A Revolution in Migraine Care
Excerpt By Gary Gately, HealthScoutNews

Not long ago, migraine sufferers had no choice but to head for darkened bedrooms to wait out the pain. Or they could down powerful painkillers that could lead to ferocious "rebound" headaches and, ultimately, addiction.

Often, doctors couldn't -- or wouldn't -- help much. As recently as a decade ago, many of them dismissed migraines as psychologically based ailments, essentially telling patients, "It's all in your head."

But dramatic breakthroughs in recent years have led to better understanding of migraines, which produce intense, throbbing pain, typically on one side of the head, sometimes accompanied by nausea and sensitivity to light and sound. And new treatments have vastly improved the prognosis for sufferers.

That's a message specialists are hoping to convey during National Headache Awareness Week, June 1-7.

Dr. Lisa K. Mannix, a neurologist who has been treating headaches exclusively for seven years since completing her residency, says migraine care has been "revolutionized" in the past decade.

"I often joke that I didn't have to practice in the dark ages, which makes some of my [older] colleagues a little jealous," says Mannix, who's in private practice in Cincinnati. Unlike her predecessors, she says, "I know I have treatments that are very effective for the majority of patients."

A huge advance in the treatment of migraines came in 1993 when the first triptan medication hit the market. Sumitriptan, also known as Imitrex, mimics the neurotransmitter serotonin, whose supply drops off during migraines. Sumitriptan causes blood vessels to constrict, which soothes the inflammation of nerve endings in the brain and eases pain.

Over the past decade, six other triptans have hit the market. Like other classes of drugs such as antidepressants and antibiotics, different triptans might work for some people, but not others. So more choices mean more hope for migraine sufferers.

Other new treatments appear to help prevent migraines or reduce their frequency and severity. These include Botox, better known for its ability to smooth away facial wrinkles, as well as beta blockers and calcium-channel blockers, both used to treat high blood pressure and coronary artery disease, experts say.

Antidepressants that affect serotonin levels can help prevent migraines. And anti-seizure medications, used to treat epilepsy and bipolar disorders, also have shown promise for their ability to prevent migraines.

And more new treatments seem likely. Dr. Seymour Diamond, executive chairman of the National Headache Foundation, says he knows of 14 studies now under way on migraine treatments.

"There's a lot of hope," Diamond says. "There's going to be more and more help and better drugs and drugs suitable to more people."

Still, millions of sufferers aren't getting the newer, proven medications for their migraines. One reason: Experts say about half of the estimated 30 million Americans with migraines are never properly diagnosed.

"It's an awareness issue, and I do think people are suffering needlessly," says Diamond, founder and director of the Diamond Headache Clinic in Chicago.

On a more positive note, the number of doctor visits for migraines nearly doubled from 9.4 people per 1,000 to 18 per 1,000, from 1990 to 1998, a recent Wake Forest University study says. This jump in visits may reflect the newer treatment options.

However, the study also found that many migraine sufferers rely on too many addictive painkillers that provide only short-term relief instead of more effective drugs, such as triptans.

What's more, many migraine sufferers remain unaware of the triptans and other newer treatments, including the preventive drugs, experts say. This ignorance stems in part from earlier, failed treatment for migraine sufferers, relatives or acquaintances, says Mannix, a member of the headache foundation's board of directors.

"People may not come back to the medical system because they may not realize we have better drugs," she says. "People say, 'I went 10 or 15 years ago and got side effects and [treatment] didn't work.' Or they say, 'It didn't work for my mom so why should it work for me?'"

Mannix says that about 25 percent of migraine patients could benefit from preventive medications, such as anti-seizure drugs, but only 5 percent take them. "So there's some serious under-treatment going on here," she says.

Primary-care doctors -- the front line in treatment of most migraines -- typically don't have the time necessary to assess the headache patient thoroughly and decide the best treatment, Diamond explains.

Besides medication, practical steps such as eating and sleeping well, exercising regularly, and reducing stress can help fight migraines, specialists say.

But for persistent migraines, Mannix says, "The big thing is you don't have to suffer. We've sort of unraveled some of the mystery, and there's a lot of good treatment available."

As part of Headache Awareness Week, the National Headache Foundation has introduced a new tool for sufferers called MAP, or Migraine Attack Profile.

By tracking the duration of individual headache attacks with MAP, doctors can learn which aspects of a migraine affect a patient most, how long each phase of an attack lasts, and what tends to make them get better or worse. Eventually, a pattern appears and doctors can use this information to help select the most appropriate medication for the patient, as well as identify the best time to start treatment for individual attacks, the foundation says.

For a free copy of the Migraine Attack Profile, contact the headache foundation at 1-888-NHF-5552 or visit www.headaches.org.

More information

For more on migraines and their treatment, visit the Mayo Clinic the Migraine Awareness Group, and the National Headache Foundation.

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