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Migraines - Many Suffer Silently
More than 29.5 million Americans suffer from migraine, with women being affected three times more often than men. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70% to 80% of sufferers have a family history of migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider. Migraine is often misdiagnosed as sinus headache or tension-type headache.
Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise.
Migraine characteristics can include:
Pain typically on one side of the head
Pain has a pulsating or throbbing quality
Intense to severe pain affecting daily activities
Nausea and/or vomiting
Sensitivity to light and/or sound
Attacks last from 4 to 72 hours, many times longer
Visual disturbances and/or aura
Exertion such as climbing stairs makes headache worse
Approximately one-fifth of migraine sufferers experience aura, the warning associated with migraine, prior to the headache pain. Visual disturbances such as wavy lines, dots or flashing lights and blind spots begin from twenty minutes to one hour before the actual onset of migraine. Some people will have tingling in their arm or face or difficulty speaking. Aura was once thought to be caused by constriction of small arteries supplying specific areas of the brain. Now we know that aura is due to transient changes in the activity of specific nerve cells.
The pain of migraine occurs when excited brain cells trigger the trigeminal nerve to release chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem, an area of the brain that processes pain information. The pain of migraine is a referred pain that is typically felt around the eye or temple area. Pain can also occur in the face, sinus, jaw or neck area. Once the attack is full-blown, many people will be sensitive to touch anywhere on their body. Activities such as combing their hair, showering, or even just sitting up is extremely painful.
Diagnosis of migraine headache is made by establishing the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. By definition, the physical examination of a patient with migraine headache in between the attacks of migraine does not reveal any organic causes for the headaches. Tests such as the CT scan and MRI are useful to confirm the lack of organic causes for the headaches.
There is currently no test to confirm the diagnosis of migraine.
Treatment
Many factors may contribute to the occurrence of migraine attacks. They are known as trigger factors and may include diet, sleep, activity, strong odors, as well as many other factors. The use of a diary to record events that may play a role in causing the headaches can be useful for you and your healthcare provider. Avoidance of identifiable trigger factors reduces the number of headaches a patient may experience. Non-pharmacological techniques for control of migraine are helpful to some patients. These include biofeedback, physical medicine, and counseling. These, as with most elements of migraine, need to be individualized to the patient.
The use of other prescription anti-inflammatory agents may be effective for some migraines. These agents may have gastrointestinal side effects, which limit their use since larger than normal doses may be required to treat the migraine attack.
Migraine-specific therapies are designed specifically to treat migraine attacks. Ergotamine preparations are no longer readily available. Dihydroergotamine (DHE) may be used for self-injection. DHE is also available as the nasal spray Migranal. A combination product containing isometheptene (Midrin®) is not usually effective for migraine. Sumatriptan (Imitrex®), a 5-HT agonist, is available in self-injectable, nasal spray and rapidly-dissolving tablet forms. Other 5-HT agonists are almotriptan (Axert®), naratriptan (Amergeý®, rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®) and eletriptan (Relpax®). All are available in tablet form. Both rizatriptan and zolmitriptan are available in an orally disintegrating tablet (Maxalt-MLT and Zomig-ZMT), which can be taken without water. Zomig also comes in a nasal spray.
Abortive medications are most effective when taken early in an attack, while the pain is still mild and before skin sensitivity increases. The goal is complete relief of pain and associated symptoms, allowing the sufferer to quickly return to normal functioning.
Some attacks may not be eliminated by abortive therapy, yet the patient requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic. Butorphanol (Stadol®) is available for intranasal administration and is not typically associated with dependency problems. Alternative medical treatments with medications belonging to the group known as the Phenothiazines have proven useful as non-analgesic options for treating severe migraine headaches. Patients with prolonged migraine attacks lasting more than 24 hours are experiencing status migraine and corticosteroids may be used in these cases due to their anti-inflammatory effects.
