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Migraine: Many Things to Many Patients

Tim Kirn
JAMA. 1987;257(1):12-13. doi:10.1001/jama.1987.03390010014003.
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KENNETH PETERS, MD, tells his patients that migraine is like a reservoir. When water spills over the dam, you get a headache.

Peters, who is medical director of the Northern California Headache Clinic, Mountain View, compares the "contributing factors" that can trigger a headache, such as alcohol, food items or stress, with tributary rivers and streams above the reservoir. For some people, he says, stress is "a major river" that is very likely to cause a migraine; while chocolate, for example, is only "a minor stream," and therefore unlikely to have much effect on their headaches.

For others, stress is only a relatively innocuous, bubbling brook while alcohol is equivalent to a flash flood. The task for physician and patient is to find out which are the rivers and which are the streams, Peter says.

In a separate conversation, Donald Dalessio, MD, chair of the Department of Medicine at the


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