Million Americans Suffer From Migraine

¶ … million Americans suffer from migraine headache, which is the most common neurological disorder in the modern world and modern times. This affliction reduces work performance by 50% and accrues to wasted resources and a generally low-quality of life. The more common type of migraine afflicts 80% of all sufferers, who mostly do not consult with physicians. At present, migraine attacks are managed with pain-killers, herbal medications, and alternative therapies. But research continues to discover more effective, safer and readily available modes to its control

An estimated 28 million Americans suffer from migraine headaches and this affliction accounts for much loss of time from work, school and daily activities (Khosh 2002). Many sufferers report severe disability at 80% and 23% have taken recourse in emergency room treatment, while 39% of them said they are bedridden for a number of days. Migraine has remained prevalent since 1989 in spite of unprecedented medical and technological advancements and discoveries. Migraine affects one in every four household members. If left untreated or un-prevented, it can lead to a substantial reduction in the quality of life. Migraine accounts for a huge loss of time at work, school and daily activities: 51% of sufferers report a 50% or more of lost work and/or school productivity and 66% report a 50% or more reduction in household work. A substantial number of them say they must be bedridden because they are unable to control the pain and the symptoms. Approximately 80% of them experienced severe aches and 23% of them were prompted to seek emergency treatment, while 39% of them say their condition gets so bad that they must be bedridden for a number of days (Khosh).

Migraine is a debilitating type of headache that usually affects only one side of the head (USA Today 2004, Robinson 1999, Rowland 2001). There are two types of migraine, the common type and the classic type. There are no known and definite causes but these seem to develop from triggers. Current management or treatment modes, therefore, use appropriate pain killers, such as acetaminophen and ergotamine. There are non-medical approaches to its treatment and prevention, including a natural method, acupuncture, coenzyme Q10 and lisinopril, an angiotensin enzyme converting inhibitor. A holistic approach is seen as the best mode of management in its control and prevention.

Materials and Methods

Belinda Rowland (2001), Richard Robinson (1999) and USA Today (2004) provided basic information on the nature, causes, diagnosis and management of migraine headache. Anne Walling (2002) wrote about migraine in women in the American Family Physician Journal. Constance K. Cottrell et al. (2002) wrote about the perceptions and needs of migraine sufferers Life Sciences and Biotechnology Update (1999) discussed the utilization and costs involved in caring for patients with chronic migraine patients. Sadovsky (2003) discussed pharmacologic management options and prevention; Huffman (2002) suggested triptans as treatment while Vickers et al. (2004) called attention to acupuncture as another mode of treatment and Khosh (2002) suggested a natural approach. Other options under study included Angiotensin, as discussed by Schader (2001) and Singer (2003). Gaby (2003) discussed prevention with the use of coenzyme Q1 and Rose (1999) explored the efficacy and appropriateness of Botulinum Toxin A as treatment. Polizzotto (2002) wrote about treating the adult patient of migraine.

This paper used the descriptive-normative method in recording, describing, interpreting and analyzing gathered information from the authoritative sources mentioned. It focuses on the nature and incidence of migraine headache and the available treatments and management approaches to its control and prevention.

Results

Migraine is a debilitating type of headache, three times more common in women than in men (USA Today 2004, Rowland 2001, Robinson 1999). It is the most serious neurological condition in the modern world and modern times. Its cause is unknown but associated with triggers, which are of various kinds. Those who suffer from it report that at least half of the work they do is lost to migraine and only 23% of them secure medical advice. Current management includes taking prescribed painkillers, such as acetaminophen, aspirin and caffeine. One of the most trusted is ergotamine. But there have been reliable management approaches to controlling migraine pain and these include herbs, biofeedback, hydrotherapy, acupuncture, TENS and Botulinum Toxin A.

