Escrima - The Filipino Martial Art
3 September 2008
Escrima is a popular Filipino martial art dating back to the 1500s, during the colonization of the Philippine Islands by the Spanish. Escrima is a very simplified but practical form of combat technique originally designed as a self-defense tool. Escrima is also known by many other names such as Eskrima, Arnis, Arnis de Mano, Kali and FMA (Filipino Martial Art). Because of its effectiveness, Escrima is also taught extensively in many Special Forces including the Navy Seals and Army Special Forces.
Brief History:
Many believe that Escrima or Filipino Martial Art originated from Chinese influenced Indonesian fighting tactics such as Kun Tao, Chuan Fa and Tai Chi double stick forms. Others believe the Escrima art form to be wholly developed by the Filipino people. However, the most plausible explanation seems to be rooted in the history of the Spanish colonization.
When the Spanish occupied the Philippine Islands, a form of art similar to Escrima had already existed but was only recreational. However, this art began to develop into a more martial discipline when the Spanish prohibited indigenous Filipino weapons such as the Bolo (machete), daggers and fighting sticks in the 1700s. It remained a clandestine art until the Americans took over in 1898. From then on, the Filipino Martial Art started to gain recognition and popularity.
In the West, Escrima was introduced and popularized by Filipino immigrants after the Second World War, particularly in the American states of Hawaii and California.
Weapons and Footwork in Escrima:
Unlike other forms of martial arts, the primary tool to learn the basic concepts of Escrima is focus on weaponry, which is followed by empty-hand techniques. The Rattan stick is the most common weapon used in Escrima training, which includes hand and head protection when sparring. Other weapons include burned and hardened stick made of hardwood, such as Molave or Kamagong (ebony). Modern versions may be made out of aluminum, other metals, or high-impact plastics. The Nunchaku (also known as Kung Fu sticks or Double sticks) weapon was popularized by actor Bruce Lee, an avid practitioner of Escrima.
Each range - the distance between opponents - in Escrima has its own characteristics and footwork techniques. Good footwork enables efficient control of these ranges. The footwork is demonstrated in terms of triangles with two feet occupying two corners of the triangle and the step to the third corner. The shape and size of the triangle is dependant on the particular situation.
Escrima Facts:
1. Escrima is mixture of hard (like Karate) and soft (like Tai Chi Ch’uan) styles.
2. Escrima is taught on ideal street-fighting settings without the need for uniforms.
3. Restraining techniques are not focused on but rather on offensive, combat styles.
4. There are no official rankings in Escrima except for titles to recognize seniority of instructors.
5. Most of the power in Escrima is derived from body movement and economy of motion, rather than strength.
6. Escrima is a complete martial art, focusing on weaponry and empty-hand techniques.
7. Escrima provides effective training in sparring against multiple opponents.
Martial Arts HQ martialarts-hq.com/ offers articles, tips and tricks about different martial arts.
The Big Pete Vibrating Dildo from Flex
1 September 2008
The Big Pete moulded out of easy to rinse resin, to be certain it is very safe to enjoy. The Big Pete has marvelously sculpted ticklers at the base, which are sure to help lift your out of hours fun to another place entirely. The Big Pete has a free additional vibrator package, making this a sex toy of the highest quality. This can be ordered in plenty of colours, lengths and widths. The flexible construction of the Big Pete allows for penetration at angles that are rarely achieved during sexual intercourse, making it possible to explore new and stimulating found enjoyment and previously un found erogenous parts of your body.
Over the last five years the Big Pete has remained amongst the top selling dildos for Flex. It’s popularity is based on it’s versatility and low price. This aid would make a great addition to any ones collection. The Big Pete is the perfect choice for stimulation of any of the female erogenous zones. This sex toy would be a great first sex aid for anyone who does not yet possess a sex toy. The great glass dildo for quiet nights alone alone. Men of both orientations also have fun times with the Big Pete.
