Just before one of Lisa's intense, throbbing headaches and vomiting
would begin, she typically saw an aura with shimmering spots.
I used to tell her this was caused by the constriction of blood
vessels in the brain followed by dilation. Over the past several
years, however, a better explanation has evolved. For nearly 30
million migraine sufferers -- three-fourths of whom are women
-- the current view may foster some helpful ways of warding off
these debilitating headaches.
The body electric
Using imaging advances to visualize patients' brains during an
attack, scientists have devised a new theory of migraine genesis.
Doctors now know that patients like Lisa are susceptible to severe
headaches because their brain cells are hypersensitive to changes
in or outside the body. Any migraine trigger -- such as certain
foods, stress, or hormone variations -- may stimulate nerve cells
to start firing. The smallest spark ignites an explosion of activity
that surges across the brain. In this way, a migraine is much
like a seizure, I explain to patients, since both begin with a
tiny, spreading electrical discharge.
Any migraine trigger -- such as foods, stress, or hormone
variations -- may stimulate nerve cells to start firing.
That's where the similarities end. A seizure usually produces
convulsions, while most migraines culminate in a severe headache.
This happens when the electrical storm reaches a remote part of
the brain called the trigeminal nerve. Here substances called
neuropeptides are released that cause blood vessels to swell and
leak, spurring the inflammation and ungodly pain of a migraine
Fresh insights, novel ideas
An improved understanding of migraines has opened the door to
new approaches for prevention. Recently, the U.S. Headache Consortium,
formed by seven organizations led by the American Academy of Neurology,
released migraine guidelines that emphasize prevention and self-care.
The guidelines recommend keeping a diary to help identify and
control factors that trigger headaches. They also advocate taking
steps to reduce the frequency of migraines if, despite treatment,
the disorder significantly interferes with your daily routine
or is difficult to control.
In situations like these, the guidelines say, you should strongly
consider using preventive medication. Some of the treatments take
advantage of the recently proven similarity between migraines
and seizures. Antiseizure pills like valproic acid and gabapentin
work by dampening excessive nerve activity that can instigate
migraine symptoms. In addition, a whole host of traditional drugs
can effectively head off migraines, including blood pressure medicine
such as calcium-channel blockers and beta-blockers, or antidepressants
For those reluctant to take medicine, several alternative therapies
are available to help forestall migraines. The herb feverfew,
the mineral magnesium, and the B vitamin riboflavin all had some
efficacy when scientifically reviewed by the consortium. Moreover,
stress management, relaxation training, and biofeedback may benefit
some migraine sufferers, says the report, especially in combination
with other preventive measures.
There's still no magic cure for migraines. But today, thanks
to research breakthroughs, patients like Lisa can choose from
a greater variety of options.
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Elizabeth Smoots, M.D., F.A.A.F.P., is a board-certified family
physician in Seattle, Washington. A fellow of the American Academy
of Family Physicians, Dr. Smoots specializes in prevention and primary