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Migraine? Relief Is Heading Your Way

An Ounce of Prevention continued...

Lisa K. Mannix, MD, is a migraine researcher and headache specialist in private practice in Cincinnati. Like Diamond and Haas, she sees many patients whose migraines have proven difficult to treat.

"I see the tip of the iceberg, because the people referred to a specialist usually aren't doing well on their first or third or fifth migraine drug," she tells WebMD. "Approximately 2% of migraine sufferers are on a preventive medicine. But based on epidemiological studies of people missing work and having restricted activity due to migraines, it is estimated that 20% of these people need to be on a preventive. From my clinical experience, the majority of my patients are on preventive medicine, and all need it because they have very tough and very frequent headaches."

Mannix hopes that new migraine-preventing drugs will come out of new understandings of how the brain works.

"From the preventive standpoint, we now think you may be able to take some drugs already in the pipeline for other central nervous system conditions and modify them for migraine," she says. "For example, something in the epilepsy pipeline may have migraine applications."

Behavioral Therapies

Drugs are not the only way to treat migraines, though, and all of the experts consulted for this report stress the importance of combining them with other ways to manage migraines.

"I think the most important treatment tool is education," Mannix says. "You can't educate yourself out of an acute attack, but you can lessen the number and severity of attacks by being more knowledgeable about what to take and when to take it. The patients who really get involved in their care, who figure out the lifestyle modifications that they have to make and maintain, do better than those who say, 'Doctor, give me a pill.'"

One technique already in use by many headache specialists is biofeedback. Stress is a major trigger for migraine attacks, and biofeedback machines combat stress by training people to use effective relaxation practices.

"One recent report found biofeedback ineffective, but that goes against everything we know as migraine specialists," Mannix says. "It is not one of those decisions like, 'I am in the middle of acute attack, do I want biofeedback or Zomig?' But it is part of the things that patients have to do. It is something you actively participate in -- you learn about your responses to different conditions that add to or trigger migraines. Those type of things, as well as acupuncture and alternative medicines, need to be combined with good pharmaceuticals. It is not an either-or thing."

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