RICHARD LIPTON, MD: Headache, far and away, is the most common human affliction, and in the United States, there are 28 million people who have migraine, which is perhaps the most disabling form of primary headache.
ANNOUNCER: Hippocrates described the symptoms of migraine as far back as 400 BC. While centuries have passed and quantum strides in medicine have been made, migraine is still turning some lives upside down.
RICHARD LIPTON, MD: Migraine headaches tend to be one-sided, throbbing, moderate or severe pain that are made worse by routine physical activities. And some people talk about headbanger headaches, but all that refers to a quality of pain that's throbbing. And, in fact, during migraine attacks, the blood vessels become inflamed and dilated. And, in many people, the pulsing or throbbing pain is actually coordinated with the pulse, because what's triggering the pain is the blood vessel stretching every time the heart beats.
Migraine attacks are always accompanied by something other than the pain; people may have nausea, sensitivity to light, sensitivity to sound. Some people have sensitivity to odors. And in 20 percent, the aura, or the visual display.
ANNOUNCER: That unusual "aura" is an unwelcome light show that can accompany migraine.
RICHARD LIPTON, MD: The most common kind of aura is the visual aura, which often consists of spots of light or zigzag lines or a graying out of vision. And, in a textbook case of aura, those features may begin in a small part of the visual world and then expand to encompass a greater and greater part of the visual world.
ANNOUNCER: Experts can't really predict who it will strike, although it does run in families. And it even happens to kids who might have stomach pain with their headache.
RICHARD LIPTON, MD: When children have abdominal migraine, the diagnosis is very long-delayed, because it just gets written off as, "Oh, he's got another episode of the flu, it's something he ate."
ANNOUNCER: Migraines don't last forever, although it can feel that way.
RICHARD LIPTON, MD: Migraine headaches last four to 72 hours. On average, untreated, they last 24 hours. Treated, it depends how good your treatment is, but they could last as little as ten minutes. On average, migraine attacks occur once or twice a month.
ANNOUNCER: We also know that a wide range of factors can precipitate an attack.
RICHARD LIPTON, MD: It's important to know that triggers vary enormously from person to person and there's a very, very long list of triggers, including dietary triggers. Chocolate is actually quite an important one.
Oftentimes, shifting body rhythms is a trigger. Traveling to high altitude can be a trigger as well. Some people find that travel and shifts in time schedules, too much sleep, too little sleep. Falling barometric pressure, which is something that happens in anticipation of a rainstorm.
A lot of the things that people notice, they don't tell their doctors, because they're afraid their doctors will think that they're making foolish or crazy connections.
ANNOUNCER: Hormones can also figure into sparking migraines, which may help explain why they affect more women than men.
RICHARD LIPTON, MD: Many women find that they get headaches the day before menstrual flow begins or the day that flow actually begins. And that effect, we believe, is an effect of estrogen withdrawal.
ANNOUNCER: So is there anything you can do limit the amount of the attacks? You can pay close attention to finding and avoiding triggers by keeping a daily log.
RICHARD LIPTON, MD: When people keep a headache diary, typically, I ask them to record when the headache began, how long it lasts, what they took for it, whether the medication worked. And then I ask them to think back about the 24-hour period prior to headache onset to see if they can identify a factor that may have triggered the headache.
ANNOUNCER: There are also medications that might prevent attacks.
RICHARD LIPTON, MD: Those include beta blockers like propranolol or Inderal and calcium channel blockers like verapamil or Calan. In addition, antidepressants are sometimes used to prevent migraine attacks as well.
The new class of compounds for migraine prevention are called neuromodulators. There's an idea which I think is correct that people with migraine have a sensitive or excitable brain and what neuromodulators do is reduce the excess electrical activity in the brain.
ANNOUNCER: And some feel relaxation techniques can also help.
RICHARD LIPTON, MD: Stress management plays a role, particularly in people for whom stress is a trigger, so biofeedback and cognitive-behavioral therapy are really quite useful.
ANNOUNCER: But when a migraine strikes, there are ways to manage the pain. And the answer could be as close as your morning cappuccino.
RICHARD LIPTON, MD: Caffeine is well known to relieve migraine headaches and is a common component of combination of ingredient products that are used for migraine.
ANNOUNCER: Caffeine can constrict blood vessels which become inflamed during a migraine. So don't decide to suddenly go cold turkey on coffee.
RICHARD LIPTON, MD: Caffeine withdrawal can be a powerful trigger of migraine and caffeine withdrawal is a major cause of weekend headache in people who sleep through their morning cup of coffee. What I recommend to patients is that they limit their use of caffeine on most days to just one cup of coffee a day, but that they use caffeine, if it's effective for them, as a headache comes on, either in combination with a painkiller or in combination with whatever they're taking to relieve their headache.
ANNOUNCER: Yes, painkillers. There is a high likelihood that you'll be needing one of those.
RICHARD LIPTON, MD: The nonspecific treatments are aspirin, acetaminophen, nonsteroidal antiinflammatory drugs like ibuprofen which gets sold as Advil or Motrin and then combination medications which may include caffeine, may include sedatives, may include other compounds.
On the specific treatment side, the mainstay of acute migraine treatment is now a class of compounds called the triptans.
ANNOUNCER: Getting control over a migraine can mean finding a way to regain control over your own life.
RICHARD LIPTON, MD: The sort of underlying purpose is to give people the tools they need so they can manage their headaches rather than having their lives run by their headaches.
©2007 Healthology, Inc.