Medical Advances Help Treat Migraines
Posted on: Tuesday, 5 February 2008, 00:00 CST
Wendy Dooley is not alone.
Migraines affect a substantial percentage of adults, especially women of childbearing years, said Dr. Edward Pegg, a Bloomington- based neurologist.
But most people don't seek help from a doctor because they don't realize there are medicines specifically for migraines.
"There are medicines available that can change your life," Pegg said.
The American Migraine Study II in 1999 found that 12.6 percent of Americans suffer from migraines, according to the 2005 book, "A Study of Migraine." About 18.2 percent of women and 6.5 percent of men get migraines.
Between puberty and menopause, nearly 30 percent of females get migraines, Pegg said.
However, 74 percent of males and 59 percent of females surveyed said they hadn't seen a doctor for their migraines, Pegg said.
That may be because some people aren't aware of medical advances. They think, as their parents did, that little can be done for their migraines.
"Their parents' generation just considered it a headache and didn't think anything could be done," Pegg said. "There were no good treatments (years ago), so we'd knock people out with pain medicine and they'd wake up without the migraine."
Some people would take over-the-counter headache medicine, which would have little to no effect on a migraine, Pegg said. Others would self-medicate by drinking caffeine, which would help some people but, for others, would make the migraine worse.
These treatments didn't help much because a migraine is different from a sinus headache or a tension headache.
A tension headache is a generalized head pain, as if you are wearing a hat that's too tight, Pegg explained. The pain is constant.
A sinus headache is head pain, generally over the sinus and behind the eyes, with sinusitis, including nasal discharge, according to "The Migraine Monitor," a publication of the University of Kentucky College of Medicine.
A migraine is severe, throbbing pain on one side of the head and is worsened by movement, said Pegg and "The Migraine Monitor." In some patients, the head pain is coupled with nausea, vomiting and an aura or visual phenomenon, including sparking lights, a hole in your vision or jagged, vibrating, geometric shapes. For some people, it appears as if they are looking through broken glass. For others, the vision is steamy.
In some patients, head pain is coupled with dizziness and a tingling sensation or numbness that appears to be marching down their arm.
"It's not a stroke because it's marching down their arm; in a stroke, it's everywhere all at once," Pegg said.
The location of the throbbing pain depends on which blood vessels are involved. Migraines are vascular headaches, meaning the blood vessels are involved, Pegg said.
In a migraine, blood vessels expand. Nerves that wrap around those blood vessels are stretched and send pain signals to the brain, Pegg said. "With every heartbeat, it's more intense," he said.
Why the blood vessels expand from time to time is unclear. Migraines are hereditary. Certain things also appear to trigger a migraine, including lack of sleep, stress, a change in the weather, some strong perfumes and certain foods, including chocolate, MSG (monosodium glutamate, an additive often found in seasonings and Chinese food), nuts, wine and cheese, Pegg said.
A major trigger is estrogen, which is why migraines are more prevalent during women's childbearing years, Pegg said.
Pegg first works with patients on identifying and controlling their migraine triggers, including getting enough sleep, managing stress and avoiding certain perfumes and foods.
When patients continue to get migraines, he prescribes medicine that may help. Medicines specific to migraines have been available for several years. The medicines work by stopping the release of chemicals that cause the blood vessels to swell, Pegg explained.
One category of prescription medicine is called abortive because those medicines are to be taken when a migraine starts and reduce the duration and severity of the migraine.
Tablets take effect after about 90 minutes. For people who don't mind giving themselves an injection in the arm or thigh, the injection abortive medicines take effect in about 20 minutes, Pegg said.
Examples are Imitrex, Maxalt-MLT and Relpax. The medicines are effective for about 80 percent of patients who try them and have few side effects, Pegg said. However, patients with coronary artery disease or uncontrolled high blood pressure can't take those medicines.
Patients who get frequent migraines - about six or more a month - may not want to wait 90 minutes or more for an abortive medicine to take effect. For those patients, Pegg prescribes a preventive migraine medicine. These tablets are to be taken once or twice a day to prevent migraines from occurring.
They include Elavil, Topamax and Depakote.
These medicines also are effective in about 80 percent of patients. But people with asthma can't take them and people with heart failure need to consult their doctor first.
Topamax is popular with women because it also can suppress appetite and promote weight loss, but there also is a rare risk of a kidney stone, Pegg said. Elavil may result in weight gain and Depakote also may increase appetite and can affect the liver, he said.
(c) 2008 Pantagraph. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Pantagraph
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