Discussion

Migraine is an intensely debilitating kind of headache, the most common neurological disorder in the modern world, that afflicts 24 to 28 million people in the United States alone (Rowland 2001, Robinson 1999, USA Today 2004). It comes from the Greek word hemikrania, which means "half a head," because it is characterized by intense and throbbing pain on one side of the head. A migraine becomes worse with movement and is often accompanied by nausea, vomiting and extreme sensitivity to light and sound. An attack can last many hours and many days. Statistics say that migraine costs billions of dollars in lost work, poor job performance and medical expense (Rowland). Figures also show that 18% of women and 6% of men suffer at least one migraine attack each year. At present, one in every 11 Americans experiences an attack. Women develop migraine three times more than men and mostly before the former enter the pre-menopausal stage. Migraine often starts in adolescence and seldom extends beyond 60 (Rowland). It is more common than diabetes, epilepsy and asthma combined, with more than half of the cases left undiagnosed. Assistant neurology professor Dion Graybeal of the University of Texas Southwestern Medical Center in Dallas noted that 75-85% of those who experience chronically recurring headaches go through migraine rather than tension or sinus headaches (USA Today).

There are two types of migraine. One is common migraine or migraine without aura, which occurs in approximately 80% of sufferers and the other is classic migraine or migraine with aura (USA Today 2004). Classic migraine is accompanied or preceded by visual or other sensory disturbances, such as hallucinations, partial obstruction of the visual field, numbness, tingling or a feeling of heaviness. The ache on one side of the body starts as early as 72 hours before the actual migraine attack (Rowland). Common migraine is often characterized by an increase in mood or energy level up to a day before the attack or by fatigue, depressive and excessive yawning (Robinson 1999). The sensations that characterize classic migraine may also spread and be accompanied by weakness or heaviness on that limb. The throbbing pain ranges from mild to incapacitating. Vision may also become blurred. During an attack, the sufferer is weak, weary and sensitive to sudden movements of the head.

The cause of migraine is difficult to establish. Some believe that genetics seems to play a part in many sufferers but there are many other potential stimuli that can trigger a migraine attack (Robinson 1999). But most medical experts agree that a migraine attack develops from pain-sensing nerve cells in the brain, called nociceptors, which release chemicals called neuropeptides. They also believe that the unbearable pain comes from the combination of pain sensitivity, tissue and vessel swelling and inflammation. They likewise maintain that it tends to run in families, wherein a child of a migraine sufferer has as much as 50% chance of developing the same affliction in that family members are exposed to and predisposed to the same environmental factors and personal experiences. The genes responsible have, however, not been identified. Certain foods, drugs, environmental "cues" and personal events have triggered migraine attacks, such as cheese, alcohol, coffee drinking or withdrawal, chocolate, intensely sweet foods, dairy products, fermented or pickled foods, citrus fruits, nuts, processed foods - especially those containing nitrites, sulfites or monosodium glutamate - stress or time pressure, menstrual periods or menopause, sleep changes or disturbances or oversleep, prolonged or overexertion or an uncomfortable posture, hunger or fasting, odors, smoke or perfume, glare or strong lights, and certain drugs (Robinson).

The diagnosis of migraine includes a careful medical history, lab tests and imaging studies, like a computer tomography or a magnetic resonance imaging scans (Robinson 1999). Diagnostic procedures must first rule out brain tumors and structural changes.

Conventional treatment for migraine involves placing the person in a dark and quiet room in order to reduce painful stimuli (Robinson 1999). Non-steroidal anti-inflammatory drugs or NSAIDS have been found useful in the early and mild stages and these include acetaminophen, ibuprofen and naproxen. Recent studies show that a combination of acetaminophen, aspirin and caffeine has proved effective against migraine. One effective over-the-counter preparation is Exedrin Migraine. More severe or resistant attacks may be managed with drugs that act on serotonin receptors in the smooth muscle surrounding cranial blood vessels. Serotonin, or 5-hydroxytruptamine, constricts these vessels and relieve migraine pain as do drugs that imitate the action of serotonin. One old drug is ergotamine, which is derived from a common grain fungus, and dihydroergotamine. Either may be used to control or prevent migraine attacks. For acute attacks, meperidine and metoclapramide are also helpful. Other drugs that can be used with fewer side effects are available in the form of nasal sprays, intramuscular injections and rectal suppositories. Continued use of some anti-migraine drugs has been found to lead to what is known as "rebound headache," a condition marked by frequent and chronic headaches, especially in the early morning hours. The condition can be prevented if the patient takes the drugs only on a doctor's supervision and when taken only in minimal doses. Those suffering from frequent attacks may need preventive therapy (Robinson 1999).

