The misery of migraine

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Not just another form of a painful headache

Editor's note: The following in-depth study is based on interviews with patients and medical experts in the specialized field of headaches and migraine disorders, current medical literature, and recent scientific research. Credits are listed on Page 7.

Migraine is a biological disorder, not the result of a psychological problem, although mood changes, depression, and irritability often precede a migraine attack.

Q: Why is there so much confusion between the ordinary headache and migraine headaches?
A: Many practitioners treat patients who come to them with migraine headache and patients with other forms of headache as if they are the same. Migraine disorders are associated with many other symptoms, are seldom trivial, and can usually be avoided if the patient is informed of the causes.

Millions of dollars are wasted and needless suffering is invoked by doctors who resort to jaw reconstruction, neck surgery, hormonal manipulation, and sinus surgery in an effort to "cure" the migraine headache. Too often migraine headaches .are lumped together with other forms of head pain, with the opportunity for relief thus being missed.

Migraine headaches are often dumped into the basket of psychological disorders; in actuality, they are the result of a chronic condition that can be controlled and effectively treated when considered the result of brain "wiring," faulty flow of brain hormones, and particular "trigger" influences in diet and the environment. Ordinary headaches have entirely different "triggers."

Q: Is migraine ever life-threatening?
A: Although migraine is one of the most painful and frustrating disorders known, it is relatively benign and not life-threatening. Most migraineurs (migraine sufferers) function well even while the symptoms are coming on. Not until they are overcome by the fatigue, head pain, and nausea do they become functionally "disabled."

Q: In which ways do migraine symptoms differ from the onset of a headache?
A: The head pains of migraine are attributed to biochemical changes causing nausea, vomiting, irritability, visual impairment, and unsteady gait.

Q: Could migraine be the result of our stressful, noise-filled society?
A: The famous physician Hippocrates (460357 B.C .) described the pains of a migraine episode. Pliny the EIder (23-79A.D.), the great Roman medical writer, refers to the symptoms we now know as migraine. Remote aborigine tribes have elaborate rituals meant to deal with symptoms of particular head pains that correspond to our knowledge of migraines.

Q: Is there a particular type of personality that is prone to suffer from migraines?
A: Before researchers discovered that migraineurs are varied in personality traits, it was believed by doctors, psychiatrists, and laymen alike that migraine sufferers were hypersensitive and compulsive. Many have these traits, but the traits can probably be attributed to the stresses of their illness.

Q: Is it a coincidence that migraine sufferers are also persistent users of allergy aids? Could this habit provoke severe headaches?
A: Many people who have headaches also suffer from allergies. Some individuals get minor relief from headaches because the medication (a decongestant) constricts blood vessels, including those involved in head pain.

Q: Is migraine onset a matter of age?
A: Most migraineurs experience their early attacks before they become adults. Rarely does migraine begin after age 50. Often, children who have migraine attacks often outgrow them by adolescence.

Q: Can race affect the incidence of migraine?
A: Some evidence indicates that Negroes have a higher blood level of an enzyme that metabolizes tyramine, a chemical usually found in red wine and cheese, that could trigger migraine reactions.

Q: What great changes have taken place in medical science that have given us more insight into the physiology of mirgraine disorders and differentiated them from ordinary headaches?
A: During the past few decades, advances in medical technology have provided researchers and the medical profession with imaging techniques that make it possible to study blood flow in the brain without the use of dangerous blood vessel punctures and dyes. Such techniques include magnetic resonance imaging (MRI), positron-emission tomography (PET), singe-photon emission computed tomography (SPECT), and transcranial Doppler (TCD), along with the more well-known computed tomography (CT).

Q: What is there about brain activity characteristic of migraineurs that causes very severe headaches?
A: We now believe that migraine headaches are unusually painful because of the way in which the migraine process affects the body's pain control system. (The pain control system, located deep in the brain stem, determines our perception of degree of pain and the body's reaction to limit the damage.)