The manufacturer responsible for the Big Pete, Flex are in fact the oldest and most respected names in the production and distribution of sex toys. They are producers of a huge selection of alternative premium sex toys for example the Soft Touch Penis and the renowned Sensual Shapeshifter. Flex are known to be price competitive, so you can be confident of the fact you are not likely to see a better offer offered by a competitor.
Are You Combat Fit?
31 August 2008
If you are looking to compete in submission grappling then one of the main factors to consider and improve is fitness. This, in and of itself, is a vast subject.
Now, when I first began to compete, my supplementary training was primarily weight training and long slow distance running. In terms of strength development I scoffed at anything else other than weight training.
However when sparring with friends and training partners, while initially strong, I soon found myself running out of steam. Eventually, I had to admit, my physical training (while providing aesthetic benefits) was not functional for the goals I had.
When I fought in competition in the earlier days I relied too much on strength and this led to technically superior fighters often using this against me. Essentially, due to my supplementary training, I was gifting fighter’s victory over me!
I began to look into other training and fitness methods from old time fighters and wrestlers, along with more contemporary training protocols.
The result?
Out went the longer slow distance style training along with the weight training the way I had been doing it and in came bodyweight exercises along with deep breathing exercises. As I began to train using my own bodyweight more, and using it as a unit and not isolating little muscles here and there, I noticed my strength endurance go up noticeably!
This is vital when training to compete in a competition format. I also developed a better awareness of my breathing that allowed me to loose tension when I gained a decent controlling position against my opponent. Instead of wasting energy in these positions I conserved it while letting my opponent use his energy trying to escape.
I found that working my body in this more holistic fashion allowed me to condense my workouts into quick, brutal, sessions that closer reflected the chaos of a real time fight than did my previous training methods.
When I first began I could barely do fifty body weight squats in a row, but that repetitive use of strength is often what is required in a tournament format. I worked my way up to doing, at one time, five hundred in a row in about fifteen to sixteen minutes (I don’t suggest you do this or that it is necessary, it is just I am an extremist!).
Combining squats, push-ups of different varieties, bridge work, hill sprints (a favourite of collegiate wrestlers in America) and many other exercises done in sequence with little rest in-between all served to really improve my competitive fitness.
Also, due to the nature of the training, using as it does the whole body with a keen focus on the breath, I found that my RHR (resting heart rate) dropped down to the low forties! (A normal adults should be around sixty to eighty).
OK, what lesson can be learnt from my experiences?
Well, first of all, I have to say that such training won’t make you technically better. However, it will often allow you to push your opponent beyond his physical thresholds while you remain within yours.
First, train your Ju Jutsu.
Secondly, add in relevant physical fitness and health training.
Allow this training to reflect the full-bodied activity that fighting actually is.
Don’t make the same mistakes I did!
NOTE: This article is not meant to be a knock on weight training. I teach weight lifting as part of my job. It certainly does have benefits and has helped many people. However, never ignore the power and functional strength you can create using your bodyweight from all angles and positions. The crossover to competing is substantial!
Tim Webb is a fitness instructor, Ju Jutsu instructor, and competitor. His site http://www.JuJutsu-Training.com offers inspiration through articles and product recommendations that can boost your mental focus and physical fitness for martial arts!
Religion and Identity: The Conservation of Personal Power
28 August 2008
How do individuals identify themselves? If you took a fair survey of the adult population, the large majority would identify themselves with a particular institutional religion. They may not be active in that religion, but it would serve as their means of identity. A smaller group would use their nationality as their primary means of identity. It may be their nationality or that of their parents or grandparents.
Using institutional religion as one’s primary means of identity carries some consequences that may not be positive for the individual. Making this statement then begs the question of what is religion? Religion is a spiritual connection between the individual and the creator (however you wish to define him). Religion, therefore, is not institutionally based; it is individually based.