There are alternative treatment modes aimed at preventing migraine (Robinson 1999). Because it is often linked with food allergies and intolerances, the identification and elimination of the offending foods can contain or decrease the frequency of the attacks. Herbal therapy with the use of feverfew or chrysanthemum parthenium can work this way. Biofeedback training may also help prevent some vascular changes when an attack begins by increasing the flow of blood to the extremities. The patient must put the lights down low, put his or her feet in a tub of hot water and place a cold cloth on the back of the head or occipital region. This should draw blood to the feet and relieve pressure in the head (Robinson).

Most migraine sufferers can control migraine attacks by recognizing and avoiding what triggers them and by using appropriate drugs when the attacks begin (Robinson 1999). Those with severe migraines, unfortunately, do not respond to preventive or drug therapy. Prevention can include keeping record of headaches and particulars, taking note of what triggers each attack. Specific actions may be eating at regular times, reducing intake of coffee and pain-relievers, restricting physical exertion, especially during warm days, keeping regular sleep hours without oversleeping, and time management that will avoid or reduce stress at work and at home. Drugs that can prevent migraine are classified into beta blockers, tricyclic antidepressants, calcium channel blockers, anticonvulsants, prozac, monoamine oxidase inhibitors and serotonin antagonists. Preventive drug therapy is not the appropriate option for most migraine patients because it requires the use of powerful drugs. There appears to be limited benefits for preventive treatment for women with migraines that coincide with their menstrual period (Robinson).

There are still other alternatives in the control of migraine headaches (Rowland 2001).. These include acupressure, acupuncture, aromatherapy, cognitive behavior therapy, hydrotherapy, relaxation techniques, the use of supplements, allopathic treatments, the use of a transcutaneous electrical nerve stimulation or TENS, aerobic exercises, taking celery juice twice daily, ginger, and pulsing electromagnetic fields. Acupressure involves pressing the so-called Gates of Consciousness or GB 20 points to relieve migraine. The use of acupuncture as a useful treatment for migraine headache has also been endorsed by a National Institute of Health or NIH panel. The essential oil of rosemary in aromatherapy can also be beneficial. Herbals that can prove of some value include valerian or valerian officianalis, passion flower or passiflora incarnate, ginkgo or ginkgo biloba, goldenseal or hydrastis Canadensis, hawthorn or crataegus oxyacantha, linden, wood betony or stachys officianalis, skullcap or scutellaria lateriflora, or cramp bark or vibrurnum opulus. On the other hand, hydrotherapy involves the alternate use of a short hot shower followed by a long cold shower or a hot enema to relieve migraine pain. Relaxation techniques include meditation, yoga, hypnosis, visualization, breathing exercises and progressive muscular relaxation to inhibit the progression of an attack. Supplements may be in the form of Vitamin B2 or Riboflavin, magnesium, 5-HTP or melatonin (Rowland).

Migraines are thrice more frequent with women than with men throughout their child-bearing years (Walling 2002). Furthermore, women's migraine attacks are linked with their menstrual cycle and thus warrant safety measures in the use of contraceptives and bodily changes in pregnancy and menopause. These are the findings of Matharu and his colleagues in their review of migraine in women. The team found that, while 60% of these women sufferers reported these attacks during menstruation, only 14% of them had migraine exclusively linked with the menstrual cycle and almost always only in the first two days of menstruation. These attacks during the menstrual period do not seem to differ from other migraine headaches and less likely to be preceded by aura. A record of headaches will be needed to confirm the link between migraine and menstruation, especially if the latter is irregular (Walling). Doctors recommend prophylactic medication two days before the start of the menstruation period with drugs like naproxen or fenoprofen. They recommend mefenamic acid if the patient has dysmenorrheal. Perimenstrual estrogen supplementation, like the 100-mcg transdermal estrogen patch, may be effective. Danazol, tamoxifen and bromocriptine may be used in severe cases, the doctors say (Walling).

In the case of women with migraine, headaches get worse in 18 to 50% of the cases, improve in 3 to 35% of the cases or have no change in 39 to 65% of the cases when taking oral contraceptives (Walling 2002). Migraine has also been observed to occur with estrogen withdrawal but this can be contained by the continuous use of oral contraceptives. The most serious concern is an increased risk of ischemic stroke, which at present, is still small but, nonetheless, is increasing at the rate of 5-10% per 100,000 women among those without migraine and at the rate of 17-19% per 100,000 women in those with migraine. The risk appears greater in those with aura and in those women with additional risk factors, such as new and persisting headache or new-onset migraine aura. Hence, doctors recommend that the women use the lowest possible dosage of estrogen and avoid the use of oral contraceptives if they have migraine aura (Walling).

