Migraine Headaches

Migraines are a mystery. For many years, scientists believed that migraines were linked to the opening and narrowing of blood vessels in the head. Now, doctors believe genes that control the activity of some brain cells are the cause of migraines. Either way, abnormal brain activity may result in a migraine headache.  Many different things can trigger this activity, but the exact chain of events has not been discovered. It is commonly believed that they begin in the brain and involve nerve pathways and chemicals. According to the National Institute of Neurological Disorders and Stroke, there is no absolute cure for migraine since its pathophysiology has yet to be fully understood. but there are some effective treatments available to reduce the pain and frequency of this condition.

Everybody Gets a Headache

Many different things can cause a headache: lifestyle changes, diet, stress, and too much or too little sleep. These factors can bring on a tension or migraine headache, two of the most common forms of headaches. For most people, headaches are a mild annoyance and over-the-counter medicine works quickly to relieve the pain. While stress can trigger a tension headache, it also gets its name because when it occurs, the neck, face and scalp muscles contract, causing tension. The National Headache Foundation reports that approximately 78 percent of adults experience a tension-type headache at some point in their lives.

When it’s More Than Just a Headache

Migraine headaches are more intense and occur with regularity. They involve severe throbbing, nausea and are accompanied by intolerance to light and noise – a condition that is very disabling, making it difficult to focus well or participate in normal activities.  The syndrome usually starts with intermittent attacks but can become chronic, with some people getting headaches more days than not in a single month. Women are three times more likely to get a migraine than man.

If you’ve never had a migraine, it’s hard to really understand how debilitating they are.  According to the Migraine Research Foundation, 113 million work days are lost every year because of headache or migraine. “Sixteen percent of the population suffers from migraine headaches,” says Dr. Kirk Bowden, a fellowship-trained pain management specialist and anesthesiologist of Pain Management Associates at Hedley Orthopaedic Institute in Mesa. “It is important to go to a headache specialist to determine the type of headaches you are getting so that you can get the proper treatment.”

“Chronic Migraine is a debilitating but under-recognized neurological condition,” explains Scott Whitcup, M.D., Allergan’s executive vice president of research and development and chief scientific officer. “Oftentimes, Chronic Migraine patients mistakenly self-diagnose their symptoms as headaches or infrequent migraine and treat them with drugs that provide rapid, but temporary, relief rather than seeking an evaluation, diagnosis and treatment from a qualified headache specialist.”

What Sets it Off?

There are many factors that can trigger a migraine: anxiety, stress, lack of food or sleep, glaring or flickering lights. Certain cheeses, wine, tomatoes or chocolate can also be triggers. Because so many different factors are involved, keeping a headache diary, a record of what you ate, how many hours you slept and what was going on in your life during the time of your headache can help your doctor determine what might be causing your migraine. For those people who only have one or two triggers, avoiding these things can make their migraines occur less frequently.

What Can be Done?

Unfortunately, some people have a lot of triggers, and it is impossible to stay away from them. In the past, there was not much hope for these people. The medications that were available were so strong they would put people to sleep, and they could not function for the rest of the day. Recently, medications called triptans have become available that can help stop a migraine. They must be taken as soon as the migraine is coming on, and they usually take about an hour or two to work.

Getting control of the condition is important. On top of the pain associated with migraine, there is also fear. Suffers constantly worry about when it will happen again, what will it keep them from doing and how it affects those around them.

“Chronic Migraine is one of the most disabling forms of headache.  Patients with chronic migraine experience a headache more than 14 days of the month,” says Russell Katz, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “This condition can greatly affect family, work and social life, so it is important to have a variety of effective treatment options available.”

Prevention

For people who suffer from more frequent bouts, there are preventative measures that may help. In 2010, the U.S. Food and Drug Administration approved Botox® injection (onabotulinumtoxinA) to prevent headaches in adult patients with chronic migraine. The treatment is getting positive results for many patients. “With Botox® approved by the FDA for Chronic Migraine patients, there is now a new preventive treatment option to reduce the days and hours spent in pain as a result of this condition,” says Whitcup of Allergan, the company that distributes Botox®.

“When we think of Botox,® we think of getting rid of wrinkles,” explains Bowden. “But, it can be used for much more than that…Like a lot of things in medicine, we stumbled across another application. People who were getting it for cosmetic purposes noticed that they were having fewer headaches. We realized that headaches were reduced in intensity and occurred with less frequency.”

Who, What, Where and Why?

Botox® is a drug made from the toxin that causes botulism, a life-threatening type of food poisoning. In small doses, in addition to treating chronic migraine, it is used to temporarily smooth wrinkles, treat severe underarm sweating and overactive bladder by weakening or paralyzing certain muscles or by blocking certain nerves.

“Botox® should be considered for people who have 15 or more migraines a month,” explains Bowden. “We don’t fully understand the cause of migraines or why it works but, compared to a placebo, it works.” Botox® prevents up to nine headache days a month (verses up to seven for placebo). Bowden believes, “the neurotoxin, in small doses, relaxes the muscles.”

“Unfortunately, a smooth forehead is not a side effect of the treatment for Chronic Migraine,” says Bowden. “The injections are given in very different areas.”  Treatment involves using very fine needles to inject seven different areas in the head and neck. The injections feel like tiny pinpricks and, if successful, need to be repeated every 12 weeks.

To see results, more than one treatment may be necessary. “People do respond differently,” explains Bowden. “One person may have a complete resolution, while others experience a reduction in how often they occur.”

The Future

Research on headaches is continually ongoing, offering hope, understanding and better tools for treatment. The National Institute of Neurological Disorders and Stroke, www.ninds.nih.gov, and the National Headache Foundation, www.headaches.org, both offer advice and information for headache sufferers.  Understanding more about your headaches may help you spend less time suffering from them.