Living with migraines

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Living with migraines

by Lois M. Deseret News (Salt Lake City) > Sep 2006

It's an odd thing, sitting at your desk or going for a walk or just

watching TV and having half your vision shut off. Jan Burrell says

she can still see, but it's as if she placed a hand over one eye.

It signals the start of a race that's familiar to Sky Bauman and

Carol Cabanillas, as well.

Sometimes Bauman is sitting in his office and feels a sharp pain

over one eye. Other times, he sees faint little zigzag lines or

spots in the air, " almost like the kind of interference you see on

TV. "

Cabanillas is a marathon runner, but when she gets a sudden sharp

pain in her left temple or eye, she knows she's starting a different

kind of race.

Each of them has a very few minutes to take medications or start

healing rituals that will ward off a migraine. And some people who

suffer the debilitating condition might consider themselves the

lucky ones. They, at least sometimes, experience " auras " -- visual

or other signals that precede a devastating headache. On the other

hand, most migraine sufferers -- about 85 percent -- have

the " common " type, rather than the " classic " migraine.

Those strike without warning.

An estimated 30 million Americans, three-fourths of them female,

suffer from migraines, according to the American Council for

Headache Education. The tendency runs in families, and symptoms

often begin in childhood, although a young child may have abdominal

pain and nausea rather than headache, which will come when he's

older.

The American Academy of Neurologists says that 3 percent of

preschool children, up to 11 percent of elementary-age children and

as many as 23 percent of teens have migraines.

Headache is just one symptom of migraine, though sufferers often say

it's the most memorable one. In fact, intensity is one way to

diagnose migraine, says Baggaley, a nurse practitioner in the

University of Utah Department of Neurology. " A tension headache

doesn't keep you from activities. One important element clinically

is the amount of lost activity, of lost time, of disability. If you

can't do anything, you are probably having a migraine. "

Not all experts agree on what causes migraine. The traditional view

was the blood vessels tightened, narrowing the flow of blood to the

brain, and that caused the auras, if there were any. When the

vessels dilated again, the pain began.

More recently, researchers have begun to believe that the brain may

actually be causing the problem, although it's not as well- defined.

A neurologist at Albert Einstein College of Medicine in New York

told FDA Consumer magazine earlier this month that changes in the

brain may trigger the blood-flow changes. And brain chemicals and

the channels in nerve cells that determine the movement of minerals

across them may contribute. There's no question that the vessels

dilate and constrict in the process. But whether that's the cause is

uncertain.

Migraine sufferers, called migraineurs, each have their own

triggers. People who successfully learn what, if any, their own

triggers are can go a long way toward avoiding migraine. In fact,

avoiding triggers and taking medications are the heart of migraine

treatment.

Baggaley treats migraineurs four days a week at the U. headache

clinic. She calls migraine a disease and headache a symptom.

Migraine, she says, is different from other types of headaches, like

sinus or tension. And often, she says, people assume they have one

of those when it's actually migraine. The condition is

underdiagnosed.

" A migraine has many different facets. It's a multimechanism disease

that involves blood vessels, the neurochemistry of the brain and

pain receptors. If you can't stop it you get more headache. And the

medicines people take for headache treatment can trigger migraine.

The earlier we can intervene and understand what triggers it, people

get to be the champion of their disease versus the victim. "

Migraine experts tell patients to keep a diary of their headaches so

they can identify what triggers their migraine. Many people have

multiple triggers. For some it's fumes or perfumes, while someone

else can't stand the flash of sunlight as they drive along tree-

lined streets.

Smokers and obese people have a higher risk of migraines. Lack of

sleep, skipped meals and other factors can play a role. Sunlight

flashing in a rearview mirror may set it off.

Foods are a common trigger, including MSG, sodium nitrates, cheese,

chocolate, onions, citrus, peanut butter, red wine. Bauman says

chocolate always set him up for debilitating migraines.

Baggaley sees a link between migraines and people who got carsick as

kids.

Migraines typically start in childhood and may improve or get worse

over the years. Migraines may last from a half hour to several

hours. Some people suffer for days at a time. Frequency also varies.

The headaches may plague someone only occasionally. Or they may be

nearly daily visitors, the duration and severity variable. It's not

uncommon for the headaches to trigger nausea and even vomiting.

People with classic migraines may experience neurological effects,

ranging from tingling to temporary partial paralysis or difficulty

speaking.

Any migraine headache is generally made worse by noise, light or

activity. That's why most migraineurs slug down some pain medicine

and caffeine and head for dark, quiet places.

Burrell, a counselor at Freedom Elementary School in Hooper, tries

to head things off with ibuprofen, caffeine and a trip to the

darkest place she can find to try to sleep. Besides headache, she

tends to throw up and an arm goes numb. If she can't head it off --

something she says she's getting better at -- Burrell says she can

only ride it out.

Bauman, a Utah native now in graduate school in Arizona, can't

remember not having migraines, although they may not all be preceded

by aura and they vary in misery. When one hits, he has to find a

dark room because he becomes hypersensitive to light. Occasionally,

he can take an aspirin very quickly and head it off or weaken it.

But recently, after a particularly bad, three-day episode, he

decided to try one of the medications designed to prevent or reduce

the intensity before it even starts.

Cabanillas, on the other hand, relies on rescue medicine when one

hits, although she hates the side effects of feeling achy and

sluggish. She gets migraines a lot and has learned to try to work

through them, " though it's definitely hard, " telling students at

Bennion Junior High where she teaches what's happening and asking

them to keep their voices down. Noise is excruciating.

Medication may be preventive or " rescue. " The former are designed to

reduce frequency and severity of attacks and improve function, if it

doesn't stop them entirely. The FDA has approved four drugs for

prevention, including Inderal, Blocadren, Depakote and Topamax.

They're each designed to be used daily, migraine or not. Because

they are very different from each other, it's important that

migraineurs work with their health-care providers to decide if a

prevention drug is needed and, if so, which one, Baggaley says.

Rescue medicines can cause harm if they're taken daily. And there's

an even bigger variety of those, from aspirin or ibuprofen and

caffeine over-the-counter combinations to controlled analgesics,

opiates and others. Experts warn that while caffeine provides some

relief, it can also trigger headaches.

The medications also come in various forms, from injections to pills

to nasal sprays. And many of them have side effects that should be

discussed with a physician.

Exercise is crucial. So is adequate sleep, Baggaley says.

Some migraineurs say acupuncture helps them. Others use yoga or

herbal remedies.

In some cases, it may be a matter of getting enough of certain

minerals, such as calcium and magnesium. There are products to

prevent the back teeth from clenching during sleep that are marketed

to stop migraines.

Even patients who eschew prescriptions need to take their treatment

of choice as if it were prescription, in controlled amounts and

times, Baggaley says. " One at a time and make sure you don't get a

side effect. I tell people to go low and slow, even with

nonprescriptions. "

Hormones are believed to play a strong role, perhaps explaining why

more women than men get migraines. The National Headache Foundation

says more than half of migraines are linked to menstrual cycles and

estrogen levels. But again, variables abound. Hormone- linked

migraines may occur before, during or immediately after

menstruation, suggesting that for some women an increase in estrogen

is a trigger and in others it's a deterrent. That's further borne

out by the fact that some women see a decrease in migraines after

menopause, while some see an increase. Many women who suffer

migraines see no links to their cycles at all.