The Keeler Migraine Method: A Groundbreaking, Individualized Treatment Program from the Renowned Headache Clinic - Softcover

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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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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...