Migraine Management Remains Elusive

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June 8, 2000 (Bethesda, Md.) -- Researchers have unlocked some of the mysteries of migraines, offering patients and their physicians the potential to better manage the literal headaches that the disorder brings. The National Institutes of Health's (NIH's) National Institute of Neurological Disorders and Stroke is in the midst of a two-day scientific conference on the disorder.

About 28 million Americans suffer migraine headaches, which can bring severe disabling pain in attacks that last several days, accompanied by nausea and an increased sensitivity to light and/or sound.

But institute Director Gerald Fischbach, MD, tells WebMD, "My impression is that this is an undertreated disorder, and physicians need to be more aggressive."

And it appears migrainesdo discriminate to some degree. About 18% of women suffer the disorder, compared to 6% of men. Fewer than half of those with migraines, however, have been diagnosed.

Migraines can kick in at any age, but those aged 25 to 55 are most likely to suffer. Since those years are a peak productive time for most, the disorder brings a daunting price tag: It costs American employers an estimated $13 billion annually in missed work and reduced productivity.

But scientific understanding has come a long way. Michael Welch, MD, vice chancellor for research at the University of Kansas Medical Center, recalled that when he entered medical practice 35 years ago, the disorder "was a disease of neurotic women." More recently, scientists believed migraines were caused by blood vessel problems. But advances now indicate that genetics may be to blame, and that attacks originate through "overexcited" brain cells.

Researchers do not yet know how the overexcited cells cause headaches, although they know that light, sleep deprivation, and menstruation often act as triggers for attacks. Foods, however, are not a strong culprit in attacks. "The food thing is clearly overdone," said Stephen Silberstein, MD, neurology professor at Thomas Jefferson University.

Migraine experts emphasize that there are effective "medications to prevent and manage migraines. Nevertheless, the treatments may not be being used to their full potential.

Fischbach tells WebMD, "The real message for consumers is that there is an increase in options for new treatments." If someone is suffering persistent headache pain, he says, "You shouldn't try and suck it up and say, 'I can get through this, I've done it all my life.' There isn't the need to suffer."

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According to Richard Lipton, MD, "The best available treatment isn't perfect. But it makes a difference between feeling you've got a problem that completely makes your life out of control, to feeling like you have a burden but have the tools to manage it." Lipton is professor of neurology at the Albert Einstein College of Medicine in New York.

Lipton says that current preventive drugs can decrease headache frequency by half. But fewer than a million take these medications, he notes. With medications, Lipton says, "For between 50% to 80% of attacks, people go from moderate or severe pain to having mild pain or no pain within a couple of hours."

Silberstein recommends that women with migraines who are taking birth control pills take their pills constantly for three to four months. That will keep their estrogen levels high, since low levels of the hormone may trigger attacks.

The American Academy of Neurology and other medical groups have developed new drug treatment guidelines that are available online at www.aan.com

Fischbach says that many doctors may not focus enough on migraines. He notes, "Patients have to get the attention of busy doctors to sit down and listen." This article and all articles on WebMD have been medically reviewed.

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