With institutions, religious or secular, there exists a conservation of personal power that pervades all societies. What it says is that personal power (the power to control your own destiny for example) can neither be created nor destroyed, but it can be transferred.
When you align your identity with a particular institutional religion, in essence you are transferring control over your personal power to that institution. The institution becomes the focus, not the individual. In other words you are surrendering part of your identity to the institution. The institution trumps the individual. This is diametrically opposed to what religion is supposed to be.
Therefore, what is your identity? Your identity is you; your beliefs, your goals, your dreams, your enthusiasms, your accomplishments, your nationality. It is a mixture of many different and sundry things.
In the end, though, your true identity is your freedom–don’t lose it.
Sanford Kahn has been an economic/business author and speaker for 30 years. He was also the host and producer of the popular Times Mirror cable vision program “Ask the Economist”. He has authored many articles dealing with the impact of future economic trends on both individuals and businesses. He is also the founder of the Kahnian Society. The Seven Precepts of this society can be found at http://www.kahniansociety.org These Seven Precepts were developed to give people a different and realistic view on life and eventsdevoid of popular myths and seductive illusions. He can be contacted at sanford16@yahoo.com
Information, Tips, and Comparison: Rolling Walkers versus Standard Walkers
28 August 2008
There are many advantages that a rolling walker can provide, including the freedom to keep you mobile. And with stylish colors and designs available, you can feel good shopping at the mall or strolling outdoors. If this is your first purchase of a walker, start by looking at brand models such as the Guardian Envoy 460 or the Nova Cruiser GetGo. These two walkers are reasonable priced and include many smart features. Read on for more information and comparisons of standard walkers versus rollators.
Who should consider a walker with wheels?
If you’re steady on your feet and still able to get around but have some trouble with balance then the answer is: you. Since many people have just one mobility walker: standard or rolling, consider whether or not the rollator will benefit your lifestyle. These mobility aids are work best for:
Flat surfaces
Living facilities
Strolling
Performing daily activities such as shopping
In addition, state of the art features and a handsome design make the wheeled walker a stylish piece of equipment. Typical features include: 4 wheels and hand brakes. Deluxe features include: padded seats and baskets. Top manufacturers such as Invacare, Nova and Guardian, typically allow you to customize your walker, adding on the accessories that you desire. Besides the accessories listed above you may also want to add on such extras as a: tray, cup holder, tote bag, travel bag or hanging walker bag.
For individual selection, there are also walkers designed with 3 wheels such as, Nova’s Traveler Rolling Walker. This mobility aid can be used on any terrain, is lightweight (only12 pounds), and is very easy to maneuver (It is recommended for those not requiring the extra stability of a 4 wheeled walker.)
Another choice, the Nova Cruiser II, is designed for first time walker users. Instead of 4 wheels it has two 5″ front wheels and rubber tip rear legs. This feature helps prevent the walker from rolling away as well as providing more stability.
For heavy weight models that can handle 375 pounds and 600 pounds respectively, take a look at the Guardian Envoy 480 and the Nova Mighty Mac. The Mighty Mac features a 20″ wide seat and is good for people between 5′5″ to 6′1″.
For great value and quality the Guardian Envoy 460 is worth considering. With a 275 pound weight capacity and users height range from 5′5″ to 6′1″, this is a sturdy yet lightweight aluminum framed walker on wheels. What’s nice about this piece of equipment is that it includes the padded seat and under seat basket for the price: often you pay more for these features. You can also choose your color - blue, green or red.
Another popular light weight choice is the Nova Cruiser GetGo. This walking aid weighs only 12 pounds and is suitable for users from 5′4″ to 6′1″. What’s nice about this walker is that it has a gentle “feather touch” braking system. It is also easy to lift and perfect for strolling outdoors.
Rolling walker versus standard walker
There are many factors to consider when deciding on which style of walker to buy. What will Medicare pay for? What’s the lowest price? What features are necessary?
