theUniversity of Southern California (USC), I learned a great deal abouthow to improve care for headache sufferers. I also began to understandwhat would be required to care for headache sufferers effectively. I cameto envision the perfect headache clinic, a facility that offered both traditionaland alternative treatment modalities. It would have a closeaffiliation with a cutting- edge research institution committed to applyingstate- of- the- art scientific investigation to the problems of headachepathophysiology and treatment. This clinic would be free of economicconstraints, so any headache sufferer who needed help could get access,regardless of their ability to pay for it. And I wanted it all housed in afriendly environment with skilled nurse practitioners, physical therapists,psychologists, biofeedback technicians, yoga instructors, nutritionists,and patient educators— all working with patients to improve theirlives, given the reality that, at least for the present, headaches are a partof life. My years trying to care for and understand headaches in a traditionalmedical environment convinced me that such a model was theonly option. At the time, it was all a fantasy, unless I won the lottery.Since I didn’t play the lottery, this seemed unlikely.

With the dawn of a new millennium, the fates conspired to makemy fantasy a reality. First, I met Michael Harrington, M.D., Ch.B., FRCP,formerly of the National Institutes of Health (NIH) and the CaliforniaInstitute of Technology (Caltech), and presently director of the molecularneurology program at the prestigious Huntington Medical ResearchInstitutes (HMRI) in Pasadena, California. Dr. Harrington came to presentgrand rounds at USC, and offered the most innovative approach tothe study of a variety of neurological disorders that I had ever encountered.Unfortunately, migraine was not on his radar. But after his lecture, wetalked. And talked and talked. Before long, we wrote a proposal for NIHfunding. We received the funding and began to research migraines.

The next bit of good fortune came from the family of the late FredKeeler, a very successful businessman and philanthropist in Ojai, California. When Mr. Keeler passed away, his family wanted to honor hismemory by continuing his good works in the community. The familygenerously funded the Keeler Migraine Center in Ojai. Essentially, theygave me carte blanche— and the resources— to create a state- of- the- artclinical facility as well as the advice and expertise of a remarkable assemblyof people to guide the fiscal, administrative, and creative efforts thatwould guarantee the clinic’s success.

Located just inland from Santa Barbara, California, the KeelerMigraine Center treats patients suffering from some of the most difficultand severe headaches in the world. One of the most renowned clinics inthe country, the center is a refuge for headache sufferers. It is quiet, thecolors are soothing, the pace is calm. As medical director, I work witha team of specialists, the best minds with the most powerful treatmentoptions and newest resources, to practice at the cutting edge of migrainemanagement. Closely affiliated with Dr. Harrington and HMRI’s molecularneurology program, we focus our efforts on helping patients overcometheir migraines. At the Keeler Center, we study new and innovativeapproaches, and integrate the latest science with treatments dating backthousands of years and crossing many cultures, so we can offer every scientifically proven tool— including traditional and alternative modalities—to treat chronic headaches.

Comprising physicians, scientists, and many others, the Keeler teamintegrates the latest research discoveries and cutting- edge science intoour treatment plans. Not only do we have our own laboratories investigatingthe biology and chemistry of migraines, but we also activelyincorporate discoveries from other researchers into our treatmentstrategies.

Making the Study of Headache a Priority

Today, we know a great deal about why we get headaches, how to preventthem, and how to take care of them when they break through ourdefenses. We know that migraine is a genetic disease with a clear (ifincompletely understood) biological basis. We know that migraine is a chronic condition, which does not mean that patients always have aheadache, but that they are always susceptible to getting one, just as anasthmatic is always susceptible to an asthma attack. We also have a muchbetter understanding of what triggers, worsens, and alleviates headaches.We even have medicines that are not simply generic painkillers, but thatwork specifically for migraines.

There is still a lot we don’t know. We don’t know if migraines start inthe cortex (the “thinking” part of the brain) or if they start in the brainstem, where “unconscious” processing takes place. We don’t know if peoplewho have an aura or warning before their migraines have a differentcondition from those of us whose headaches come on without warning.We don’t know why chocolate triggers headaches in one patient but not inthe next. Nor do we know if having migraines places you at increased riskfor other medical conditions, particularly neurological ones. Migraine isa very complicated puzzle. But it is one that is coming together quickly.

Since the 1940s, the scientific underpinnings of migraine had notchanged much, until the introduction of the triptans. With the introductionof sumatriptan in 1993 and the ensuing infusion of money fromdrug companies, an explosion in research funding and clinical fellowshipsin studying headache followed, and as a result, our understandingof and ability to care for migraine changed dramatically.

