Migraine myths busted

No wonder the plethora of sinus remedies on the market and the endless prescriptions for antibiotics have yielded so little relief.

While the findings may bring joy to the afflicted, the good news is that there are many drugs available now that can either prevent migraine attacks or abort the headaches once they start.

DON8217;T SUFFER ANY MORE

Migraine therapy has come a long way in two decades. Surveys indicate that only about half of 8220;classic8221; migraine sufferers are reaping the benefits of what modern medicine offers.

Those who know or suspect that they have migraines should see a neurologist or a headache specialist to obtain a proper diagnosis for the best available treatment. In fact, the doctor is the most important part of availing relief.

Too many people try to muddle through, sometimes causing more frequent migraines by overusing self-prescribed medications. Others may see a physician who fails to help and then conclude that their headaches are beyond help. Even if an expert was unable to help you years ago, there are now so many new therapies8212;and a far better understanding of the nature of migraines8212;that you8217;d be wise to try again.

THE SYMPTOMS

The World Health Organisation ranks migraines among the most disabling ills. A migraine is more than a headache. The throbbing pain, which typically occurs on one side of the head, is often accompanied by nausea, vomiting and extreme sensitivity to light and sound. A person feels sick all over.

Symptoms may include nasal stuffiness, blurry vision, diarrhoea, abdominal cramps, abnormal sensations of heat or cold, anxiety, depression, irritability and inability to concentrate. Without effective treatment, those most severely affected are unable to cope with even the simplest tasks and must take to their beds till the attack ends.

Afterward, people often feel tired, irritable, listless or depressed, though some feel unusually refreshed and energized. About 4 per cent of pre-pubescent children have migraines. After puberty, the incidence rises to 6 per cent among men and 18 per cent among women and gradually declines after age 40.

THE REASON

The higher rate of migraine among women is linked to fluctuations in blood levels of estrogen: the drop in estrogen just before menstruation sets off menstrual migraines, which tend to be more severe and longer lasting than other forms. Though long believed to be primary vascular headaches, the result of constriction then expansion of blood vessels in the head, migraines are now recognised to stem from neural changes in the brain and the release of neuroinflammatory peptides that in turn constrict blood vessels. The headache often begins before these vessels dilate. The inflammatory peptides sensitise nerve fibers that then respond to innocuous stimuli, like blood vessel pulses, causing the pain of migraine.

For some people, the headache is preceded by an aura of visual, sensory or motor symptoms that last for less than an hour. They include seeing flashing lights or specks, numbness in the hand, dizziness and an inability to speak.

People who experience these have a doubled risk of cardiovascular diseases, according to findings published last month in The Journal of the American Medical Association. Migraines sometimes run in families, and these familial migraines have been traced thus far to mutations in either of two genes.

PIN DOWN YOUR CAUSE

To determine what may set off your headaches, keep a calendar to record occurrences, noting the foods you ate or the circumstances preceding each one. If you are a woman of childbearing age, record the stages of your menstrual cycles. If necessary, to uncover foods that may cause your headaches, try an elimination diet, cutting sharply on various foods, then reintroducing them one at a time. This way, a friend discovered that her migraines were set off by corn and corn products.

THE MEDICATION

Preventives and treatments are numerous. If one doesn8217;t work, try another, but under medical supervision. Do not try self-medication.

In case of migraines that are rare, a drug in triptans class at the very onset of a headache can usually abort it or reduce its severity and duration.

But some people are helped by relaxation therapy, biofeedback or stress management. Also, several good studies have shown benefits from supplements of the B vitamin riboflavin or the herb butterbur.

THE MYTHS

8226; Migraine sufferers have long been cautioned to avoid certain foods believed to bring on attacks, especially chocolate, alcohol red wine in particular and aged cheese. But the evidence supporting this notion is meager. More common causes include stress positive or negative, weather changes, estrogen withdrawal, fatigue and sleep disturbances hence, perhaps, the association with alcohol, which can disrupt sleep, as well as overuse of over-the-counter pain medications.

MIGRAINE OR SINUS HEADACHE?

8226; Migraines are misclassified as sinus or tension headaches probably because they can cause nasal congestion, pressure or pain in the forehead or below the eyes, and discomfort on both sides of the face.

In one study by Dr Eric Eross of Scottsdale, Arizona, 90 of 100 people with self-diagnosed sinus headaches were found to have migraines. Neither the American Academy of Allergy, Asthma and Immunology, nor the American Academy of Otolaryngology recognises 8220;sinus headache8221;. Headaches only sometimes occur with sinus infections. But call it sinus or migraine, one thrapy does work: Nasal irrigation, a traditional rinsing technique can be learnt easily, reports researchers from the University of Wisconsin. Used for thousands of years in the Ayurvedic and Yogic traditions, nasal irrigation involves rinsing the nasal cavity with a saline solution to get rid of mucus that may contain allergens or infectious agents. A six-month trial of nasal irrigation in patients with chronic stuffy nose rhinitis and sinusitis reduced symptoms and medication use and improved the quality of life.

JANE E BRODY