Preventive
If patients have frequent migraine attacks, if the attacks do not respond consistently to migraine specific acute treatments, or if the migraine specific medications are ineffective or contraindicated because of other medical problems, then preventive medications should be given to reduce the migraine frequency and improve the response to the acute migraine medicines. Cost considerations also may lead to increased use of preventive medications. The FDA has approved four drugs for migraine prevention. These include propranolol (Inderal®), timolol (Blocadren®), topiramate (Topamax®) and divalproex sodium (Depakote®). These have had many years of use and make up the majority of the items considered 'first line' therapy for migraine prevention. Amitriptyline, which is an antidepressant, may also be very effective as a migraine preventive. All migraine preventive medications require that adequate doses of the medicine be given for a sufficient length of time to determine the effectiveness. Titration of the doses may be needed to reduce adverse effects to medicines.
There are a host of alternative choices for patients whose headaches do not respond to the first line medications. These include calcium channel blockers, NSAIDs, a variety of antidepressants and several miscellaneous medications.
Biofeedback
As an alternative to drug therapy, this training uses special equipment that monitors physical tension to teach the patient how to control the physical processes that are related to stress. Once familiar with this technique, people can use it, without the monitoring equipment, to stop an attack or reduce its effects. Self-hypnosis exercises are also taught to control both muscle contraction and the swelling of blood vessels. This patient-directed therapy, with the clinician serving as a guide or teacher, should be practiced daily. Children have an excellent response to biofeedback training, since they are open to new methods, learn quickly and have not become firmly entrenched in a chronic pain pattern.
Visit Migraines are 'US'
You Are In Good Company!
Celebrities and historical figures with Migraine disease include, among many: President, and architect of the Declaration of Independence Thomas Jefferson; the great painters Vincent Van Gogh, George Seurat (after which is named the Seurat effect, a current medical term often used to describe the visual phenomena of scintillating aura aka scotoma), and Claude Monet; great authors Virginia Woolfe, Cervantes (best known as the author of the classic, 'Don Quixote'), and Lewis Carroll who's Migraines are said to have influenced his gifts of literature still so popular today; leaders such as Julius Caesar, Napoleon, Ulysses S. Grant, Robert E. Lee, and Mary Todd Lincoln; scholars such as psychoanalyst Sigmund Freud, and Friedrich Nietzsche, the great German philosopher and poet who kept his enemy Migraine closer; and Icon Elvis Presley, the King of Rock & Roll who struggled with the king of all 'headaches.
Performing artists who suffer from Migraine include Academy Award winning actress Elizabeth Taylor, actor James Cromwell who received a best actor nomination for his portrayal of Farmer Hoggett in Babe, movie star and Friends actress Lisa Kudrow sometimes suffers from attacks, supermodel and Friends actress Elle Macpherson, actress Lee Grant, Grammy award winning singer and songwriter Carly Simon, her number one single "Your So Vain" as popular now as it was in the 70's, country singing giant Loretta Lynn, Susan Olsen of Brady Bunch fame, Star Jones of The View daily TV show, Fred Norris of the ever popular nationally syndicated Radio & TV Howard Stern Show, and endearing & powerful Academy Award winning actress Whoopi Goldberg. It is important to note that for Migraine sufferers who have certain professions, such as the performing arts, which puts them in the public eye, it becomes difficult for them to admit that they have Migraine. With hundreds of thousands of dollars, or even millions of dollars riding on a performer being on a set on time, the stigma of such an episodic disease can interfere with getting the best job opportunities offered to them. We applaud those with the openness and candor to have spoken publicly about their struggle with Migraine as it helps others who look up to them as role models.
Currently, some notable public figures suffering with Migraine disease are: Princess Margaret, Jennifer Ringley, the Jennicam girl (Jennicam.org) who put her life on the internet 24-7 and inspired the hit movies The Truman Show & Ed TV (she also was kind enough to model for our Michael John Coleman for the series of photographs used to create the animation on our HomePage!), Annie Glenn (wife of astronaut & Senator John Glenn who stood up to Vice President Johnson when she refused to let Johnson and reporters into her home after a launch attempt was scrubbed--a woman made of the right stuff, we might add). Other notable Migraine sufferers include sports basketball greats Kareem Abdul-Jabbar and Scotty Pipen.
