The Johns Hopkins Gazette: October 7, 2002
October 7, 2002
VOL. 32, NO. 6


Hopkins Docs Prescribe Brain TLC in Consumer Books

By Michael Purdy
Johns Hopkins Gazette Online Edition

Though neuroscientists may be known in the academic community for the specialized, highly technical writing they do for presentations and journals, some also have a talent for translating their knowledge of the brain into readable, useful consumer tomes. By coincidence, two Johns Hopkins faculty members have recently released general-audience books that have as their focus the care and maintenance of the brain.

Guy McKhann, a professor in the Zanvyl Krieger Mind/Brain Institute, collaborated with his wife, Harvard neurologist Marilyn Albert, to write Keep Your Brain Young: The Complete Guide to Physical and Emotional Health and Longevity; David Buchholz, an associate professor of neurology in the School of Medicine, is the author of Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain.

Guy McKhann, of the Zanvyl Krieger Mind/Brain Institute, gives advice on keeping the brain young. David Buchholz, of the School of Medicine, shares his expertise on how to heal headaches.

McKhann, formerly chairman of Neurology and director of the Mind/Brain Institute, says he and Albert were encouraged in their writing efforts by the Charles A. Dana Foundation, which is dedicated to promotion of brain research. The foundation's Dana Press co-published the book with John Wiley & Sons.

"We cover three kinds of things in the book," McKhann says. "One is, if you're doing pretty well in old age, how can you continue to function well? We also discuss things that can interfere with how people function when they get older but are not really life-threatening, like problems with vision and hearing. And in the last part we talk about the serious things that can go wrong, like Alzheimer's disease, Parkinson's disease or stroke."

McKhann notes that the latter part of the book covers areas of research in which he and his wife have been active for most of their professional lives. McKhann's research currently focuses on links between coronary bypass surgery and postsurgical cognitive and neurological problems. Albert studies aging's effects on memory.

McKhann says three of the key factors to keeping the brain healthy and well-functioning in old age appear to be physical activity, mental activity and a person's confidence in his or her ability to play a positive role.

Physical activity has been shown in animal experiments to promote nerve connections, increased blood supply and increased production of a protective compound known as nerve growth factor. McKhann and Albert recommend that a regular physical exercise routine be made a high priority beginning in middle age.

Mental activity can take a number of forms, among them mental exercising, a field that's been named "neurobics" and has become the subject of a number of recent guidebooks. "People who are mentally active are challenging their brain," says McKhann. "They're doing crossword puzzles, they're going to lectures, they're stimulating their brain."

McKhann suspects the final factor, a feeling of control over life and an ability to continue to make contributions, may be the most important.

"People like this don't see themselves as being on the shelf," he explains. "They see a positive role for themselves, whether it's in their family or within the framework of their community, at a church or in an organization where they volunteer. They're not just being passive and letting things wash their way."

McKhann hopes the book will be helpful to both the elderly and the generation caring for them. He thinks the younger group can benefit both in terms of the work they do now to take care of their parents and grandparents and in terms of taking care of their own brains in the long term.

Asked if this, his first general audience book, was a different experience than the usual writing he does for scientific papers, McKhann gives a hearty laugh.

"It's much harder than scientific writing," he says, chuckling. "Much harder."

Buchholz says the challenge in writing his book on headaches lay in condensing what he normally communicates to patients in a clinical setting into book form. "I had to accomplish in print with my readers what I do face to face with my patients: explain their headaches in a way that really makes sense and motivate them to do the right things to gain control," Buchholz explains.

Buchholz has overturned many conventional tenets of headache diagnosis and treatment to develop an innovative program of headache prevention. His work is centered on a key theory: that "nearly all headaches stem from the mechanism of migraine."

"When I began practicing neurology, I never intended to become a headache doctor. By realizing that virtually all headaches--including so-called sinus and tension headaches--are forms of migraine and by figuring out how migraine can be controlled in three simple steps, I've learned how to help headache sufferers regain control of their lives," Buchholz says.

Migraine produces painful swelling and inflammation of blood vessels in the head. Scientists suspect a center in the hypothalamus may trigger this process. When fully activated, it can lead to symptoms that include severe head pain, vomiting, visual problems, sensitivity to light and sound, dizziness and other symptoms. However, migraine is often just partially activated, resulting in "regular" headaches.

The first step in Buchholz's three-step program might be the most surprising for frequent headache sufferers: Reduce usage of painkillers. Buchholz argues that dependence on painkillers to deal with headaches after they develop is a strategy that leaves sufferers reacting to headaches and being victimized by them. In addition, painkillers offer only temporary relief at best and come with potentially significant health risks, according to Buchholz. It's even possible for painkillers to create a vicious cycle of ever-increasing headaches and drug use.

Buchholz urges his patients to take a more proactive approach that reduces the chance that a headache will occur through reduction of their exposure to factors that help trigger headaches. Such triggers include stress, barometric pressure changes, hormonal cycles and, most important, diet.

"If the sum of your triggers exceeds your individual threshold, the migraine process becomes activated and you'll have symptoms," Buchholz writes in the book.

Modification of diet is the crux of the second step of Buchholz's program: Reduce your triggers. Included in the book are descriptions of foods and drinks that may help trigger migraine, such as chocolate, caffeine, cheese and processed meats. Buchholz notes that these foods and many other potential food triggers frequently go unrecognized.

He emphasizes that headache sufferers don't necessarily have to give these foods up forever. Instead, they need to avoid them initially, bringing migraine under control, and then individually reintroduce them, paying close attention to the impact of each on headache frequency.

For those who continue to have headaches even after exposure to avoidable triggers is reduced, the third step is migraine-preventive medication, which is taken daily to raise the trigger threshold.

Also included in the book are sections on headache myths and misdiagnoses, headaches in children and a section with answers to frequently asked questions.

Heal Your Headache is published by Workman Publishing.