Migraine

Migraine is a form of headache. It is a neurologic disease of vascular origin characterized by attacks of sharp pain involving (usually) one half of the skull and accompanied by nausea, vomiting, photophobia and occasionally visual (or rarely other) disturbances known as aura. The symptoms and their timing vary considerably among migraine suffers, and to a lesser extent from one migraine attack to the next.

Migraine is caused by the constriction of the blood vessels of the head and neck. Classical migraine (migraine with aura) is forerun by a group of symptoms called aura, whereas common migraine does not have any indicator for the impending headache. A few (perhaps fortunate) people actually get aura without migraine.

Migraine can accompany, in some cases, another type of headache called tension headache. Migraine often runs in families and starts in adolescence, although some research indicates that it can start in early childhood or even in utero. Migraine occurs more frequently in women than men, and is most common between ages 15-45, with the frequency of attacks declining with age in most cases.

Treatment

Treatment focuses on three areas:

1. Elimination of triggers
2. Abortive drugs
3. Preventive drugs

In many patients the incidence of migraine can be reduced through diet changes to avoid certain chemicals present in such foods as cheddar cheese and chocolate, and in most alcoholic beverages. Other triggers may be situational and can be avoided through lifestyle changes.

Until the introduction of Imitrex (sumitriptan) c. 1985, there were no drugs available that could stop a migraine once it was underway. Analgesics and caffeine were used to provide some relief, though they are not effective for most sufferers. Narcotic pain medications, and antipsychotic drugs such as thorazine and compazine, are effective but have debilitating side effects at the doses required to achieve control.

Imitrex (sumitriptan) and the related 5-hydroxytryptamine receptor agonists are now available and are the therapy of choice for severe migraine that is relatively infrequent. They are highly effective and have few side effects when used occasionally. Some members of this family of drugs are

• sumatriptan
• zolmitriptan
• naratriptan
• rizatriptan
• elitriptan

These drugs are available by prescription only (U.S.). Many migraine sufferers do not use them only because they have not sought treatment from a physician.

For patients who suffer frequent, intractable and severe symptoms, preventive and prophylactic medications can be used. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patent is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next.

Beta blockers, such as propranolol and atenolol are usually tried first. Antidepressents, such as amitriptyline may be effective. Antispasmodic drugs are used less frequently.

The plant feverfew (Tanacetum parthenium) is a traditional herbal remedy believed to reduce the frequency of migraine attacks. Clinical trials have been carried out, and appear to confirm that the effect is genuine (though it does not completely prevent attacks).

Migraine sufferers usually develop their own coping mechanisms for intractable pain. A warm bath, or resting in a dark and silent room with a nice friend may be more helpful than any other medication for many patients.

The human side of migraine has been expertly captured in the book of the same name by Oliver Sacks.