Disease is more than a headache

Headaches, like the common cold, are a malady that is ubiquitous among humans (and likely other animals). They are difficult, if not impossible, to prevent in their entirety, and are experienced at all levels from nagging and annoying to excruciating and disabling. Headaches have been around for millennia; scientists have found ancient skulls with perfectly healed, round holes in them, performed by healers hundreds of thousands of years ago, which are thought to have been attempts at releasing the demons causing chronic, persistent headaches. Many of my most desperate patients can relate to wanting just such a “cure.”

June is Migraine Awareness Month.

This typically goes unnoticed by most folks, so I am glad to be allowed to address this problem, which affects 12% of the population around the world. Unlike a head cold, there are few, if any, outward signs that a person is having a headache, so many people are unaware someone is sick. This plays a role in propagating a lack of awareness of the fact that migraine is a disease. It causes significant disruption to the lives of people who have migraine, as well as their families and employers. Migraine can lead to legitimate disability from any employment and cause a downward spiral socioeconomically and psychologically.

Women are three times more likely than men to experience migraine, probably due to the brain’s sensitivity to estrogen fluctuations. It is passed down from either or both parents. The extent to which each individual suffers the effects of the genes involved varies widely — from no headaches to occasional attacks to almost daily suffering. Since many different genes are involved and many environmental factors play a role, we cannot predict who will be affected and to what degree. It is known, however, that severe childhood trauma, either from natural or wartime disasters, child abuse or other extreme stressors, can lead to detrimental changes in the developing brain, causing a higher incidence of chronic pain and/or headache for the rest of that person’s life.

Due to old ideas of migraine patients being weak or hysterical, they often “suffer in silence,” especially at work. But migraine is a legitimate brain attack! You may be surprised to learn that a headache is only one element of a migraine episode. Migraine episodes also cause severe sensitivity to lights, sounds and smells. During an episode, the brain starts to misfire, causing visual and sensory disturbances and problems concentrating. Speech can be affected. Nausea and sometimes vomiting happen as well. Normal movement, such as walking, worsens the symptoms, so the migraine sufferer then has to go to bed until the worst of the attack subsides.

Although most types of problematic headaches cannot be cured per se, medical researchers have discovered critical elements of migraine that have advanced the available treatment to a greater degree of control than we have ever seen. Before the 1990s, headache relief remedies consisted mainly of painkillers (good for pain from a broken bone, not so practical for a headache), compounds stemming from ergot, a crude but effective substance, and vinegar-soaked rags tied around the head. Preventive agents were drugs that were “borrowed” from other medical specialties and consisted mainly of medications for blood pressure, depression or epilepsy. Although we still use those drugs, and they work for some, we now have the advantage of pharmaceutical agents designed from the beginning to specifically address the problematic processes that lead to a migraine attack. We can both support the brain to have fewer and milder attacks and the ability to stop an attack before it gets too far, all with far fewer side effects.

People with headaches should seek medical attention. Migraine is a disease that can be associated with other dangerous medical problems in the brain, head or neck region or from a more remote illness. Once those problems have been ruled out by proper examination and testing, the goal is to allow the person to start to control the attacks rather than the headaches controlling their lives. Patients can learn how to manage environmental triggers and maintain a healthy lifestyle to decrease attacks. Contemporary migraine-specific pills, nasal sprays, self-administered injections, infusions or, in specified cases, Botox injections, can significantly decrease the effects of this illness. Medications to stop attacks are available that can allow a person to stay at work after a short rest, keep their plans to attend family activities or enjoy a social outing and avoid spending a miserable night in the emergency room.

For those of you wanting more information on migraine and other headache disorders, the reader is encouraged to look into the American Migraine Foundation, the National Headache Foundation and the American Headache Society.

Debra Davis, M.D., is a clinical professor of neurology at LSU Health Shreveport.