Top athletes cannot hide their disease as skillfully as many actors can, as we saw when MVP Denver Broncos running back Terrell Davis almost was knocked out of the Superbowl XXXII due to an ill-timed Migraine attack. Other gifted major athletes who currently fight one of their toughest adversaries (Migraine) include Cleveland Browns Strong safety Marquez Pope, LSU's top quaterback Rohan Davey, and Arizona top runningback J.R. Redmond. Baseball's David Bell of the Seattle Mariners, Dwight Gooden pitcher for the Cleveland Indians, Minnesota Twins Pitcher Eric Milton, Jose Canseco of the Tampa Bay Devil Rays, and Sacramento Kings Jason Williams have been struck out by severe head-pain and the deep bench of ancillary symptoms from nausea to visual disturbances. Top woman golf pro Se Ri Pak, as well as LPGA leader Kathryn Marshall and golfer Fred Couples have to overcome the unpredictable Migraine hazard. Basketball's Sacramento Kings flashy Jason Williams and collage basketball player Jordan Adams who starts for Kentucky, both have had debilitating Migraine take them from key games.
Nationally ranked living visual artists who suffer from Migraine include our own Michael John Coleman (for more on Coleman see below), as well as New York painter Janet McKenzie whose work you will find thoughout the site. Other well known contemporary artists include California painter and sculpture Trevor Southy, painter Dennis Frings, and BJ Anderson who suffers from Migraine-like headaches (she is known around the world for her popular renderings of Cape Cod.)
And finally, some of the most notable Migraineurs of all are mothers, many of whom around the world are challenged by Migraine disease. Despite their disease, they go on to raise families, manage households and/or careers, and contribute to communities. Many fathers, too, are Migraineurs, who continue to care for family and loved ones, carry out careers, build homes, and participate in their communities. To continually fight a debilitating episodic disease while continuing to contribute to others makes them unsung heroes deserving of celebratory status in society as a whole, even though they are not household names. Well, they are ,of course, household names, (as "Mom" and "Dad" are household names) --- so for those who read this and recognize their family member as a Migraine sufferer, give them the love and respect they need and deserve.
Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise.
Migraine characteristics can include:
Pain typically on one side of the head
Pain has a pulsating or throbbing quality
Intense to severe pain affecting daily activities
Nausea and/or vomiting
Sensitivity to light and/or sound
Attacks last from 4 to 72 hours, many times longer
Visual disturbances and/or aura
Exertion such as climbing stairs makes headache worse
Approximately one-fifth of migraine sufferers experience aura, the warning associated with migraine, prior to the headache pain. Visual disturbances such as wavy lines, dots or flashing lights and blind spots begin from twenty minutes to one hour before the actual onset of migraine. Some people will have tingling in their arm or face or difficulty speaking. Aura was once thought to be caused by constriction of small arteries supplying specific areas of the brain. Now we know that aura is due to transient changes in the activity of specific nerve cells.
The pain of migraine occurs when excited brain cells trigger the trigeminal nerve to release chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem, an area of the brain that processes pain information. The pain of migraine is a referred pain that is typically felt around the eye or temple area. Pain can also occur in the face, sinus, jaw or neck area. Once the attack is full-blown, many people will be sensitive to touch anywhere on their body. Activities such as combing their hair, showering, or even just sitting up is extremely painful.
Diagnosis of migraine headache is made by establishing the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. By definition, the physical examination of a patient with migraine headache in between the attacks of migraine does not reveal any organic causes for the headaches. Tests such as the CT scan and MRI are useful to confirm the lack of organic causes for the headaches.
There is currently no test to confirm the diagnosis of migraine.
Treatment
Many factors may contribute to the occurrence of migraine attacks. They are known as trigger factors and may include diet, sleep, activity, strong odors, as well as many other factors. The use of a diary to record events that may play a role in causing the headaches can be useful for you and your healthcare provider. Avoidance of identifiable trigger factors reduces the number of headaches a patient may experience. Non-pharmacological techniques for control of migraine are helpful to some patients. These include biofeedback, physical medicine, and counseling. These, as with most elements of migraine, need to be individualized to the patient.
