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Migraines are often misunderstood, or dismissed as “just a headache.” Yet, they have the capacity to disrupt a person’s life, relationships, and sense of well-being. A study from Thomas Jefferson University in Philadelphia found that chronic migraine sufferers experience as much social stigma as people with epilepsy—a disease that produces far more obvious and dramatic symptoms. Some of that stigma is external—for example, getting treated differently by friends or colleagues. “Migraines are the unseen and undocumented pain that takes them away from work,” says Dr. R. Joshua Wootton, of pain psychology at the Arnold Pain Management Center, and assistant professor of anesthesia at Harvard Medical School. “There’s no empirical test for migraine yet. That’s why people who report these problems with chronic pain are often not believed or are thought to be exaggerating in the work environment’.
Effective migraine treatments are available—but many migraine sufferers don’t take advantage of them, either because they don’t seek help or they mistakenly believe they’re just suffering from regular headaches. ”l think 80% of all migraine sufferers can be effectively helped, but only about a quarter of them are effectively helped at the present time,” says Dr. Egilius Spierings, associate clinical professor of neurology at Harvard Medical School. The gold standard for migraine relief is a class of drugs called triptans. When taken at the first twinge of a migraine, triptans can relieve pain, nausea, and light sensitivity. “These medication have been on the market for about 20 years now,” Dr. Spierings says. “They are generally very safe and well tolerated, and also very effective.”
Despite being the seventh leading cause of time spent disabled worldwide, migraine “has received relatively little attention as a major public health issue,” Dr. Andrew Charles, a California neurologist, wrote recently in The New England Journal of Medicine. It can begin in childhood, becoming more common in adolescence and peaking in prevalence at ages 35 to 39. While the focus has long been on head pain, migraines are not just paining in the head. They are a body-wide disorder that recent research has shown results from “an abnormal state of the nervous system involving multiple parts of the brain,” said Dr. Charles, of the U.C.L.A. Goldberg Migraine Program at the David Geffen School of Medicine in Los Angeles. He hopes the journal article will educate practicing physicians, who learn little about migraines in medical school.
Before it was possible to study brain function through a functional M.R.I. or PET scan, migraines were thought to be caused by swollen, throbbing blood vessels in the scalp, usually affecting one side of the head. This classic migraine symptom prompted the use of medication that narrow blood vessels, drugs that help only some patients and are not safe for people with underlying heart disease. Neurologists who specialise in migraine research and treatment now approach migraine as a brain-based disorder, with symptoms and signs that can start a day or more before the onset of head pain and persist for hours or days after the pain subsides. Based on the new understanding, there are now potent and less disruptive treatments already available or awaiting approval. However, to be most effective, the new therapies may require patients to recognise and respond to the warning signs of a migraine in its so-called prodromal phase — when symptoms like yawning, irritability, fatigue, food cravings and sensitivity to light and sound occur a day or two before the headache.
Even with current remedies, people typically wait until they have a full-blown headache to start treatment, which limits its effectiveness, Dr. Charles said. His advice to patients: Learn to recognise your early symptoms signalling the onset of an attack and start treatment right away before the pain sets in. Conditions that can trigger a migraine in susceptible people include skipped meals, irregular intake of caffeine, erratic sleep habits and stress. Accordingly, Dr. Charles suggests practicing consistent dietary, sleep, caffeine and exercise habits to limit the frequency of migraines. Keeping a migraine diary that includes your stress level and what you’ve eaten and drunk can also help identify triggers.
But they aren’t just a physical condition. Living with chronic pain, or the constant worry that they may strike at any moment, can take an emotional toll, too. Migraines have been linked to an increased risk of depression. A study presented at the American Academy of Neurology’s annual meeting found that women with a history of migraines are 41 % more likely to be depressed than those without the condition. “When you can’t find effective ways to manage your migraines that frequently results in feeling helpless, hopeless and as if everyone is against you,” Dr Wootton says. If you’re having these feelings, it can be helpful to see a psychiatrist or psychologist, particularly at a center that specialises in pain management. “If you have considerable anxiety and/or depression, addressing those issues is important because they can negatively affect migraine. They also make it much more difficult to cope with a condition like migraine:’
