July 13, 1998
Volume 50, No. 35
Better information and medicines for migraine sufferers
Myths and information about the basic nature of headache disorders have prevailed throughout history. First and foremost is the belief that headaches are largely psychological and affect only women. In fact, headache problems often appear in childhood and affect both men and women, though they are more prevalent in women during childbearing years.
Mostly it's otherwise healthy individuals who are headache prone, which reflects an inherited vulnerability rather than the presence of serious underlying medical problems. Migraine and tension-type headaches are common examples of these so-called primary headache disorders. In fact, migraine headaches commonly occur in about 24 million Americans, with more than 11 million suffering one or more episodes of migraine a month. The good news is: although migraines cannot be cured, almost all sufferers can be helped.
Approximately one-quarter of migraine patients can decrease the frequency and severity of their headaches without using medication but by making lifestyle changes. Avoiding dietary triggers such as monosodium glutamate (MSG), processed foods containing nitrites and red wine, and a regular bedtime and waking schedule-including weekends and holidays-are helpful in cutting down on the number of attacks, as is engaging in regular mild to moderate exercise. Biofeedback can also be helpful, either alone or along with medications.
For patients who need medicinal help from time to time, there are many medications from which to choose. Newer drugs, known as abortive medications, are designed to halt an attack once it has begun and are highly effective in most patients. For patients with frequent attacks, usually defined as three or more per month, daily medications that decrease the individual's vulnerability to headaches can be prescribed. These medications are typically less effective in preventing headache than the abortive medications, which can halt pain once it has begun, but they can make a significant difference in the lives of patients with frequent attacks.
A great deal of current research is making an important contribution to our understanding of headache. In the past decade alone, we have witnessed phenomenal growth in the body of knowledge about primary headache disorders, most notably in understanding the genetics of certain headache disorders and the specific events in the brain that trigger an attack.
For example, a rare type of headache, known as familial hemiplegic migraine, has been linked to chromosome 19, and it seems likely that more "garden-variety" forms of migraine may be linked to this chromosome as well. Anticipated breakthroughs in identifying genetic markers may make more accurate diagnosis possible in the foreseeable future.
The vast amount of progress made to date in understanding events that occur in the brain and blood vessels during a headache attack has made the development of effective abortive medicines possible, a trend likely to result in many more treatment options than have been available in the past.
Sarah DeRossett is an assistant professor in the Department of Neurology and head of the Pain and Headache Center and the department's residency program.
"Wellness" is coordinated by the Office of Health Promotion of the Rollins School of Public Health.