Here’s what you need to know

New treatments ahead for migraine headaches: prevent the ache and ease the throb: here’s what you need to know

Characterized by throbbing pain, usually on one side of the head, nausea, and sensitivity to light and sound, migraine headaches can knock you out of commission for anywhere from four to 72 hours. About one third of migraine sufferers also experience an aura–flashes of light, zig-zag lines, numbness and tingling in the face and arm–prior to the onset of the migraine. Worse, migraines usually occur in phases, according to the National Headache Foundation: the pre-headache phase; the migraine itself; and the post-headache phase. Both the pre- and post-headache phases can last hours to days, causing muscle tenderness, changes in mood and fatigue. An estimated 29.5 million people suffer from migraines. While some people have them occasionally, others may suffer for 15 or more days per month.


A recent study published in the Journal of the American Medical Association reported that women older than 45 who have migraine with aura had an increased risk of major cardiovascular disease and stroke. The risks ranged from a 1.7-fold increase for surgery to repair or replace a blocked artery to a 2.3-fold increase in death from cardiovascular disease. Migraines need to be taken seriously.


Researchers believe a migraine is an inflammatory process, set in motion by an interaction between nerve and blood vessels in the coverings of the brain. No one is certain why some people develop migraines and others don’t. But the headaches seem to be caused by triggers. Certain foods, smoke, hormones, stress–even exercise can bring on a migraine.


Not all treatments work for every patient. Migraine medications are divided into two categories: those that prevent an attack and those that ease symptoms once a migraine has started. Preventive medications, taken daily, help people who suffer from two or more migraines per month. “Abortive” medicines are taken once the headache starts. Most need to be used at the first sign of symptoms to be effective.


But non-drug treatments also help lots of migraine sufferers. Avoiding trigger foods (see “What You Can Do”) can lessen the number of attacks. Regular exercise can help stave off episodes. Biofeedback, relaxation techniques, massage and even hot and cold therapies have helped many people.

Acupuncture may also play a role. German researchers recently found that acupuncture was as effective as standard drug treatment in reducing the number of migraine attacks people had. After six months, patients who received 10 to 15 half-hour sessions of traditional Chinese acupuncture therapy reported a 47 percent reduction in the number of days they had migraine symptoms, while those who took medication reported a 40 percent decrease. However, patients who received sham acupuncture–needles inserted into non-traditional healing points–experienced a 39 percent decrease in their migraine days. Based on this, the researchers suggest that the decision to use acupuncture should rest with the treating physician.


Even something as simple as changing your sleep habits may help. Researchers at the University of North Carolina at Chapel Hill found that women who improved their sleep reduced the frequency and intensity of their headaches. In the study, 43 women who had “transformed migraine”–meaning their migraines had progressed from occasional to daily or near daily–were divided into two groups. One group was told to schedule eight hours of sleep time each night and received behavioral sleep modification (BSM) instructions: to go to bed at the same time every night; refrain from watching TV, reading or listening to music while in bed; avoid naps; use visualization techniques to fall asleep faster; eat supper at least four hours before going to bed, and limit fluid intake within two hours of bedtime.

Women in the control group were given “sham” directions. All the women received regular medical care for their headaches. At the first follow-up visit, six weeks after the start of the study, the women in the BSM group reported a 29 percent reduction in the frequency of their headaches and a 40 percent reduction in intensity. The group who received the “sham” treatment saw no improvement. After the second follow-up visit, women in the control group were given the same BSM instructions. By the third visit, nearly 44 percent of the women in the study who were given sleep modification techniques had a decrease in frequency and intensity of their headaches.


A host of new treatments for migraines is expected, including a skin patch, which releases drugs into the skin, a nasal spray and neuro-stimulation devices. New research from Ohio State University Medical Center found that an electronic device called TMS (transcranial magnetic stimulation) may interrupt the aura phase of migraine. It seems to work by creating a magnetic pulse, which, when held against a person’s head, interrupts the aura. Even Botox, widely used cosmetically, seems to reduce the number of migraine attacks in some people. More research is needed on these and other promising therapies.


The good news: Plenty of effective medications are available–if only people used them. A nationwide poll by the National Headache Foundation found that 52 percent of people with migraine-like symptoms were undiagnosed, and six out of 10 migraine sufferers rely on over-the-counter medicines–or worse, no medication–to relieve their pain.



If you are migraine prone, work with your doctor to find a regimen of lifestyle changes and medication that can control your headaches. And become familiar with your migraine triggers. Here are some strategies that can minimize your headaches:

* Avoid foods with tyramine, such as red wine, aged cheese, smoked fish, chicken liver, figs and some beans. Also steer clear of the flavoring monosodium glutamate (MSG), and foods containing nitrates, such as hot dogs, bacon and salami. Chocolate, nuts peanut butter, avocado, banana, citrus, onions and pickled foods can also bring on migraines.

* Eat regularly. Skipping meals can cause migraine in some people.

* Get enough sleep. The more sleep-deprived you are the more susceptible you may be to a migraine episode.

* Don’t smoke.

* Limit alcohol and caffeine.

* Exercise regularly. But keep in mind: High-impact exercise, such as running can bring on a migraine attack in some people. If that has been your experience, try a gentler activity such as cycling or swimming.

* Avoid bright lights, loud noise and strong smells, such as perfume.

* Minimize stress.

* Consider taking supplements. Both magnesium and B2 (or riboflavin) seem to help some migraine sufferers. Ask your doctor about the proper dosage.



FRED FREITAG, DO, Associate Director, Diamond Headache Clinic, Chicago, IL

“The risk of cardiovascular disease in women who have migraine with aura is greatest in women age 45 and older, according to a recent JAMA study. The good news is that the risk of migraine begins to diminish after age 40. But if you are older than that and are still getting migraine, this is a worry. It appears there is nothing you can do from a lifestyle or risk-factor modifying point of view. We have to find out what it is about migraine with aura that puts women at risk for heart disease and stroke. On the other hand, we also need to investigate what would happen if we changed the natural history of migraine. We know that there are things people can do to prevent migraine headaches, such as taking preventive medication. If we have a person in her 40s or older with migraine, are we going to alter her long-term prognosis if we get her on the appropriate preventive medicine that causes her migraines to go into remission? We don’t know. But we do know that if you had migraine with aura in the past and no longer get it, your risk factor for a cardiovascular event is the same as it would be if you never had a migraine. It would seem that women with migraine need to take optimal control of their headaches. That wasn’t talked about in this study. One of the saddest things about this study is that the women in the study were healthcare professionals but only three percent were using migraine-specific medications.”

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