Thursday, June 2, 2011

Snapshot: Migraines

Comic credit: Linda Causey
I started getting migraines when I was 16, a genetic gift from my mom. (Thanks, mom!) I participated in clinical trials throughout high school, after which they began to recede slightly. In college I began noticing that alcohol was a trigger, so I stopped drinking.

After college the migraines began ramping up, but as they did two fortunate things happened: I met a great neurologist and I started recognizing the various triggers. Over four years we have developed a strategy for both preventing and treating my migraines. I now take daily preventatives, and carry a stash of medication with me at all times.

Migraines are often misunderstood as merely headaches, but worse. Migraines are a completely different animal, characterized by debilitating neurological symptoms like aura, nausea and intense throbbing. Add to this the incredible diversity of symptoms and reactions to medications that migraine sufferers experience, and a migraine is not just a minor inconvenience; it can be completely debilitating.

While a headache can often go away with an over-the-counter treatment, like ibuprofen, one of my migraines would laugh hysterically were you to offer an ibuprofen to treat them.

Migraines affect as much as 10% of the population, including children. According to the Migraine Research Foundation, migraines contribute to 113 million missed days from work each year. Therefore not only are they a serious impediment for individuals, but their incidence constitutes a wider public health problem.

There are many treatment and prevention options available, but they often require a substantial investment in time - think years, not days - to determine what works, and a dedicated neurologist who can help a patient track their treatment. Despite years of treatment, my migraines have reduced in intensity and frequency, but not been eliminated.

As difficult as my experience with migraines has been, it actually falls on the luckier side of the spectrum. The reality for many migraine sufferers is mixed: a successful regimen of medication will often only work temporarily or sporadically.

My mom got her first migraine while pregnant with me. During my childhood, I can remember being woken up in the middle of the night to her crying; sometimes my dad would take her to the hospital just to receive pain medication strong enough to put her to sleep. She would give herself shots in the leg and sit in complete darkness for five days at a time.

If sporadic migraines weren’t bad enough, around 4% of the US population has daily migraines. A family friend has had a migraine for three years, almost uninterrupted. He has lost his job and basically remains in seclusion.

So what can be done? Clearly, more research is required to understand migraines, especially the factors that determine susceptibility and treatment success. Some of the current research examines genetic factors, changes in brain circuits, the role of estrogen, and the prevalence of “rebound headaches”.*

For the sake of all Americans who suffer from migraines, more research and better options are vital. Migraine research represents another critical part of the NIH portfolio. For patients, research could answer questions about why drugs work well for some but not others, thus cutting down the trial and error time. But most of all, it would spell relief for the millions who spend so much of their life in debilitating pain.

*Rebound headaches are a perfect example of the uncertainty and constant balancing act that migraine management requires. Some medications will take away your migraine for that moment, but will increase the odds of a rebound headache occurring at a similar time the following day, thus giving you a rebound headache.

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