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Question of the Day
Michael John Coleman has suffered from migraines since he was about 6 years old. His mother also suffers from them, as did both of her parents.
As executive director and co-founder of MAGNUM, Migraine Awareness Group, a National Understanding for Migraineurs, based in Alexandria, Mr. Coleman tries to foster an awareness of the condition.
“These are very personal, private events,” Mr. Coleman says. “You go through them in public and try to not let anyone know how bad you feel.”
Migraines happen to people with various levels of severity for a number of reasons. Though medication has helped some people, it has not been the answer for others, leaving researchers to seek new forms of treatment.
One option being studied focuses on the heart rather than the head, specifically, closing an opening in the heart, which may reduce or eliminate migraines, says Dr. James Thompson, division chief of pediatric cardiology at Inova Fairfax Hospital in Merrifield.
The patent foramen ovale is an opening between the two upper chambers of the heart that fails to close naturally soon after birth. Every baby has the opening in utero, Dr. Thompson says; it allows oxygenated blood from the placenta to circulate properly. About 20 percent of adults have a patent foramen ovale.
“Approximately twice as many people with migraine headaches have PFO compared to the general population,” Dr. Thompson says. “We have closed them in the past to prevent strokes. As a byproduct of that, we find that people would come back and say, ‘Hey, my migraines are gone.’ ”
Because the procedure isn’t approved by the Food and Drug Administration for treatment of migraines, Inova Fairfax Hospital is enrolling patients for a trial to determine whether closing the hole will improve people’s migraines, Dr. Thompson says.
Though surgery may be the answer for some people, others turn to medicine. GlaxoSmithKline has been producing the migraine medication Imitrex for years, and it is about to release Trexima, a combination of Imitrex and Aleve, says Dr. Marc Schlosberg, a neurologist at Washington Hospital Center in Northwest. The combination of the two drugs may help people more than Imitrex alone, he says.
Further, various companies are conducting research to try to develop a drug that blocks calcitonin gene-related peptide. It is one of the peptides that causes inflammation in the covering of the brain, causing migraines.
Giving subanesthetic doses of Diprivan, an intravenous anesthetic, also has been known to stop migraines, but no one knows why, Dr. Schlosberg says.
“It’s expensive to give,” Dr. Schlosberg says. “People have to be hooked up to an EKG (electrocardiogram) machine in a recovery room.”
After seeing a neurologist and having common reasons for migraines eliminated, patients might want to undergo a diagnostic nerve-block test, says Dr. Ivica Ducic, an associate professor in plastic surgery and chief of peripheral nerve surgery at Georgetown University Hospital in Northwest.
The positive effect of the nerve block confirms which nerves are involved in headaches, Dr. Ducic says. Most often, patients have migraines in the front, back or side of the head. After doctors have clarified which nerves are involved in the migraine, the patient might be a candidate for surgically decompressing the nerve.
“You release the muscle around the nerve pinching the nerve without cutting the nerve,” Dr. Ducic says. “Not everybody qualifies for the surgery, if they are not having positive effects on nerve block.”
Even though new medications and procedures are investigated, patients shouldn’t forget the role daily choices play in their health, says Dr. David Buchholz, author of “Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain.” He is an associate professor of neurology at Johns Hopkins University in Baltimore.
Patients should do whatever they can to prevent headaches, he says. Everyone has a host of triggers, such as stress; hormones; lack of sleep; medications such as birth control pills; food sensitivities; and the influence of the weather, including drops in barometric pressure. The triggers can add up, placing a burden on the body.
Common food triggers include caffeine; chocolate; monosodium glutamate; processed meats and fish; aged cheese; yogurt; nuts; alcohol; vinegar; certain fruits and juices, such as citrus fruits; certain vegetables, especially onions; fresh yeast-risen baked goods; aspartame; and possibly soy, tomatoes and mushrooms, he says.
“In your migraine control center, you have an individual tolerance, a threshold,” Dr. Buchholz says. “You can tolerate up to a certain level; that’s when the migraine becomes turned on. The higher the trigger level above the threshold, the more activated the migraine will be, with a larger headache.”
Many times, medication has just made matters worse for patients, Dr. Buchholz says. However, aspirin, Tylenol and ibuprofen are acceptable. He recommends that patients do not take certain painkillers for headaches more than two days per month.
“As much as they help temporarily, they produce a rebound effect,” Dr. Buchholz says. “Your exposure to the drug makes your next headache more likely. It pushes your threshold down. As your threshold is lower, it becomes easier to cross with more headaches.”
Most patients have to stop the drugs to become responsive to preventive treatment, such as over-the-counter products with caffeine and prescription drugs, including triptan drugs such as Imitrex, he says.
“Most doctors don’t help this because the path of least resistance is to give another drug,” Dr. Buchholz says. “The good news is that the substantial portion of overload is avoidable triggers. Aim to keep it below the threshold.”
Sitting on a bus by a person who is wearing too much perfume, being exposed to cigarette smoke or driving along a road by the water with flashing lights might trigger a migraine, says Dr. John W. Cochran, medical director of Inova Fairfax Hospital’s stroke program. He also is involved in the patent foramen ovale trial at the hospital with Dr. Thompson.
“Some people know if they skip a meal they will get a headache, or if they don’t get enough sleep, they get a headache,” Dr. Cochran says. “If you figure out what your trigger is, you should try to avoid it.”
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