Scientists Cast Misery of Migraine in a New Light

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Scientists Cast Misery of Migraine in a New Light

 

By JANE E. BRODY

Published: August 8, 2006

 

Everything you thought you knew about migraine headaches — except that they

are among the worst nonfatal afflictions of humankind — may be wrong. At least

that’s what headache researchers now maintain. From long-maligned dietary

triggers to the underlying cause of the headaches themselves, longstanding

beliefs have been brought into question by recent studies.

 

As if that were not enough dogma to overturn, there is growing evidence that

almost all so-called sinus headaches are really migraines. No wonder then that

the plethora of sinus remedies on the market and the endless prescriptions for

antibiotics have yielded so little relief for the millions of supposed sinus

sufferers.

 

While these findings may not be an obvious cause for joy among the afflicted,

the good news is that there are available many drugs that can either prevent

migraine attacks in the frequently afflicted or abort the headaches once they

start.

 

Knowing Where to Turn

 

Migraine therapy has come a long way in two decades, and those who know or

suspect that they have migraines would be wise to see a neurologist or a

headache specialist to obtain a proper diagnosis and the best treatment now

available.

Surveys have indicated that only about half of “classic” migraine sufferers

are reaping the benefits of what modern medicine offers. If those presumed to

have sinus headaches are included, the numbers of underserved migraine sufferers

could easily be doubled.

The World Health Organization ranks migraines among the most disabling ills.

About 28 million Americans suffer from severe migraines that leave them

temporarily unable to function at work, at home or at play. Many more millions

have them in milder forms. All told they cost employers about $13 billion a year

in lost productivity, with another $1 billion spent on medical care.

A migraine is more than a headache. The throbbing pain of a migraine, which

typically occurs on one side of the head, is often accompanied by nausea,

vomiting and extreme sensitivity to light and sound. A person feels sick all

over.

 

Symptoms may include nasal stuffiness, blurry vision, diarrhea, abdominal

cramps, abnormal sensations of heat or cold, anxiety, depression, irritability

and inability to concentrate.

 

Without effective treatment, those most severely affected are unable to cope

with even the simplest tasks and must take to their beds until the attack ends.

Afterward, people often feel tired, irritable, listless or depressed, though

some feel unusually refreshed and energized.

 

About 4 percent of prepubescent children have migraines. After puberty, the

incidence rises to 6 percent among men and 18 percent among women and gradually

declines after age 40.

 

The higher rate among women is linked to fluctuations in blood levels of

estrogen; the drop in estrogen just before menstruation sets off menstrual

migraines, which tend to be more severe and longer lasting than other forms. I

suffered from estrogen withdrawal migraines three times a month from age 11

until menopause. Each attack lasted three days. Pregnancy, when estrogen levels

remain high, was my only respite until menopause ended the estrogen

fluctuations.

 

Though long believed to be primary vascular headaches, the result of

constriction then expansion of blood vessels in the head, migraines are now

recognized to stem from neural changes in the brain and the release of

neuroinflammatory peptides that in turn constrict blood vessels. The headache

often begins before these vessels dilate. The inflammatory peptides sensitize

nerve fibers that then respond to innocuous stimuli, like blood vessel pulses,

causing the pain of migraine.

 

In some people, the headache is preceded by an aura of visual, sensory or

motor symptoms that last for less than an hour. They include seeing flashing

lights or specks, numbness in the hand, dizziness and an inability to speak.

People who experience these have a doubled risk of cardiovascular diseases,

according to findings published last month in The Journal of the American

Medical Association.

 

Migraines sometimes run in families, and these familial migraines have been

traced thus far to mutations in either of two genes.

 

Although hard to mistake in their classic form, migraines can be — and

apparently often are — misclassified as sinus or tension headaches, probably

because they can cause nasal congestion, pressure or pain in the forehead or

below the eyes, and discomfort on both sides of the face.

 

Getting the Right Diagnosis

 

In one study by Dr. Eric Eross of Scottsdale, Ariz., 90 of 100 people with

self-diagnosed sinus headaches were found to have migraines. On average, they

had seen more than four physicians for their headaches before getting the

correct diagnosis and significant relief. Neither the American Academy of

Allergy, Asthma and Immunology nor the American Academy of Otolaryngology

recognizes “sinus headache”; headaches only sometimes occur with sinus

infections.

 

Migraine sufferers have long been cautioned to avoid certain foods believed to

bring on attacks, especially chocolate, alcohol (red wine in particular) and

aged cheese. But the evidence supporting this notion is meager. More common

causes include stress (positive or negative), weather changes, estrogen

withdrawal, fatigue and sleep disturbances (hence, perhaps, the association with

alcohol, which can disrupt sleep), as well as overuse of over-the-counter pain

medications.

 

Finding the Cause

 

To determine what may set off your headaches, keep a calendar to record

occurrences, noting foods you ate or the circumstances preceding each one. If

you are a woman of childbearing age, record the stages of your menstrual cycles.

If necessary, to uncover foods that may cause your headaches, try an elimination

diet, cutting sharply on various foods, then reintroducing them one at a time.

This way, a friend discovered that her migraines were set off by corn and corn

products.

 

Preventives and treatments are numerous. If one doesn’t work, try another. If

your migraines are rare, using a drug in triptans class at the very onset of a

headache can usually abort it or reduce its severity and duration. Frequent

migraines are best treated preventively, with rescue medication — like a triptan

or an opiate, perhaps combined with aspirin, amphetamine and caffeine to relieve

a breakthrough headache.

Among the medications most effective as preventives are tricyclic

antidepressants, beta blockers like propranolol and anti-epileptic drugs like

gabapentin. Some people are helped by relaxation therapy, biofeedback or stress

management. Several good studies have shown benefits from supplements of the B

vitamin riboflavin (400 milligrams a day) or the herb butterbur (50 to 75

milligrams twice daily).

 

Perhaps most important in finding relief is seeing a doctor highly experienced

in diagnosing and treating migraines. Too many people try to muddle through,

sometimes causing more frequent migraines by overusing self-prescribed

medications. Others may see a physician who fails to help and then conclude that

their headaches are beyond help. Even if an expert was unable to help you years

ago, there are now so many new therapies — and a far better understanding of the

nature of migraines — that you’d be wise to try again.

http://www.nytimes.com/2006/08/08/health/08brody.html?ex=1155355200 & en=18b2fc74a\

9bb9618 & ei=5087%0A

 

 

 

 

 

" The care of the Earth is our most ancient and most worthy, and after

all our most pleasing responsibility. To cherish what remains of it and to

foster its renewal is our only hope. " Wendell Berry

 

 

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