Today, we have an awareness of the basic pathophysiology of migrainesthat simply did not exist as recently as 2007. Drugs now in developmentcould revolutionize our current rescue and prevention strategies.We are learning about the microenvironment of the brain and its interactionswith the outside world and the rest of the body. Even our understandingof migraine pain has become much more sophisticated. Wenow know that headache pain proceeds in several distinct phases, eachof which can (and should) be addressed differently. Pain begins peripherallyin the nerves that mediate sensation in the head, and then proceedsinto the central nervous system where, if left unchecked, it eventuallybecomes a vicious cycle of inflammation. We have a better understandingof how to recognize where in this pain cycle a patient is at any givenmoment, and how best to treat the pain.

Despite the recent explosion of information, the science of migraineis still in its infancy. The Keeler Center works closely with the HMRImolecular neurology lab to understand the basic science of migraine byexamining the spinal fluid of headache sufferers. Through a combinationof private and federal funding (from the National Institutes of Health),our laboratory, under the direction of my colleague Dr. Harrington, useschromatography and other sophisticated technologies to study the spinalfluid of hundreds of volunteers. Eventually, this research will yieldinformation about diet, medication, and genetics that will dramaticallyimprove the lives of those suffering from debilitating migraines.

Our approach to research is a little like that of a private detective whogoes through a subject’s garbage looking for clues. In our case, the subjectis migraines, and the garbage is the spinal fluid, which carries theproducts of brain metabolism (its garbage, so to speak) off to the veinsand eventually to the kidneys for excretion in the urine. Since spinalfluid can be obtained only through an invasive spinal tap, we hope eventuallyto access this information from more obtainable fluids such asblood, urine, saliva, and even tears. We are interested in understandingthe basic biology of headache; developing an easy test to determine ifa given headache is a migraine (for which certain medications will beeffective); learning the effect of dietary alterations, such as changing theratio of omega- 3 fatty acids to omega- 6 fatty acids; and developing noveldrugs that work at specific sites in the brain to prevent or stop a migraine.We already have promising data in each of these areas.

Our laboratory research has already helped our patients at the KeelerCenter in many ways. Many of our treatment protocols, dietary recommendations,and lifestyle modifications are based on research from ourlaboratories and the research of the laboratories of our colleagues acrossthe country and around the world.

For example, recent work has shown that migraine has two stages andthat triptans are effective primarily in the first stage but considerably lessso in the second. A phenomenon called cutaneous allodynia helps usidentify when the first stage is ending and the second stage beginning.Basically, cutaneous allodynia refers to that time in a headache when theskin and skin appendages, such as hair and teeth, become very sensitive,even painful to the touch. For most migraineurs, this occurs between' thirty minutes and two hours into a headache and can last for hours,often beyond the end of the pain phase of the headache. In terms of treatment,this is very helpful information because it

  • explains why triptans are often not effective if taken late in aheadache;
  • gives valuable guidance as to when to take a triptan;
  • indicates when it is too late and probably useless to take a triptan,


  • which is expensive medication.

    Another example of recent scientific progress influencing migrainetreatment comes from our own laboratory, where we identified a particularprostaglandin found in high concentration in the spinal fluid ofmigraineurs compared to nonmigraineurs. This prostaglandin is associatedwith sleep. This lends insight into the healing magic of sleep formigraineurs, and also gives us a tool for managing migraines through themedical manipulation of the prostaglandin pathway. We are also studyingdietary manipulations.

    By closely following the scientific literature and meeting with thescientists and clinicians in the group on a regular basis, we continuallyupgrade and modify our treatment strategies as our understanding ofheadaches continues to evolve.

    The Keeler Method forMigraine Management

    Most of us have ideas about how to take care of our headaches. Mostpatients try to avoid situations they think might cause a headache, andsometimes go to the emergency room when things get really bad. For themost part, these are partial solutions or desperate measures. They do notconstitute a plan. But thirty million Americans suffer from headaches.They can’t all come to Ojai— nor do they need to.

    This book outlines my general principles as well as specific steps youcan take to develop your own unique treatment plan, your own strategyto guide you away from a life dominated by headaches. This is the KeelerMigraine Method, the culmination of more than twenty years of caringfor people with headaches, myself and thousands of others.The Keeler Migraine Method is different. The Keeler Method offerseach patient a customized, personalized, workable plan for managingtheir headaches. This approach works much better than trial- and- errormedications, chiropractic adjustments, purges, purgatives, electroshock,or any other treatment out there. We combine many tiny adjustmentsand interventions that, when taken together, dramatically reduce thenumber of headaches you get as well as the severity of the pain and othersymptoms when headaches do occur. The Keeler Method provides aphilosophy of migraine management to help patients understandtheir headaches and use that understanding to create an antimigraineenvironment.