It has been noted that 60-70% of these women experience some relief during pregnancy (Walling 2002). Their treatment options are restricted during this period when ergotamines and triptans are not recommended. Acetaminophen is used for pain during this period rather than ibuprofen and naproxen. Antiemetics like metoclopramide, chlorpromazine, prochloperazine and promethazine are considered safe during pregnancy

It has also been observed that migraines improve in two-thirds of women who go through physiologic menopause, although attacks can be severe and frequent during the perimenopause stage. There appears no increased risk of stroke with the increased use of hormone replacement therapy or HRT in these women. Symptoms may improve or get worse with HRT. Doctors recommend that these women use low-dose and continuous regimens of synthetic ethinyl estradiol if their symptoms become severe or frequent (Walling).

A recent study conducted with 24 subjects uncovered the perceptions and needs of patients with migraine (Cottrell 2002). Results of the study centered on the impact of migraine attacks on family, misunderstanding by others, effect on work, physician care issues and issues concerning medical insurance and insurance companies. These results showed that the subjects were interested in understanding their migraine and would like to acquire information besides relief from their pain. They would want to build a relationship with their physicians with whom they could come up with a treatment plan suited to their particular situation rather than receive only generic educational materials. They preferred a team approach to their treatment (Cottrell).

Duke University report identified and summarized evidence derived from other reports of empirical studies on the cost of care and economic impact of chronic headaches (Life Sciences 1999). Findings covered the utilization of health care resources, such as provider consultation, predictors of securing a headache diagnosis, the use of the emergency department and hospitalization; pharmaceuticals for prescription as well as nonprescription drugs, preventive medications, frequency of medication use and the effect of sumaltriptan; non-pharmacological therapy; and work loss. The report says that chronic headache sufferers come from a diverse population, which is difficult to study. Population-based studies reflect that many of them do not seek medical assistance or use prescription medicines for their pain. Those who consult physicians have more severe headache symptoms, use more prescription drugs and are heavier users of medical resources (Life Sciences).

Of all the surveyed adult sufferers of migraine, less than half have been diagnosed by a physician or received prescription treatment from a physician (Polizzotto 2002). Records show that 2.8 million clinical visits per week are for migraine complaints and that it costs U.S. employers more than $13 billion per year. Direct medical costs account for more than $1 billion annually.

The five approved and available triptan medications for the treatment of migraine headache are sumatriptan, zolmitriptan, rizatriptan, almotriptan and naratriptan (Huffman 2002). They are of comparative effectiveness. Studies show that there are about 3.4 migraine-related strokes for every 100,000 persons each year and link a history of migraine to a higher risk of stroke. Triptans vasoconstrict the meningeal blood vessels and this action links the higher incidence of vascular events to the use of anti-migraine drugs (Huffman).

A randomized trial on subjects who suffered from migraine revealed the benefits of acupuncture in combination with usual pharmacologic care (Vickers et al. 2004). Participants on the trial who received acupuncture scored higher and had fewer visits with medical practitioners and fewer sick days at work. The overall results prompted that a policy using local acupuncture service be adopted to improve clinical benefits of standard care for sufferers (Vickers et al.).

A holistic approach in the management and prevention of migraine is preferable and should include changes in lifestyle and behavior, in one's diet or nutrition and in the proper therapeutic approach (Knosh 2002). This can be done by identifying and avoiding migraine triggers, taking certain herbs and supplements. Among the herbs that can relieve migraine are tanacetum parthenium, petasites hybridus and zingiber officinalis. Supplements that help do the job include 5-HTP, cal itonin, essential fatty acids, riboflavin and magnesium. Migraine attacks may also be prevented by the use of coenzyme Q10 (Gaby 2003) and lisinopril, an angiotensin converting enzyme inhibitor (Schader 2001 and Singer 2003). Botulinum Toxin A also promises to be a cure for migraine, as suggested by the findings of a study on 90 subjects, about half of whom responded positively to the test (Rose 1999). The toxin was injected in the occipital and surrounding areas of the head.