But essentially the needs and mobility level of the user is the first place to start. We’ve discussed rolling walkers but there are also good choices in standard walkers. Brands such as Invacare, Guardian, TFI Health Care and Carex are all popular manufacturers.
A typical standard walker features 4 legs with rubber feet. These mobility aids are generally lighter weight than rolling walkers, about 6 pounds on average. They also tend to cost less. And, many standard walkers fold easily, with some models folding flat for compact storage.
To accessorize, baskets can be added. You can also add 2 wheels to increase maneuverability and allow the walker to glide easily over rough terrain. Another item, the Walkerball Tennis Ball Glide, provides effortless, scuff free movement across the floor. These balls are designed to fit most standard walkers.
So you can see with quality choices in both types of walkers there are plenty of options to keep you mobile. For more information on http://www.wheelchair-ramps-and-mobility-aids.com
Nicole Martins is a contributing author and publisher to http://www.wheelchair-ramps-and-mobility-aids.com a comprehensive guide to the mobility products and assistive technologies, helping you to overcome disabilities and live a more active life.
Separation Is Just What You Need to Focus on You
27 August 2008
If you are contemplating how to get your ex boyfriend back, I suggest not doing anything to try and convince him to take you back. Separation gives him the opportunity think about the reason for your break up. And, it gives you the opportunity to spend some time getting to know yourself. You might become pleasantly surprised when you realize that the two of you had nothing in common that is necessary for a long lasting relationship. Often, we get caught up in the heat of a new romance and are blinded by a lot of facts that affects our judgment.
If you are considering ways on how to get your ex boyfriend back, think about being in the right frame of mind before you approach him. This may take some time, perhaps several months. It really depends on how long the two of you were together and the reason that the two of you broke up. Some wounds take longer to heal than others. You certainly do not want to approach him too soon and end up reopening a wound you thought you were over. Also, being in the right frame of mind includes acknowledging the part that you might have played in the break up. It takes two to tango.
A No-Brainer Way Of Getting Credit And Credit Cards
21 August 2008
What Is Your Credit Rating Now?
If you have any charge accounts now, or have ever borrowed from the bank to buy a car, or if you ar paying on a mortgage, there is credit information on you.
Up until a few years ago, you could only guess at what your credit rating was, because the credit bureaus who keep track of borrowers wouldn’t tell the borrowers anything! But that’s been changed through several laws, and now the bureaus have to send you your credit file when you request it.
If you’ve been denied credit on the basis of their record, they will send you a copy of that record without charge, if you request it within 30 days of the credit denial. If you haven’t been denied credit but just want to know what your file says, you must pay a small fee to find out.
Why You Really Must Get Your Credit Report…
It is well worth your trouble to obtain your report. You may well find (because thousands do) that there is a piece of misinformation that is injuring you without your knowing it, which you can straighten out by submitting copies of documentary proof (never mail originals of anything important - it may get lost in the mail) of bills paid, payments made, etc.
What To Do If You Are “Unlisted”
If, for one reason or another, you are not listed, or they have insufficient information on you to “rate” your suitability for credit, you must take steps to correct this.
What To Do If You’re New in Town
If you have no record because you hold no cards and have no charge accounts, or because you have just come in from out-of-town, then you’d better start assembling one. It may sound a little ridiculous, but nobody will lend money to someone’s who’s always paid cash! You have to have borrowed money or run up charges and paid them back to be able to borrow larger sums as time goes along.
Start with the local merchants in your immediate area, the ones that already know you.
Even if you don’t need it right now, ask them if you can set up a charge account with them. In most cases they’ll be glad to oblige you, they already know you’re local, and that you patronize them regularly. when you get the credit, charge a few items each week, and pay your account promptly when presented. In this way, you’ll build up a good credit record with these merchants in a short time.
Get Your Bank In on the Act
Go to the bank where you keep your checking account, and ask to borrow a nominal sum (say $500), which they are unlikely to refuse you.