The use of other prescription anti-inflammatory agents may be effective for some migraines. These agents may have gastrointestinal side effects, which limit their use since larger than normal doses may be required to treat the migraine attack.
Migraine-specific therapies are designed specifically to treat migraine attacks. Ergotamine preparations are no longer readily available. Dihydroergotamine (DHE) may be used for self-injection. DHE is also available as the nasal spray Migranal. A combination product containing isometheptene (Midrin®) is not usually effective for migraine. Sumatriptan (Imitrex®), a 5-HT agonist, is available in self-injectable, nasal spray and rapidly-dissolving tablet forms. Other 5-HT agonists are almotriptan (Axert®), naratriptan (Amergeý®, rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®) and eletriptan (Relpax®). All are available in tablet form. Both rizatriptan and zolmitriptan are available in an orally disintegrating tablet (Maxalt-MLT and Zomig-ZMT), which can be taken without water. Zomig also comes in a nasal spray.
Abortive medications are most effective when taken early in an attack, while the pain is still mild and before skin sensitivity increases. The goal is complete relief of pain and associated symptoms, allowing the sufferer to quickly return to normal functioning.
Some attacks may not be eliminated by abortive therapy, yet the patient requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic. Butorphanol (Stadol®) is available for intranasal administration and is not typically associated with dependency problems. Alternative medical treatments with medications belonging to the group known as the Phenothiazines have proven useful as non-analgesic options for treating severe migraine headaches. Patients with prolonged migraine attacks lasting more than 24 hours are experiencing status migraine and corticosteroids may be used in these cases due to their anti-inflammatory effects.
Preventive
If patients have frequent migraine attacks, if the attacks do not respond consistently to migraine specific acute treatments, or if the migraine specific medications are ineffective or contraindicated because of other medical problems, then preventive medications should be given to reduce the migraine frequency and improve the response to the acute migraine medicines. Cost considerations also may lead to increased use of preventive medications. The FDA has approved four drugs for migraine prevention. These include propranolol (Inderal®), timolol (Blocadren®), topiramate (Topamax®) and divalproex sodium (Depakote®). These have had many years of use and make up the majority of the items considered 'first line' therapy for migraine prevention. Amitriptyline, which is an antidepressant, may also be very effective as a migraine preventive. All migraine preventive medications require that adequate doses of the medicine be given for a sufficient length of time to determine the effectiveness. Titration of the doses may be needed to reduce adverse effects to medicines.
There are a host of alternative choices for patients whose headaches do not respond to the first line medications. These include calcium channel blockers, NSAIDs, a variety of antidepressants and several miscellaneous medications.
Biofeedback
As an alternative to drug therapy, this training uses special equipment that monitors physical tension to teach the patient how to control the physical processes that are related to stress. Once familiar with this technique, people can use it, without the monitoring equipment, to stop an attack or reduce its effects. Self-hypnosis exercises are also taught to control both muscle contraction and the swelling of blood vessels. This patient-directed therapy, with the clinician serving as a guide or teacher, should be practiced daily. Children have an excellent response to biofeedback training, since they are open to new methods, learn quickly and have not become firmly entrenched in a chronic pain pattern.
Visit Migraines are 'US'
You Are In Good Company!
Celebrities and historical figures with Migraine disease include, among many: President, and architect of the Declaration of Independence Thomas Jefferson; the great painters Vincent Van Gogh, George Seurat (after which is named the Seurat effect, a current medical term often used to describe the visual phenomena of scintillating aura aka scotoma), and Claude Monet; great authors Virginia Woolfe, Cervantes (best known as the author of the classic, 'Don Quixote'), and Lewis Carroll who's Migraines are said to have influenced his gifts of literature still so popular today; leaders such as Julius Caesar, Napoleon, Ulysses S. Grant, Robert E. Lee, and Mary Todd Lincoln; scholars such as psychoanalyst Sigmund Freud, and Friedrich Nietzsche, the great German philosopher and poet who kept his enemy Migraine closer; and Icon Elvis Presley, the King of Rock & Roll who struggled with the king of all 'headaches.
