University Times

Chocoholics take heart. A study being conducted by the headache clinic of the University of Pittsburgh Medical Center's Pain Evaluation and Treatment Institute has not turned up any evidence that chocolate is a trigger for migraine or tension headaches in most people.

Headed by research specialist Lisa Scharff, a clinical psychologist, the study is one of four headache studies currently underway at the clinic. All of the studies focus on women and include, along with chocolate, one study on the treatment of migraines, and two on pregnancy and headaches.

"My recommendation is not to automatically associate chocolate with migraines," said Scharff. "People should sort of experiment with chocolate to see if it actually triggers their headaches. But for the most part, at this point, it looks like most people can eat chocolate without getting a migraine." The idea for the chocolate study originated with a questionnaire in which 20-30 percent of the respondents reported chocolate as a "strong and consistent trigger" both for migraine and common tension headaches.

According to Scharff, respondents to the questionnaire who concluded that chocolate was the trigger for their headaches did so based on personal experience or after hearing about other people getting headaches from chocolate.

"However, often what people will find, especially with food headaches, is that there is a lack of consistency," Scharff said. "Sometimes a food will trigger a headache and sometimes it won't. Usually, what is found is that you need more than just one headache trigger. You need to have a really stressful day, go home, eat chocolate, and then you get a headache." For women, who are far more prone to migraines than men, Scharff said, their most predictable or worst headaches occur just before the onset of their menstrual periods, which also is a common time when women crave chocolate. "So, the two together often indicate a really severe headache," she noted.

People who reported that chocolate gave them headaches generally thought that the caffeine in the candy was the trigger. But Scharff said chocolate contains a natural amphetamine called phenylethylamine that "is the chemical we really think is the trigger for headaches from chocolate." In addition to looking at chocolate as a trigger for headaches, the study also is seeking to determine how many people actually have their headaches triggered by the candy and if chocolate is as much of a trigger for migraines as for tension headaches.

The headache clinic's migraine treatment study is designed to investigate the muscular/skeletal components in migraine headaches. According to Scharff, relaxation and biofeedback training work very well for about 60 percent of migraine suffers. The aim of the migraine study is to determine if the other 40 percent of people on whom relaxation/biofeedback techniques do not work well can be helped by physical therapy techniques.

What the study has revealed so far is that a little over 50 percent of the people who try physical therapy techniques experience a significant reduction in the number of their migraine headaches "That shows that physical therapy is a very useful addition to relaxation/biofeedback," Scharff said. "However, the physical therapy in and of itself did not work very well at all. Only about 30 percent of the people who went through that treatment experienced significant relief, which is just slightly more than what could be expected by giving people a placebo." The two pregnancy and headache studies being conducted by the clinic were undertaken because various other studies have shown that some women, possibly because of a change in estrogen levels, experience severe headaches during pregnancy.

But even though pregnant women are extremely limited in medication options for headaches, she said, the effectiveness of non-medical treatments has not been examined.

An earlier study conducted by the clinic showed that a combination of physical therapy/relaxation and biofeedback treatment is effective for treating headaches during pregnancy. The current study is examining the possibility of using more cost- effective biofeedback alone to treat the headaches of pregnant women.

Since women in the first pregnancy and headache study could have gotten better anyway once their pregnancy progressed and their estrogen levels changed, the clinic has begun a longitudinal study that follows women throughout their pregnancies.

"We want to see if women who have headaches early on in their pregnancies continue to have headaches throughout their pregnancies," said Scharff.

Preliminary results indicate that the headaches of about 40 percent of the women in the study improved as their pregnancies progressed. The same results were found for up to three months after the women gave birth. Women were selected as subjects for the clinic's current studies because they represent the largest proportion of migraine patients, they are much more likely than men to report chocolate as a trigger and hormones are a major influence in their headaches. One of the major thrusts of the clinic is to investigate the influence of hormones on headaches. –Mike Sajna The headache clinic is still looking for women to take part in some of its studies. For more information, call Lisa Gourley at 578-3100.