Do this even if you don’t need the money, because you do need the repayment record on their books. Repay the loan on a regular basis when due.
Do not accelerate, and pay it all back the next month. Strangely enough the banks do not like that, because to them that indicates a “feast or famine” situation, rather than a steady payer.
The interest cost on this loan, even if you have no need for the money, will be well worth paying to build up your credit record. Besides, you can minimize this interest cost by depositing the money you have borrowed (assuming you do not immediately need it), in a savings account, and collecting the interest, which will defray a good part of the cost of the interest you are paying.
Once these charge accounts and the loan have been operating for a while, proceed to stage two, and ask a large local department store for a charge account. Most likely they will be happy to give you their charge card.
Build up your rating with them by occasional purchases and prompt payment, and then you proceed to stage three, and apply for the less selective national credit cards, Master Charge and Visa, which you should a this point be able to get without too much difficulty.
On the Road
Once you have national bank credit, it’s easy to get credit from all the oil companies, which makes traveling around a cash-free pleasure. Some gas stations take national cards like Master Charge, but most only take their own credit cards, so you should not overlook these, just because you already have others.
First Class With No Cash
Once you have all the other cards, a paid-up loan or two, and a fine record of promptly paying your bills, you may be able to get the most selective cards of all, the “travel and entertainment” cards.
These are American Express, Diners’ Club and Carte Blanche. These cards operate on a different system than ordinary retail store cards, or the national bank cards, both of which are revolving credit plans on which you pay a small amount each month, until your balance is all paid up.
The store or bank hopes you take a long time to pay, because they make their money on the 1 1/2% monthly (which is 18% yearly!) finance and, or interest charges.
The T&E cards, however, expect you to pay your bills at the end of the month! Let your account get 60 days or more delinquent, and they’ll cancel you out as fast as a flash of lightning. Although these cards do not charge interest, they do charge you a fee for membership.
Let Me Entertain You
So how do you get these marvelous bits of plastic that open up the doors of exotic nightspots in Tangiers as easily as your nearby Howard Johnson’s? Your good credit record, that you have already established, will be the most help.
Since the T&E people want you to pay your bills promptly each month, they want to know that you have a steady record of paying bills promptly to other people.
So first American Express, or Carte Blanche, or Diners’ Club, looks at your credit record. Then at your salary or other income. Most of them have cut-off points below which they will not grant their cards. But even if you earn more than their minimum requirements, they don’t automatically okay you for their credit…
They look at your stability!
How do they measure stability? How long have you worked on your present job? If you don’t have a minimum of two years of steady work in one place, they may not consider you at all. How long have you lived at your present address? At your previous address? And do you rent an apartment which means you could move tomorrow, or do you own your own house, which means you will probably still be in the same place next year. How stable is your livelihood? Do people in your field of work get laid off frequently?
Now You Can Really Start to Live!
Once you have all the major national credit cards in your wallet, you can live like the millionaires do, even though you haven’t yet become one.
You can go into a fancy store, or even call them on the telephone, and order those wonderful luxuries which make life so much more exciting, like furs and diamonds, for your loved one, or new furniture or appliances for your living room, bedroom or kitchen.
All of this can come true in the wonderful world of credit.
Now in today’s world you can charge almost anything on a credit card, from admission to a medical care at a hospital in Atlanta, university courses in New York City, funerals in Los Angeles, and even the services of legal prostitutes in Las Vegas.
Erasing the Bad Marks
But what do you do if you haven’t been able to pay your bills promptly, or you’ve run up more than you can handle, or you don’t have a very stable work history? Do you have to give up the dreams of credit-card living? Not entirely!
Once you find out which credit conditions in your background are the most troublesome (from the credit report you have already sent for), you then start to create new conditions that you can then base your records on.
If you were out of work, perhaps you can get a reference from someone you know who owns a business and is willing to say that you worked for him, if the credit card company checks your references.