The pain control system employs natural chemicals called endorphins, pain killers similar to opiates. To function efficiently, however, the endorphins require neuro-transmitters, such as serotonin. Migraines may be especially painful because serotonin reserves are reduced by the excessive demands of the migraine process.

Another theory identifies an additional brain chemical, bradykinin, that accumulates around blood vessels and causes them to dilate. During a migraine attack, bradykinin affects the arteries in the scalp and may cause localized scalp tenderness and burning sensations.

Q: The statistics indicate more women suffer migraines than men. Female estrogen hormones have been implicated. Why?
A: Estrogen is a powerful stimulator of chemicals called prostaglandins, which cause blood vessels to constrict or dilate. They play a part in the experience of pain. In recent studies, women with menstrual migraines had lower than normal levels of a prostaglandin called PGI2. A woman's levels of PGI2 tend to be high during pregnancy (a time during which women with menstrual migraine often see their headaches improve).

Q: Is migraine disorder inherited?
A: In clinical studies, more than 60 percent of migraine sufferers report having family members with the same problem. Researchers of headache ailments believe that a predisposition to migraine is genetic (an autosomal dominant disorder in which a parent with migraine can pass a predisposition to the illness).

There is no test for susceptibility to migraine. Genetic research, however, has already identified familial hemiplegic migraine, a rare form of complicated migraine, to be caused by a genetic defect on chromosome 19,$one of the 26 strands of DNA in human cells.

Q: "Men don't get migraines" is a common commentary on the subject. Is this belief a myth, or do statistics prove the assumption?
A: Why not begin with history? Among the list of males who were known to suffer from migraine are George Bernard Shaw, Charles Darwin, Sigmund Freud, Thomas Jefferson, Frederic Chopin, St. Paul, Julius Caesar, Immanuel Kant, Lewis Carroll, Ulysses S. Grant, and Edgar Allan Poe. An estimated six million Americans have experienced migraine headaches during their lives. Men are probably more vulnerable to work-related stress, such as a headache trigger.

Q: Can vitamins and minerals be helpful against migraine?
A: Many patients find their migraines are aggravated by a deficiency in certain vitamins and minerals. Vitamin C proved helpful for a patient at the University of California Medical Center in San Francisco. His migraines disappeared (for the first time in six years) when he took six grams of vitamin C. (Reported in Migraine, by Eileen Herzberg, Element Books,) (Editor's note: A consultation with a nutrition-oriented physician is advised.

Q: Is the pre-headache period always filled with signs of a migraine to follow?
A: Technically, the pre-headache period is known as the prodrome, and has been known to begin hours to days before the headache begins. During the prodrome, the patient experiences irritability, mood changes, fluid retention, frequent urination, or increased thirst. Food cravings often increase, especially for carbohydrates and "trigger" foods, such as chocolates, dates, and other sweets.

Q: Aspartame has been implicated in causing migraine headaches. What is the rationale?
A: Aspartame contains the chemical phenylalanine. Some research has suggested that aspartame may result in decreased serotonin levels, which are known to trigger migraine.

Q: Migraine sufferers have difficulty traveling by airplane. They seem to link their travels with migraine headaches. Is there a link?
A: Airplane travel exposes an individual to many triggers: high altitude. dry air, unusual motion, and noise. Travel by auto or railroad also poses problems because migraine patients often experience severe motion sickness.

Q: If migraine is caused by a genetic defect, how can avoiding triggers ward off attacks?
A: A migraineur can inherit susceptibility to migraine; susceptibility to a trigger has not been proven. Therefore, the body probably learns to respond to the particular trigger with a biochemical chain reaction that can lead to migraine.

Q: Then the important aspect of reaction to trigger factors is sensitization. In a migraine family, for example, would the same item cause a migraine reaction in all individuals?
A: Sensitization is usually a matter of individuality. A mother may experience a violent attack after being exposed to cigarette smoke but her daughter may react to ingestion of chocolate, not to exposure of cigarette smoke.

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By Willia Renaurd, Jr.

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