Everything you thought you knew about
migraine
headaches — except that they are among the worst
nonfatal afflictions of humankind — may be
wrong. At least that’s what headache researchers
now maintain. From long-maligned dietary
triggers to the underlying cause of the
headaches themselves, longstanding beliefs have
been brought into question by recent studies.
As if that were not enough dogma to overturn,
there is growing evidence that almost all
so-called sinus headaches are really migraines.
No wonder then that the plethora of sinus
remedies on the market and the endless
prescriptions for
antibiotics
have yielded so little relief for the millions
of supposed sinus sufferers.
While these findings may not be an obvious cause
for joy among the afflicted, the good news is
that there are available many drugs that can
either prevent migraine attacks in the
frequently afflicted or abort the headaches once
they start.
Knowing Where to Turn
Migraine therapy has come a long way in two
decades, and those who know or suspect that they
have migraines would be wise to see a
neurologist or a headache specialist to obtain a
proper diagnosis and the best treatment now
available.
Surveys have indicated that only about half of
“classic” migraine sufferers are reaping the
benefits of what modern medicine offers. If
those presumed to have sinus headaches are
included, the numbers of underserved migraine
sufferers could easily be doubled.
The
World Health
Organization ranks migraines among
the most disabling ills. About 28 million
Americans suffer from severe migraines that
leave them temporarily unable to function at
work, at home or at play. Many more millions
have them in milder forms. All told they cost
employers about $13 billion a year in lost
productivity, with another $1 billion spent on
medical care.
A migraine is more than a headache. The
throbbing pain of a migraine, which typically
occurs on one side of the head, is often
accompanied by nausea, vomiting and extreme
sensitivity to light and sound. A person feels
sick all over.
Symptoms may include nasal stuffiness, blurry
vision, diarrhea, abdominal cramps, abnormal
sensations of heat or cold, anxiety,
depression,
irritability and inability to concentrate.
Without effective treatment, those most severely
affected are unable to cope with even the
simplest tasks and must take to their beds until
the attack ends. Afterward, people often feel
tired, irritable, listless or depressed, though
some feel unusually refreshed and energized.
About 4 percent of prepubescent children have
migraines. After puberty, the incidence rises to
6 percent among men and 18 percent among women
and gradually declines after age 40.
The higher rate among women is linked to
fluctuations in blood levels of
estrogen; the drop in estrogen just before menstruation sets
off menstrual migraines, which tend to be more
severe and longer lasting than other forms. I
suffered from estrogen withdrawal migraines
three times a month from age 11 until
menopause.
Each attack lasted three days.
Pregnancy,
when estrogen levels remain high, was my only
respite until menopause ended the estrogen
fluctuations.
Though long believed to be primary vascular
headaches, the result of constriction then
expansion of blood vessels in the head,
migraines are now recognized to stem from neural
changes in the brain and the release of
neuroinflammatory peptides that in turn
constrict blood vessels. The headache often
begins before these vessels dilate. The
inflammatory peptides sensitize nerve fibers
that then respond to innocuous stimuli, like
blood vessel pulses, causing the pain of
migraine.
In some people, the headache is preceded by an
aura of visual, sensory or motor symptoms that
last for less than an hour. They include seeing
flashing lights or specks, numbness in the hand,
dizziness and an inability to speak. People who
experience these have a doubled risk of
cardiovascular diseases, according to
findings
published last month in The Journal of the
American Medical
Association.
Migraines sometimes run in families, and these
familial migraines have been traced thus far to
mutations in either of two genes.
Although hard to mistake in their classic form,
migraines can be — and apparently often are —
misclassified as sinus or tension headaches,
probably because they can cause nasal
congestion, pressure or pain in the forehead or
below the eyes, and discomfort on both sides of
the face.
Getting the Right Diagnosis
In one study by Dr. Eric Eross of Scottsdale,
Ariz., 90 of 100 people with self-diagnosed
sinus headaches were found to have migraines. On
average, they had seen more than four physicians
for their headaches before getting the correct
diagnosis and significant relief. Neither the
American Academy of Allergy,
Asthma
and Immunology nor the American Academy of
Otolaryngology recognizes “sinus headache”;
headaches only sometimes occur with sinus
infections.
Migraine sufferers have long been cautioned to
avoid certain foods believed to bring on
attacks, especially chocolate, alcohol (red wine
in particular) and aged cheese. But the evidence
supporting this notion is meager. More common
causes include stress (positive or negative),
weather changes, estrogen withdrawal, fatigue
and sleep disturbances (hence, perhaps, the
association with alcohol, which can disrupt
sleep), as well as overuse of over-the-counter
pain medications.
