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Taming the migraine beast

With its sudden onset and searing pain, a migraine headache has no equal. But unlike a decade ago, when aspirin was the primary recommended treatment, researchers are now learning how to tame migraines with potent new medications and other therapies. That’s great news for the estimated 18 million women who experience migraines regularly.

Signs of trouble

Various factors trigger a migraine by somehow throwing the brain’s pain-control chemicals out of balance. This imbalance unleashes neuropeptides that flood the nerve endings surrounding the brain, resulting in severe pain.

Almost all migraines have either “classic” or “common” warning signs. Classic symptoms include an aura of sparkles, flashes, zigzagging lights or blind spots along with tingling in the face, hands or legs that occur 20 to 40 minutes before the pain arrives. A common migraine is not marked by an aura. Instead, patients feel euphoric or highly energetic; have a craving for sweets; or are unusually thirsty, drowsy or cranky several hours before the migraine hits.

To make matters worse, migraines last from four to 72 hours; can affect both sides of the head; and often cause dizziness, nausea and acute sensitivity to light and noise, too.

A family tradition

Scientists don’t fully understand migraines. They appear to be concentrated in families, which suggests a genetic cause. Who gets migraines? They’re three times more common in women than men and are most likely to strike between ages 25 and 44. Seventy percent of sufferers seem to have inherited the condition. If both of your parents have migraine, you have a 75 percent chance of getting migraine, too. If only one parent is a migraineur, you have a 50 percent chance of becoming one, too.

Stopping the attack

Successfully handling migraines involves self-care, new pain-stopping drugs and lifestyle changes that avoid triggers. Together, these measures often reduce and sometimes eliminate migraines. Here are some steps worth trying:

  • Keep a diary. When migraines attack, note the time and place; their duration; what relieved the pain; and what you ate, drank or did in the 24 hours prior.
  • Don’t pull the trigger. Migraine triggers include beer and wine, food additives, aged cheese, aspartame, caffeine, pollution, stress, fatigue, bright lights, weather changes, jet lag, strong odors, overexertion and missed meals.
  • Check the time. If you’re still menstruating, your period may be another culprit. Up to 65 percent of women have had migraines around their menstrual cycles.
  • Take it easier. Biofeedback is effective against migraine pain. Yoga and meditating can release stress. So can taking time for hobbies, reading or just watching the world go by from the comfort of your sofa.
  • Get physical. Aerobic exercise is known to limit and even prevent migraines. Work out for 30 minutes three or four days a week.
  • Give up cigarettes. Smoking not only causes headaches but makes them worse.

Drugs that work

When over-the-counter pain relievers don’t work, see your doctor. Many patients find relief with prescription-only drugs. Triptan-class drugs such as sumatriptan can stop a migraine in its tracks at the first sign of an aura. However, these drugs should not be used by people with certain heart conditions.

Some compounds for other conditions are also effective as migraine-prevention treatments, including:

  • Blockers. Beta-and calcium channel blockers for heart disease, which slow heart rate and relax blood vessels, sometimes prevent migraines. How they do this is not yet known.
  • Antidepressants. Tricyclics like amitriptyline boost serotonin levels in the brain. They’re very effective at blocking all headaches, including migraines.
  • Epilepsy drugs. Valproic acid, used to treat epileptic seizures, seems to prevent migraines in some people, though the reasons are unclear.
  • Nutrients. Taking 400 milligrams of vitamin B2 daily helps to prevent migraine pain in some patients. Magnesium infusions are sometimes helpful, too, but it’s not known if oral magnesium supplements are as effective.