Curbing the Impact of Migraines - Brief Article

USA Today (Society for the Advancement of Education), Oct, 2001

Migraine is a neurobioligical disorder affecting 28,000,000 Americans--equivalent to 13% of the U.S. population. The condition is more common than asthma, diabetes, or congestive heart failure. About one in every four households has a person who is suffering from migraine. Yet, just 48% of those with migraines have ever been diagnosed by a health care provider.

It can be a highly disabling condition that takes a heavy toll on work/ school productivity and may affect household and family/leisure activities. Because the pain pathways and symptoms are similar, migraine often is mistaken as sinus or tension headache.

Headache experts are gaining an increased understanding of what happens when a migraine attack is in progress. It is suspected that an attack is triggered from within the brain itself. Once one begins, it is thought that pain and other symptoms of migraine arise from an inflammatory process resulting from an interaction between the trigeminal nerve and blood vessels in the coverings of the brain. Serotonin, a naturally occurring chemical in the brain, has been implicated in this inflammatory process.

Recent evidence suggests that sensitization of neurons is a feature common to all migraine patients. During a migraine, pain signals from blood vessels inside the head make nerves hypersensitive. The normal pulsing of blood is interpreted as pain. Researchers believe that the neurons respond to the pain of migraine in stages, and, if it can be stopped early, the cascade of pain responses to higher areas of the brain can be halted or controlled. The development and gradual escalation of central hypersensitivity points to the need for early utilization of antimigraine drugs.

Practically anything may trigger a migraine, and triggers are not the same for everyone. In fact, what causes a migraine in one person may relieve it in another. Triggers can include one or more of the following categories: diet (e.g., red wine), environment (bright lights, smoke), emotions (stress, anxiety), activity (irregular exercise, lack of sleep), and hormones (menstrual cycle, oral contraceptives).

Migraine is characterized by a throbbing head pain, usually located on one side of the head, often accompanied by nausea, vomiting, and/or sensitivity to light and/or sound. The combination of pain, very often severe, and associated symptoms often prevents sufferers from performing daily activities. Attacks occur periodically and can last from four to 72 hours. Symptoms, incidence, and severity vary by individual and by attack.

In addition, a small number of sufferers experience what is known as "aura." They may see light flashes, blind spots, zigzag lines, and/or shimmering lights and may suffer vision loss and numbness prior to the head pain and other symptoms. A common misperception is that most patients with migraine experience aura before the onset of headache, when, in fact, 80% do not.

Migraine affects both men and women, although women experience it more often than men, at a ratio of 3:1. Peak prevalence for migraine is between the ages of 20 and 55 for both sexes. Typically, sufferers may experience an average of one attack per month.

Migraine can be managed effectively. With the help of a health care provider, patients can identify triggers that lead to their headaches and make appropriate changes in an effort to minimize migraine pain. In addition, patients can work with their doctors to determine an appropriate treatment regimen. Medications generally fall into two categories--prophylactic and acute.

Taken on a daily basis, prophylactic--preventive--medications can help reduce the number and/or severity of attacks in patients who experience more than two migraines per month. Acute therapy treats the symptoms of migraine after the attack begins. Medications available to treat an acute attack should be taken as soon as it occurs. Many headache specialists concur, however, that treating migraine when pain is mild is the optimal strategy.