Heading off migraines 

 Among the oldest and most disabling disorders, more common than diabetes or even arthritis, headaches remain in large part a mystery. Most headaches fall into three categories:

• Tension headaches: A steady dull ache associated with
muscle tension; the most common kind of headache,

• Cluster headaches; Usually brief but severe, striking in a
group for up to a few hours, often in the early morning.

• Migraine headaches.

 It's sometimes hard to teli one type of headache from another. Headaches are also sometimes classified as "primary" or "secondary." The great majority are primary, meaning they have no
identifiable cause; secondary headaches are a symptom of an underlying disease, such as an infect ion or neurological problem,
For example, sinus headaches are caused by blockage or inflammation of the sinuses. But a 2004 study found that what people describe as sinus headaches are almost always migraines.

We focus here on migraines, which affect an estimated 28 million Americans. According to a new study from the Mayo Clinic, up to one-fourth of all women have migraines in their reproductive years. Women are two to four times as susceptible as men—though, curiously, until age 7 more boys have migraines than girls.

Migraines; knowns and unknowns
"Migraine," from the Greek, means "half a skull," since the pain often occurs on only one side of the head. About 20% of migraines are preceded by, or start with. an "aura"—neurological warning signs involving distorted vision, such as zigzag patterns of shooting lights, blind spots, and/or a temporary loss of peripheral vision. Aura may also include tingling in the arm or face, speech difficulty, or confusion, The throbbing, pulsating pain of a migraine can be incapacitating and can last from a few hours to several days. It may be accompanied by nausea, vomiting, light- headedness, fatigue, and sensitivity to light and noise, Attacks typically occur one to four times a month,

Most migraine sufferers have a family history of the ailment. In women, hormonal changes clearly play a role: migraines increase after menstruation begins. Susceptible women may have more attacks if they take oral contraceptives; they may have fewer attacks during pregnancy. Menopause may or may not reduce migraines for women. With age, though, attacks usually become less severe and less frequent and may eventually stop.

Attacks can also be triggered by certain substances in foods or by fatigue, stress, and environmental factors, such as glaring light, strong odors, noise, rocking motion, and changes in weather or altitude. The evidence that changes in atmospheric pressure bring on migraines is pretty scarce, but many people with migraines believe they do. Emotional factors may also be involved, though it's hard to tell whether depression, for instance, is the cause or result of migraines. People taking certain medications to lower blood pressure sometimes report migraine relief, but that does not necessarily mean that high blood pressure is a cause- According to one theory, migraines involve abnormal expansion and contraction of blood vessels in and around the brain. A newer theory claims that something activates pain fibers in the trigeminal nerve (running through the head and supplying sensa-
tion to most of the face), which release chemicals that dilate blood vessels and irritate surrounding nerves. Imbalances in brain chemicals, notably serotonin (which helps regulate perception of pain), may also be a factor. Smoking and obesity may increase the risk.

Looking for relief
Many people never see a doctor about migraines, but if they do, they turn to their primary-care physician. Surveys show that about half of those with migraines don't know that's what their headaches are.

Your doctor will undoubtedly tell you to start with over-the counter (OTC) pain relievers. The most common are nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such as Motrin or Advil), and naproxen (Aleve), or else acetaminophen (such as Tyienol). According to recent studies, aspirin in dosages of 1,000 milligrams (about three standard tablets) or acetaminophen in the same dose is effective even for severe
migraines. Note: Don't use enteric-coated aspirin for pain relief, because it takes effect far more slowly.

If one type of pain reliever doesn't provide sufficient relief, try another type, An OTC combination of acetaminophen, aspirin, and caffeine—such as Excedrin or other "migraine formulations"—is often effective. Caffeine boosts the analgesic effect of aspirin, but in some people caffeine may actually trigger migraines.
 

If OTC pain relievers aren't sufficient and/or your migraines are frequent or severe, talk to your doctor about prescription drugs, such as prescription-strength NSAIDs, ergot-containing drugs, Midrin, and "triptans" such as sumatriptan (brand name Imitrex). The triptans affect the neurotransmitter serotonin.

Drugs work best when taken at the first sign of a migraine.They may, however, have unpleasant and sometimes dangerous side effects, and frequent use of pain relievers can result in "re-bound" headaches.

Other treatments

Icing. Reusable gel packs wrapped around the neck may provide relief, as may running cold water over your head.

Massaging muscles in the neck, forehead, and temples may provide some relief,

Tight headband. One study found that an elastic headband with two small rubber disks (positioned to apply pressure over the painful areas) provided partial relief for most migraine headaches,

Relaxation. Learning to relax can reduce muscle tension and shift attention aw^y from the pain. One common technique calls for tensing and then relaxing specific muscle groups, working from the feet to the head, while focusing on deep, regular breathing. Yoga or meditation may also help.

Biofeedback. This calls for hooking up a person to a device that feeds back readings on a physiological variable connected with headache pain—skin temperature, for instance, which is related to contraction of blood vessels. This may allow the subject to gain some control over the variable, decrease muscle tension, and reduce anxiety, all of which may contribute to pain relief,

Preventing migraines

Migraines are highly persona!, Keeping a diary (particularly a food diary) may help you find out what triggers your migraines, You may find that too much or too little sleep, a stressful circumstance, or some food or beverage is associated with the attacks. If you have severe or frequent migraines, several prescription drugs can help prevent attacks. These include beta- blockers, calcium channel b lockers, various antidepressants, and anticonvulsants. You need to take them daily.

Certain foods and beverages can trigger headaches because  they contain substances that constrict or dilate blood vessels in the brain. Major culprits are tyramine and other "amines," which occur naturally in many foods, a-s well as the nitrites used in cold cuts and hot dogs. The following have been implicated; aged cheeses, caffeinated drinks, alcoholic beverages (especially red wine), freshly baked yeast products, chocolate, nuts, peanut butter, sulfites (in dried fruit), yogurt, sour cream, hydrolyzed vegetable protein, and cured or processed meats.
Hunger can bring on migraines in some people, Try to eat regularly. Follow a regular sleep schedule, too, And try to exercise regularly,

An herb for migraines?
You may want to try the herb feverfew, though studies on it have had conflicting results, Health Canada (the Canadian FDA) recognizes it as a preventive or treatment for migraines, In Canada you can get standardized doses of the dried leaves, but in the U.S. feverfew preparations may have very little plant material in them,
Feverfew may interact adversely with aspirin. Side effects may include mouth ulcers, stomach irritation, and nausea. Pregnant women shouldn't take it, - -
Botulism toxin (such as Botox), an anti-wrinkle injection that works by paralyzing facial muscles, seems to prevent migraines for up to three months in some people, Riboflavin (vitamin B2) and magnesium have also been helpful in several studies. Some people find that hypnosis or acupuncture helps, though there isn't good evidence to support their use.

Finally, the dietary supplement coen7.yme Q-10 (a vitamin- like substance that the body manufactures) has been shown in one small study published in Neurology in 2005 so reduce the number of days per year people suffered from migraines. The dose used was 300 milligrams—but the correct dose is unknown and, in any case, you can't be sure the bottle contains what the label says. since supplements in the U.S. are largely unregulated. Also, such high doses are very expensive,

Bottom line: Nothing works for all migraine sufferers, so keep trying until you find something that works for you.

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