Aging Begins at 30

Prevention Helps Migraine Misery

Migraine, Old French for half the head, is more than a sick headache. If you have two of the following: one-sided pain of your head, throbbing pain, moderate to severe, aggravated by activity; and you also have one of the following: sensitivity to light or sound or both and nausea with or without vomiting; then you have migraine. It usually starts in adolescence or early adult life, lessens with age, and it occurs in about 75% of your near relatives.

Migraines are severe headaches that affect 17% of women and 6% of men. Most sufferers get three migraines a month, lasting for two days -- a major health problem. Patients have to have their retinas checked for swelling of the optic nerve, indicative of increased pressure inside the skull from some other severe neurologic problem, not migraine.

About a quarter of migraine patients believe their attacks are provoked by food. Red wine contains a migraine-promoting agent that is neither alcohol nor tyramine. Certain foods are thought to promote migraine such as buttermilk, Brie or Camembert cheeses, beans, avocados, figs, canned soups, mincemeat pies, pizza, nuts, seeds and any pickled, preserved, or marinated food. Sunlight, exercise, or tension are also thought to promote migraine.

Initially serotonin, one of the brain's chemical messengers, floods the brain causing a sterile inflammation and blood vessel constriction. This leads to zigzag spectra or bright spots before the eyes. Next, the level of serotonin plummets causing the blood vessels to dilate and creating blinding, throbbing headaches.

There are at least seven new drugs to replace the serotonin: serotonin agonists like sumatryptin (introduced in 1995) and its cousins alniditan, or eletriptan. They were first given intravenously or subcutaneously. Some of them now can be given as nasal sprays. Generally, they are 60% effective in abolishing the headache with a 24-hour 7% relapse. Dihydroergotamine, a derivative of the ergot parasite of rye, also can be given nasally. Injections act in 5 to 10 minutes and nasal sprays in 15 to 45 minutes. Oral tablets take 30 to 60 minutes. Ergotamine preparations also can be given rectally, which raises the level 10 to 20 times over the oral route. Lidocaine, your dentist’s local anesthetic, given intranasally, provides relief in just over half migraine sufferers within 5 minutes. Unfortunately 40% relapse but it costs about half a cent a dose compared to oral sumatripin at $10 per dose.

Because remedies constrict blood vessels, they will constrict heart blood vessels too, so patients with coronary artery disease or prior heart attacks, angina, or uncontrolled high blood pressure should not take the serotonin-like medicines. Deaths have occured. The same is true of ergotamine preparations or MAO inhibitors. Tricyclic antidepressants (amitryptyline or nortryptyline) have a success rate of about 60% as does the anti-epileptic agent valproic acid.

Migraine attacks significantly affect the quality of life, decrease productivity, and use up health care resources. Management means educating the patient, prevention, and quick abortion of attacks when they do occur. Nowadays migraine sufferers can return to work in half an hour. A very satisfactory treatment result.

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See related Patient Topics Brain and Nervous System, Headache, Migraine or Symptoms and Manifestations.

See related Provider Topics Brain and Nervous System, Headache, Migraine or Symptoms and Manifestations.

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