    Most headache sufferers can control their headaches with some education,a few simple self- assessment tests, and the help of a good and willingphysician. This book will help you understand the source of yourheadaches, show you how to isolate your specific triggers, and give youpointers on how to communicate effectively with your doctor. Here,you will learn the most current strategies for treating migraines, fromthe newest scientific discoveries to tried- and- true clinical medicine andalternative therapies, too. This book describes every aspect of the treatmentplans we use to successfully treat our patients at the Keeler Center.Every migraineur (a person whose headache meets the criteria for beingmigraine) presents unique sets of triggers and pain patterns. That’s whythe Keeler program does not include lists of forbidden foods, rigid diets, orblanket edicts about things you must avoid. The reality is that triggers differfrom person to person, and anything can be a trigger. Triggers can be:
    • dietary
    • hormonal
    • psychological
    • environmental
    • chronobiologic ( sleep- related)
    • psychosocial
    • medicinal ( medication- related)
    • medical (due to other health conditions)


  • In Chapter 3, I explain much more about the vast array of triggers thatcan cause migraines. However, some generalizations do seem to apply tomany migraine sufferers. From these observations, we have developed aphilosophy that guides our treatment strategies:

    When we understand the individual migraine sufferer’s uniquetriggers, we can influence disruptions to the lifestyle patterns associatedwith each trigger and gain control of the headaches.

    Migraineurs do not do well with chaos. Put another way, migrainesthrive on change. All individuals have a unique set of responses to disruptionsto their environment, and migraines can be one of these responses.So each migraineur has specific lifestyle elements to which that personis especially sensitive, and changes in these areas of life are more likely totrigger that individual’s migraines. The key, then, to effective migrainemanagement is for individual migraineurs to understand their personalsensitivities and to create strategies to minimize disruption of those patterns.Whether we are talking about sleep schedules or meal timing oran exercise routine, we encourage patterned behavior whenever possibleand, when a change is unavoidable (such as plane travel, a big party,or tax season), we try to anticipate that disruption and take extra headacheprecautions. This philosophy is at the heart of the Keeler MigraineMethod and this book.

    It’s not a magic formula. But when you understand the importanceof careful observation, keeping a routine, and clever planning (facilitatedby the self- assessment tools in this book), you can understand your headachesand create your own formula for controlling them. For example,Jeri is a twenty- year- old college junior who has had headaches since herearly teens. For the most part, they were Tylenol headaches, meaningshe could knock them out with a couple of Tylenol. Over the last coupleof years, her headaches became more of a problem and were now affectingher academic and social life. We had her keep a headache diary for one month. When she came back to the clinic, she said that her headacheswere no longer a problem. Just from her own observation, she realizedthat her headaches were linked to her erratic sleep pattern, caffeineconsumption, and inconsistent exercise. With a little organization andawareness, she was back on track.

    While we have yet to cure our first migraine, my patients will tell youthat their headaches have never been better, that they are less frequent,less severe, and of shorter duration. More important, their lives havenever been better. They miss fewer workdays. They attend more familyevents. They can exercise, go out to dinner, and maybe even have a drinkor two. They have regained control of their lives. While they still getmigraines, headaches are no longer the focus of their lives. They are afootnote. So while some patients (such as those who suffer from chronicdaily headaches) should see a headache specialist, and every headachesufferer should be under the care of a physician, every migraine sufferercan significantly improve their life by following the Keeler MigraineMethod.

    Constructing Your KeelerMigraine Method Treatment Plan

    Every migraine patient is unique, and so is every treatment plan, but allof our treatment strategies have three parts: lifestyle modification, prevention,and rescue. Many new patients tell me that “nothing works,” or“only one thing works.” But nearly always, these migraineurs have notexperienced such a comprehensive treatment program.The Antimigraine Lifestyle

    Generally, migraineurs need a healthy rhythm in their lives. But creatinga healthy rhythm is the last thing we want to think about after a headache.People do not want to think about their headaches when they are withoutheadaches. We are far more interested in getting on with our lives andmaking up for the time we have lost to headaches. We frantically takeadvantage of these good days, rushing about, making up for lost time,and avoiding anything that might break the delicate, pain- free balance.And when we do have a headache, we just want to lie down, never minddeveloping a migraine prevention strategy. Between these two states, thatpretty much covers all the time there is, and doesn’t leave any opportunityfor planning. As a result, we live in a constant cycle of headache,catch- up, tiptoe, trigger.

    It is clear that migraineurs do better when their lives are more patterned,but often the nature of the headache sufferer’s life resists patterning. Thisis the challenge. How do we break the cycle and create a fresh behaviorpattern?