If your bills are too high, and you’ve missed a few payments, perhaps you should see one of the free consumer- counseling services that are springing up in the larger cities which will enable you to consolidate your debts into a manageable amount.
Remember that credit card companies don’t care very much about the amount you owe, but they care a lot about whether you pay steadily, every single month, even if the amount each month is small, and the entire debt will take years to pay off!
Don’t overlook ways to establish good credit without buying anything!…
For example, you have telephone service in your own name, you have a record of paying bills to them which is then part of your credit record. The same for your gas and electric supplies from you local public utilities. These services, when they are in your name, will show prospective merchants that you do have a record of paying bills, even if you haven’t yet established retail store or bank credit.
Using Your Credit to Save Cash!
The world of credit has one more trick you should know about, this one that actually saves you money right on the spot.
All you have to do is carry your credit cards with you when you go out shopping, even if you intend to pay by cash. Then you have to keep an eye open for the smaller, personal service-type shops, where the boss himself, or one of the partners, is always present (you’ll see why in a minute).
As you walk in, check out the decals on the door to see which credit cards they accept.
Then select your purchase in the way you normally would - taking your usual care to be sure you’re getting the right item at the right price.
When the deal’s all set, produce your credit card (one of those you know he takes), and say “I’d like to charge it, please!”
At this, the merchant’s face will probably drop about six feet, but he’ll take your card and walk over to the imprinting machine (or maybe to the telephone to check your credit status).
He hasn’t got much choice, he has to take your card if he uses their decal in the window. But the point is, he hates to, because he has to pay the credit card company a percentage of the sale, usually somewhere between 6% and 10%.
Now, while he’s vulnerable, is the time to hit him with a casually dropped remark like “say, how about knocking 5% off the price, and I’ll pay cash instead?” The chances are he’ll accept your offer, because it saves him the other part of the credit card company percentage, and because it saves him bookkeeping chores, and waiting from 3 to 7 days for his money to be credited to him by the credit card company.
The reason why this gimmick doesn’t work in big stores is that the clerk doesn’t give a damn what it costs the boss, and has no authority to take an additional percentage off the price, so he’ll just go ahead and write up your credit card invoice.
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New Gaming Notebooks Set to Be Introduced by Big Brands
21 August 2008
The times where gaming notebooks were a specialist sector are disappearing really fast. Before the insignificant number of sales countered by the profit margins. These were the kind of laptops desired by all but the cost was just too prohibitive. Everybody thought they were the best laptops and rightly so. Having said that the vast number of us probably did not buy laptops of this type because of the cost. As of late all that has looked to have changed as the large companies have noticed the opportunities in gaming notebooks.
In comparison to the littler resellers these manufacturers are aware that they can make even more money. It is certainly a great option to bigger profit margins. Why would anybody buy laptops like this? I think big brands have the marketing resources to answer that. I’m trying to think what the the counter from littler manufacturers will be. I’m already seeing some price cuts. Clearly what I see happening here is that the established companies reducing prices initially to remove the competition from littler resellers. Plainly the power of an established brand name comes in here.
Surprisingly, the notebook computers they’re launching are a few of the best laptops to date. I reckon that small system builders could yet have a chance. I can predict the ability of getting to configure the laptop computer to be a cardinal purchasing factor. These types of consumers usually are well informed on the technology and would compare spec for spec. More often than not the specs hold more significance than the aesthetics for these sort of people.
All the changes are extremely favourable from the consumer’s view. I can forecast a couple of price wars taking place in this niche after the early months. Things move so quick in this industry that I cannot precisely make any certain claims. New laptops are always being introduced and that should hold prices constantly high. As the gaming laptop market becomes crowded with established brands, most will apply a wait and see strategy.
