Finally, Mercy For Migraine Sufferers

Lawrence Newman started getting migraines when he was 12. "My doctors told my family I was getting headaches because I was worried about going to a good college," he says. "You hear that, and you learn there's not much point in complaining." Many years and several degrees later, Newman, 40, is director of the Headache Institute at St. Luke's-Roosevelt Hospital in New York. He is also one of a growing cadre of doctors educating the medical profession and the public about migraine treatments.

Recently discovered therapies have given cause for optimism. A new class of drugs called triptans can stop severe migraines in 30 minutes to an hour, allowing patients to function normally. In addition, magnesium supplements have proved effective for some. "Ninety-five percent of all headaches can now be controlled," says Suzanne Simons, executive director of the National Headache Foundation in Chicago (800 843-2256; www.headaches.org). "If you're suffering, you're suffering needlessly."

PUZZLING. Migraines long confounded doctors because of their idiosyncratic nature. A classic migraine starts with a premonition or aura--vision blurred by flashing lights, zigzagging lines, or rainbows. This is followed by nausea and intense pain on one side of the head as well as extreme sensitivity to light, sound, and smells. A more common form of the ailment involves these symptoms without the aura. Headaches last from 4 to 72 hours. They run in families, and women sufferers outnumber men by 3 to 1.

Scientists still can't pinpoint the exact cause of migraines, but they believe it's a combination of genetics and environment. They used to think excessive constriction and dilation of blood vessels triggered migraines because of the headaches' throbbing. But recent research indicates blood vessel activity is only a symptom. Patients are predisposed to hyperactivity of the trigeminal nerve, which affects feeling in the face and head. The hyperactivity is related to a drop in the neurotransmitter serotonin.

In 1993, Glaxo Wellcome introduced Imitrex, an injectable triptan that acts on specific serotonin receptors in the brain and relieves symptoms quickly after onset. In the past 18 months, similar drugs have become available from various makers. "The triptans are a unique class of drugs, which treat the entire complex, not just the headache but the nausea and sensitivity to smell, light, and sound," explains Newman.

The triptans include Amerge, Zomig, and Maxalt. Because nausea and vomiting associated with migraines may prevent patients from swallowing pills, some triptans are injectable, dissolve on the tongue, or come in nasal sprays. One side effect of triptans is they constrict blood vessels in the heart as well as head, and so are not recommended for people with uncontrolled hypertension or heart disease. Nonetheless, triptans rarely lead to heart attacks. "The cardiovascular incidence is one per million doses for the most-studied drug, Imitrex," says Dr. Fred Sheftell, director of the New England Center for Headache in Stamford, Conn. (203 968-1799; www.headache.net).

Milder migraines often respond to over-the-counter drugs such as ibuprofen or naproxen. The Food & Drug Administration recently approved Extra Strength Excedrin specifically for relief of migraines and requested it be repackaged as Excedrin Migraine. It contains aspirin, acetaminophen, and caffeine.

Alternative therapies and relaxation techniques also offer hope. Studies by Dr. Alexander Mauskop, a neurologist at the New York Headache Center (212 794-3550), suggest that migraines can be caused by a magnesium deficiency. Sufferers respond to a daily intake of 400 to 600 milligrams of the mineral. Vitamin B2, or riboflavin, in high daily doses, shows promise in preliminary studies, and an herb called feverfew, derived from chrysanthemum leaves, has been effective for some patients, although the data on it are mixed.

Biofeedback has proved helpful for young sufferers. More than adults, children are open to techniques for relaxing muscles that can affect circulation. Newman's son, Daniel, 10, started learning biofeedback to control his migraines when he was 6. "He can stop a headache in five minutes," Newman says. "I'm jealous because it doesn't work for me."

Diet, exercise, and stress management are all pieces of the treatment for migraine. For more information, check out the American Council for Headache Education in Mt. Royal, N.J. (609 423-0258; www.achenet.org); MAGNUM: Migraine Awareness Group in Alexandria, Va. (703 739-9384; www.migraines.org); or Chicago's Diamond Headache Clinic (800 432-3224; www.diamondheadache.com). Sufferers can now find a more sympathetic medical community--and many more options for reclaiming hours lost to debilitating pain.