A Revolution in Migraine Care

Not long ago, migraine sufferers had no choice but to head for darkened bedrooms to wait out the pain. Or they could down powerful painkillers that could lead to ferocious "rebound" headaches and, ultimately, addiction.

Often, doctors couldn't - or wouldn't - help much. As recently as a decade ago, many of them dismissed migraines as psychologically based ailments, essentially telling patients, "It's all in your head."

But dramatic breakthroughs in recent years have led to better understanding of migraines, which produce intense, throbbing pain, typically on one side of the head, sometimes accompanied by nausea and sensitivity to light and sound. And new treatments have vastly improved the prognosis for sufferers.

That's a message specialists are hoping to convey during National Headache Awareness Week, June 1-7.

Dr. Lisa K. Mannix, a neurologist who has been treating headaches exclusively for seven years since completing her residency, says migraine care has been "revolutionized" in the past decade.

"I often joke that I didn't have to practice in the dark ages, which makes some of my [older] colleagues a little jealous," says Mannix, who's in private practice in Cincinnati. Unlike her predecessors, she says, "I know I have treatments that are very effective for the majority of patients."

A huge advance in the treatment of migraines came in 1993 when the first triptan medication hit the market. Sumitriptan, also known as Imitrex, mimics the neurotransmitter serotonin, whose supply drops off during migraines. Sumitriptan causes blood vessels to constrict, which soothes the inflammation of nerve endings in the brain and eases pain.

Over the past decade, six other triptans have hit the market. Like other classes of drugs such as antidepressants and antibiotics, different triptans might work for some people, but not others. So more choices mean more hope for migraine sufferers.

Other new treatments appear to help prevent migraines or reduce their frequency and severity. These include Botox, better known for its ability to smooth away facial wrinkles, as well as beta blockers and calcium-channel blockers, both used to treat high blood pressure and coronary artery disease, experts say.

Antidepressants that affect serotonin levels can help prevent migraines. And anti-seizure medications, used to treat epilepsy and bipolar disorders, also have shown promise for their ability to prevent migraines.

And more new treatments seem likely. Dr. Seymour Diamond, executive chairman of the National Headache Foundation, says he knows of 14 studies now under way on migraine treatments.

"There's a lot of hope," Diamond says. "There's going to be more and more help and better drugs and drugs suitable to more people."

Still, millions of sufferers aren't getting the newer, proven medications for their migraines. One reason: Experts say about half of the estimated 30 million Americans with migraines are never properly diagnosed.