Traveling With A Large Family
21 August 2008
TIPS ON TRAVELING WITH THE FAMILY
When traveling, most would not agree with ‘the more, the merrier’. But it can be! Well, it should be. Traveling with the family can be hassle- free and loaded with fun. There is no reason you shouldn’t bring the kids and the entire family with you. Here are a few tips you can use for an easy, stress- free travel.
Plan with the entire family Get each family member’s opinion on which places to go. Kids love it when they get involved. Make a short list of the places they want to visit and get the majority’s preference. Plan simple yet fun activities for the whole family to enjoy.
Distribute tasks Help each other especially when packing. Give each one a responsibility. You can have your kids check on the first- aid kit, your husband to bring all bulky equipments and you take charge preparing the food. This way, your load can be lessened and everyone would feel the importance of each one’s contribution.
Travel light Since most of the space of your car would be for people, pack only the essential things you need. If possible you can hire strollers for the kids instead of carrying one. Transfer shampoos, mouthwash and the like in small plastic containers instead of bringing the entire thing. Remember that traveling light doesn’t mean traveling incomplete. Carry all important stuff you need to bring.
Secure your house Since all of your family members are with you on the trip, you can opt to hire a house sitter. If not, have a neighbor look out for the house for you. Unplug all electrical appliances and be sure to secure all door and windows.
Be safe Always carry with you a medicine kit for emergencies. This should include aspirins, laxative, insect repellant, bandages, ointments and alcohol. More importantly, bring enough prescription drugs if any of the family members is on medication. Bring enough to last for the entire duration of the trip.
Bring in the fun Take pictures and videos to document your trip. Take turns in using the camera, this way everyone will get a memorable shot taken. You can take the pictures and put them in a nice travel journal when you get home. This way you can enjoy the fun memories as often as you want.
Remember that the entire objective of a family trip is to have fun. Follow the quick tips above and you can head your way to an enjoyable travel.
Preventing Headaches and Reducing Their Impact
19 August 2008
Whether speaking of migraines, tension-type headaches or other recurring head pains, it’s safe to say that the best headache attack is the one you don’t have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today’s as-needed treatment that will keep next week’s attack from occurring.
Headache treatments come in two formsabortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with the goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.
Billions of dollars are spent each year on abortive remedies. For the most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.
But if attacks are frequent, hard to resolve, interfere with usual activitiesor side-effects from the abortive treatment interfere with usual activitiesthen a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.
Before discussing specific treatments for specific headache types, let’s consider the impacts of recurring headaches. The more obvious impact is the sheer unpleasantness and suffering involved in an attack. However, another impactthough less obviousis in its own way just as important. And that is the associated disability or loss of function that comes with an attack.
If a headache attack is severe, then whatever else was planned for that day goes out the windowit’s just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.
An increasing trend in the field of headache management is for practitioners to address their patients’ loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called the MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.
Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect the effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.
It might be as minimal as a check-mark on the calendar for each day with any symptoms. Another system is to summarize at the end of each day that one day’s headache-impact by selecting one of the following four descriptionsnone, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.
For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of the longer-term pattern. A recording system helps capture the big picture. It would be a mistake to judge the effectiveness of any treatment by what happened with symptoms in just the last few days. Generally, a month or longer is required to judge fairly and accurately.
So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring the treatment’s outcome, what specific remedies are available?
It depends, of course, on the kind of headaches being treated. Let’s discuss two of the most common typesmigraine and tension-type headaches.
For prevention of migraine, the best-studied and most effective drug treatments are available by prescription only in the U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).
Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dosefar higher than what is needed to treat vitamin deficiencyriboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is the case with other drugs, it should not be used during pregnancy.
Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Avoiding individually determined triggers for attacks carries no risk and can reduce the attack rate.
For tension-type headaches amitripyline is the best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at the low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline’s family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.
Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migrainestress management, relaxation, biofeedback and cognitive-behavioral therapy.
It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.
(C) 2005 by Gary Cordingley
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher. For more health-related articles, see his website at: http://www.cordingleyneurology.com
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