    The Keeler Method starts with our most basic patterns: sleeping, eating,and physical activity. For most migraineurs, keeping regular hours,eating regular meals, and exercising regularly can work wonders withtheir headaches. So we want to work toward living an antimigraine lifestyle.This alone can often solve a multitude of problems— migrainerelatedand otherwise.

    While the antimigraine lifestyle thrives on patterns, it does not needto be boring. Too many migraineurs avoid special events, parties, travel,and other pleasures for fear of getting a headache. But with creativeanticipation and strategic planning, you can effectively manage mostsituations and stop letting headaches decide how and where you spendyour time.

    Lifestyle modification is the process of analyzing your behaviors,activities, relationships— everything— in order to identify those componentsthat may contribute to your headaches. Once we identify them, wecan figure out how to modify lifestyle such that the quality remains butthe headaches diminish. This is a decision- making process. It involves:
    • eliminating those activities that serve no positive purpose;
    • avoiding those that can be avoided without significant loss;
    • modifying those that are important enough to hold on to.

      While these decisions and the changes they require can be the mostdifficult part of putting a migraine treatment plan into action, over thelong run, lifestyle modification has the biggest impact on headache frequency,severity, and duration. And the payback is a vastly improved qualityof life.

      Lifestyle modification means understanding your headaches and howthey affect you, and then using that information to make decisions abouthaving wine with dinner, or going to the gym, or just scheduling yourday. This knowledge won’t limit you, it will empower you.

      An Ounce of Prevention

      Not every headache sufferer needs a daily preventive medication, butfor some migraineurs, prevention is mandatory. For most headachesufferers, though, my rule of thumb is that the patient should be on apreventive if headaches substantially interfere with life. This would bea simple rule, yet surprisingly, migraineurs often do not realize howmuch headaches interfere with their lives. Without a diary or an observantcompanion, we migraineurs tend to woefully underestimate boththe frequency and severity of our headaches and, between headaches,most of us feel quite normal. Though there may be compelling evidencethat we are not perfectly normal, we perceive that we only need medicalattention when we have a headache, so we need to learn from the peoplearound us the extent to which headaches interfere with our lives. Forexample, you may feel that, because you get only one or two headachesper month, your life is relatively unaffected, but your spouse may pointout that, for fear of getting a headache, you avoided eight social eventsand three of your kid’s soccer games, and you did not go to the gym lastmonth. Thus, your family, friends, and even coworkers can help you gainfurther insight into how your headaches truly affect you and those youcare about.

      There are a few other important points to keep in mind about prevention.When we talk about prevention, usually we are referring topreventive medications, but nonmedication preventives are also important.Prevention includes many options, from daily prescription medicationsto nutraceuticals and herbs to lifestyle modifications such as diet,yoga, massage, exercise, biofeedback, and a variety of modalities. These choices are based on personal preference, lifestyle, side effects, othermedical concerns, and, most important, what works.To the Rescue

      When most of us think of headache treatment, we tend to think of solutionsto get us out of pain. In migraine management, we call this “rescue.”Whether the rescue consists of finding a cool, dark place where we cancurl up, the strongest painkiller in the cabinet, or the closest emergencyroom, we just want rescue from the pain when it is bad. While the KeelerMethod teaches us how to prevent, avoid, and modify, we are migrainesufferers, and we are going to get headaches. So rescue is a big part of theplan, and it will remain so until a cure is found.

      In the Keeler Method, our rescue goals follow two principles:
      • Safety— Never use a rescue that can have bad consequencesdown the road.
      • Preparedness— Be armed with backup alternatives in case thefirst rescue doesn’t provide enough relief.


    • As a result, Keeler management plans involve designing medicationstrategies that will rescue you from the pain, and “layering” these strategiesso that you know what to do when plan A doesn’t work.Flexible and adaptable to your unique headache patterns, the KeelerMigraine Method incorporates the latest scientific research with a systematictreatment approach. It integrates traditional with alternative strategiesand proven methods with cutting- edge treatment into one plan. Now youcan learn more about these techniques and apply them to your headaches.In the next chapters, I lead you step by step through the Keeler Methodand help you develop your own personalized plan to regain control ofyour headaches— and your life.
  • Meet the Author

    Robert Cowan, M.D., is the founding director of the Keeler Migraine Center in Ojai, California, and a senior clinical scientist at the Huntington Medical Research Institutes. He lectures on headache management across the country and is a regular speaker at American Academy of Neurology annual meetings. As a migraine sufferer himself, Dr. Cowan brings a unique perspective to the research and treatment of headaches. He lives in Channel Islands Harbor, California.

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