Migraines Are Unique Brain Disorder
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON (AP) - The pain of a migraine
can be so
Your head pulses, usually on one side,
for hours or
Moving worsens the throbbing.
sensitive to light and sound.
Sometimes you have an ``aura,''
pinpoints of light or other
before the headache
Some 28 million Americans suffer this pain.
Yet half don't realize
that migraines -
and not some other headache -
are to blame,
millions go without treatment.
That's particularly disturbing to experts because,
in a revolutionary
shift, scientists are discovering
are caused not by the
abnormal blood vessels
but by a unique
disorder of brain cells.
The findings open new avenues
these tenacious headaches,
suffer very frequent attacks
to physical changes
inside the brain
that could lead
``We should probably be treating very quickly,''
Dr. K. Michael
Welch of the
University of Kansas
Medical Center in Kansas City,
whose neurological research is spurring
new view of
told a recent meeting
at the National Institutes of
One-fifth of sufferers are candidates for medicines
that can cut
frequent attacks by half,
yet fewer than
1 million get preventive
said Dr. Richard Lipton
of New York's Albert Einstein
College of Medicine.
Once a migraine hits,
only a fraction use
most powerful prescription treatments.
Too many primary care physicians
how to treat
migraines, specialists say.
At a recent seminar, only 45 percent
of family physicians shown
got the diagnosis right.
Plus, only one-third of
have that classic
before an attack
yet many doctors
no aura means no migraine, Lipton said.
Scientists once thought migraines were caused
dilated blood vessels.
Hence, many pain relievers work
constricting blood vessels.
But new imaging devices allow scientists
to watch patients' brains
during a migraine attack,
and they're discovering sufferers have
abnormally excitable neurons, or brain nerve cells.
When something triggers a migraine,
those neurons suddenly fire
electrical pulses at the back of the brain,
firings that ripple
across the brain's top
and then back down to the brainstem,
important pain centers are located,
Welch explains. This electrical
spreads like water ripples when you
throw a pebble in a
In minutes, blood flow jumps, until the wave passes
The resulting pain comes from either
the brainstem activation or
inflamed by the rapidly changing blood flow - or both.
SOME FACTS ON MIGRAINES
Despite significant advances in prescription
specifically to treat migraine,
57 percent of migraine headache sufferers
report still using only over-the-counter (OTC)
virtually the same percentage
as 10 years ago (59 percent).
- Total U.S. migraine prevalence was virtually the same
in 1999 (12.6
percent) as in 1989 (12.1 percent)
Current incidence (28 million) has
since 1989 (24 million) with the growth in population.
Only 48 percent of respondents who met
the clinical definition of
report ever having had their condition
diagnosed by a
80 percent said their migraine headaches
were severe or extremely
and 24 percent reported seeking
emergency room care as a
result of an attack.
The new data show that one in every four U.S. households has a
migraine sufferer. This is 13 percent of the American population.
While sufferers with a physician diagnosis
tend to have more severe
and report more symptoms versus
the undiagnosed, there is
a high level
of suffering reported by both groups:
(85 percent diagnosed
vs. 85 percent undiagnosed)
SENSITIVITY TO LIGHT
(89 percent diagnosed
vs. 72 percent undiagnosed)
PAIN ONE SIDE
(64 percent diagnosed vs. 55 percent
(80 percent diagnosed vs.
66 percent undiagnosed)
Experiments in which scientists use a powerful magnet
neurons provide startling evidence
that some people's brains are
hyperexcitability. When people prone to
were stimulated, they literally saw spots
similar to a migraine's
One even went into a migraine as
But when people who don't get migraines
stimulated, their neurons weren't affected.
In real life what triggers these neurons?
Too much or too little
sleep, hunger, bright lights,
certain foods, women's fluctuating
Adding to the push for treatment,
very frequent migraine attacks
seem to physically change
the brainstem's pain centers, sometimes
leading to constant headaches, Welch says.
While scientists use the findings to hunt
better treatments, helpful
are already available.
Most notably, some drugs that fight epilepsy
abnormal neuron firings
- Depakote and Gabapentin -
migraines, says Dr. Stephen Silberstein
of Thomas Jefferson
University Hospital in Philadelphia.
The four most powerful
prescription treatments, called ``triptans,''
shrink inflamed blood
And women often are helped by adjusting
birth control or
to stabilize estrogen levels.
The treatments aren't perfect.
But too many patients never see a
or see one who follows the outdated practice
of trying less
powerful drugs first, Lipton says.
His advice: Don't give up -
drug doesn't help, demand another.
Article and References - Lauran Neergaard covers health and medical
for The Associated Press in Washington. &
Stewart, Lipton, et al.
"Journal of the American Medical Association",
1992, vol. 267, No. 1, pages 64-69.