Performing artists who suffer from Migraine include Academy Award winning actress Elizabeth Taylor, actor James Cromwell who received a best actor nomination for his portrayal of Farmer Hoggett in Babe, movie star and Friends actress Lisa Kudrow sometimes suffers from attacks, supermodel and Friends actress Elle Macpherson, actress Lee Grant, Grammy award winning singer and songwriter Carly Simon, her number one single "Your So Vain" as popular now as it was in the 70's, country singing giant Loretta Lynn, Susan Olsen of Brady Bunch fame, Star Jones of The View daily TV show, Fred Norris of the ever popular nationally syndicated Radio & TV Howard Stern Show, and endearing & powerful Academy Award winning actress Whoopi Goldberg. It is important to note that for Migraine sufferers who have certain professions, such as the performing arts, which puts them in the public eye, it becomes difficult for them to admit that they have Migraine. With hundreds of thousands of dollars, or even millions of dollars riding on a performer being on a set on time, the stigma of such an episodic disease can interfere with getting the best job opportunities offered to them. We applaud those with the openness and candor to have spoken publicly about their struggle with Migraine as it helps others who look up to them as role models.
Currently, some notable public figures suffering with Migraine disease are: Princess Margaret, Jennifer Ringley, the Jennicam girl (Jennicam.org) who put her life on the internet 24-7 and inspired the hit movies The Truman Show & Ed TV (she also was kind enough to model for our Michael John Coleman for the series of photographs used to create the animation on our HomePage!), Annie Glenn (wife of astronaut & Senator John Glenn who stood up to Vice President Johnson when she refused to let Johnson and reporters into her home after a launch attempt was scrubbed--a woman made of the right stuff, we might add). Other notable Migraine sufferers include sports basketball greats Kareem Abdul-Jabbar and Scotty Pipen.
Top athletes cannot hide their disease as skillfully as many actors can, as we saw when MVP Denver Broncos running back Terrell Davis almost was knocked out of the Superbowl XXXII due to an ill-timed Migraine attack. Other gifted major athletes who currently fight one of their toughest adversaries (Migraine) include Cleveland Browns Strong safety Marquez Pope, LSU's top quaterback Rohan Davey, and Arizona top runningback J.R. Redmond. Baseball's David Bell of the Seattle Mariners, Dwight Gooden pitcher for the Cleveland Indians, Minnesota Twins Pitcher Eric Milton, Jose Canseco of the Tampa Bay Devil Rays, and Sacramento Kings Jason Williams have been struck out by severe head-pain and the deep bench of ancillary symptoms from nausea to visual disturbances. Top woman golf pro Se Ri Pak, as well as LPGA leader Kathryn Marshall and golfer Fred Couples have to overcome the unpredictable Migraine hazard. Basketball's Sacramento Kings flashy Jason Williams and collage basketball player Jordan Adams who starts for Kentucky, both have had debilitating Migraine take them from key games.
Nationally ranked living visual artists who suffer from Migraine include our own Michael John Coleman (for more on Coleman see below), as well as New York painter Janet McKenzie whose work you will find thoughout the site. Other well known contemporary artists include California painter and sculpture Trevor Southy, painter Dennis Frings, and BJ Anderson who suffers from Migraine-like headaches (she is known around the world for her popular renderings of Cape Cod.)
And finally, some of the most notable Migraineurs of all are mothers, many of whom around the world are challenged by Migraine disease. Despite their disease, they go on to raise families, manage households and/or careers, and contribute to communities. Many fathers, too, are Migraineurs, who continue to care for family and loved ones, carry out careers, build homes, and participate in their communities. To continually fight a debilitating episodic disease while continuing to contribute to others makes them unsung heroes deserving of celebratory status in society as a whole, even though they are not household names. Well, they are ,of course, household names, (as "Mom" and "Dad" are household names) --- so for those who read this and recognize their family member as a Migraine sufferer, give them the love and respect they need and deserve.
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