June, 2000: A great deal of research is continuing to find the cause of migraine headaches and effect better treatments. Scientists met recently at the National Institutes of Health to review and evaluate available findings and emerging treatments. Some of the headlines read:
- "Scientists Discover Migraines Are a Unique Brain Disorder"
- "New research could open doors to better migraine treatment"
Dr. Stephen Silberstein is co-chairman of the U.S. Headache Consortium and a professor of neurology and Director of the Jefferson Headache Clinic at Jefferson Medical College. At that meeting, he made a statement that gets to the heart of a problem migraineurs have experienced in getting effective treatment:
"Migraine, we used to believe, was a disorder of anxious, neurotic women whose blood vessels overreacted. Migraine is not that. Migraine is a neurobiological disorder of the brain."
For many years, it was thought that abnormally dilated blood vessels caused migraines. Advances in imaging technology now allow scientists to observe the brain during a migraine attack. This technology has led to the discovery that migraine sufferers have unusually excitable brain nerve cells (neurons). When a migraine is triggered, those neurons suddenly fire electrical pulses that ripple from the back of the brain, across the top, then back down to the brainstem where vital pain centers are located. This "wave" causes blood flow to increase drastically, then quickly drop off again. The pain of migraine is caused by the blood vessels inflamed by the swings in blood flow, brainstem stimulation, or both.
Dr. K. Michael Welch, vice-chancellor for research at the University of Kansas Medical Center, reported that frequent migraine episodes seem to physically change the pain centers in the brain, and could result in constant headaches. He stated, "We should probably be treating very quickly."
Doctors have tended to start patients with over-the-counter analgesics, then move up the scale to narcotics such as Darvon, then drugs for moderate to severe pain, and finally to emergency-level medications. Dr. Silberstein, believes this is not a good way to treat migraines. He recommends that medications be selected depending on the severity of the pain, going straight to one of the higher levels if the pain is severe. He advises patients, "Don't give up - if one drug doesn't help, demand another."
While there is no doubt that this research will lead to the development of new treatments, there are many helpful medications already on the market. Some drugs that treat epilepsy by suppressing abnormal neuron firings are already being used as preventative medications for migraine. The triptans, such as Imitrex and Amerge, work by shrinking inflamed blood vessels, and are currently in use to abort a migraine in progress. The new research will may well solidify their place in migraine treatment.
Dr. Richard Lipton, professor of neurology at Albert Einstein College of Medicine, said that the World Health Organization ranks severe migraines with the most completely disabling diseases, along with quadriplegia and active psychoses.
National Institute of Neurological Disorders and Stroke[/link] (NINDS) reflected the sentiments of migraineurs, saying that the recent discoveries about what causes migraines have opened up very exciting new avenues of research. He continued,
"There is a list of specific and testable hypotheses that are new . . . medical science is suddenly on the threshold of great change in the discovery of more effective treatment for migraine and ways to prevent it or at least to reduce its frequency and severity."
Coming up next: Encouraging Migraine News Part II: Important New Guidelines for Treatment