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Mon June 25, 2012
Many Migraines Can Be Prevented With Treatments, But Few Use Them
Originally published on Tue June 26, 2012 9:36 am
Millions of Americans suffer from migraine headaches so severe they miss work, social gatherings and important family events.
But that doesn't have to be the case, according to Charles Flippen, a University of California, Los Angeles, neurologist and researcher. "Everyone says, 'Oh, well, everyone has headaches,' so they just push through and suffer in silence," says Flippen.
But a 2007 study found that 38 percent of migraine sufferers (men or women, who get migraines more often than men) could benefit from preventive treatment, yet only 3 percent to 13 percent currently use it.
Preventive treatment can reduce migraines by 50 percent. "For a given patient, half [the migraines] is usually a significant improvement," says Flippen. "If you go from 15 headache days per month down to seven, that's a significant change."
In April, the American Academy of Neurology released new guidelines to help physicians treat migraine patients and help them reduce both frequency and severity of headaches.
High blood pressure medication — particularly beta blockers — work for certain patients. For others, anti-seizure drugs help. Some patients benefit from Botox injections, and others from antidepressants.
Bottom line: If you suffer disabling headaches, go to your doctor to see if you are actually suffering from migraines and if you are a candidate for preventive treatment.
But even the best preventive treatments aren't cures. And patients can still suffer the pain, nausea and debilitation of migraines.
When that happens, Flippen says, the drug of choice is a class of medications called triptans, which relieve pain, nausea and sensitivity to light and sound associated with migraines. "They target serotonin receptors and are probably the biggest advance in migraine treatment in the last quarter-century," Flippen says, in helping reduce the acute pain once a migraine has started by maintaining serotonin levels in the brain.
Triptans are available by prescription and come in pill form, nasal spray or an injection. They're effective and quick, says Flippen. Unfortunately, about one in five patients doesn't respond to them. These are typically people with heart disease or diabetes, and for them, Flippen says, there are combination medications that include anti-inflammatory drugs and mild sedatives.
For patients with more mild symptoms, over the counter painkillers can work if taken at the very first sign of an attack. These include ibuprofen, naproxen, aspirin and acetaminophen.
But the mandate for all patients is clear: Reduce the number of migraines. Researchers are finding that "migraines beget migraines," as Andrew Charles, director of UCLA's Headache Research and Treatment Program, says.
He says its not clear why, but the "more migraines a patient gets, the more susceptible they become to having more," adding that "there seems to be this sort of tipping point where patients go from having episodic headaches to having them really continuously and being in a state of constant sensory sensitivity."
Charles and other researchers are investigating exactly why and how that "tipping point" occurs. They're also looking into a treatment that may someday become a cure. Neuromodulation uses a low-level electrical current to stimulate nerves in order to interrupt the transmission of pain.
While extremely promising, Flippen says, it will be years before such a treatment is available for patients.
STEVE INSKEEP, HOST:
Millions of Americans suffer from migraines, and some of those headaches are so disabling that people are forced to stay home from work. They miss social events, they miss family gatherings. And many sufferers do not know that there are ways to prevent migraines and also treatments that are available once you have one. NPR's Patti Neighmond has the story.
PATTI NEIGHMOND, BYLINE: For Allison Kamerman(ph), the headaches started in her early 20s. And once they did, she got them every day, starting early in the morning when she woke up.
ALLISON KAMERMAN: The pounding headache. You know, it would start and just increase in terms of magnitude of the strength of the headache.
NEIGHMOND: It lasted all day. She relied on over-the-counter pain medications. But the headaches just kept getting worse and some days they were completely disabling.
KAMERMAN: I would get nauseous, you know, to the point where I couldn't function at that point and I'd have to basically be off my feet lying down.
NEIGHMOND: Like many people, Kamerman thought they were just really bad headaches until her doctor referred her to UCLA neurologist Dr. Charles Flippen. Flippen says Kamerman's reaction is pretty typical.
DR. CHARLES FLIPPEN: Everyone says, oh, well, everyone has headaches. And so they just sort of push through or suffer in silence.
NEIGHMOND: But they don't have to, he says. Nearly 40 percent of those who suffer from migraines can be helped by medications to prevent the headaches. Many can reduce the number of migraines by half.
FLIPPEN: For a given patient, half is usually a significant improvement. If you go from 15 headache days per month down to 7, that's a significant change.
NEIGHMOND: Flippen diagnosed Allison Kamerman with migraines five years ago. He offered her a choice of treatments that are usually used to treat other conditions but have also been shown to reduce the frequency and severity of migraines. High blood pressure medication, particularly beta blockers, work for certain patients. For others, anti-seizure drugs help. Some patients benefit from Botox injections. And for Kamerman, an antidepressant worked.
KAMERMAN: I'm not getting them every day. When I was on no medication at all I was getting them every day, and severely every day. Now, it's less severely.
NEIGHMOND: But even the best preventive treatments aren't cures. And patients can still suffer the pain, nausea and debilitation of migraines. When this happens, Flippen says, the drug of choice is a class of medications called triptans, which relieve pain, nausea and sensitivity to light and sound associated with migraines.
FLIPPEN: They target serotonin receptors, and they are serotonin - what we call, agonist or activators - and are probably the biggest advance in migraine treatment in the last quarter century.
NEIGHMOND: Triptans come in pill form, nasal spray or an injection. They're effective and quick, says Flippen. Unfortunately, one in five patients don't respond to them. These are typically people with heart disease or diabetes. And for them, Flippen says, there are combination medications that include anti-inflammatories and mild sedatives. But the mandate for all patients - reduce the number of migraines.
FLIPPEN: Migraines beget more migraines.
NEIGHMOND: Dr. Andrew Charles, also a neurologist at UCLA, is director of the headache research and treatment program. It's not clear why, but the more migraines a patient gets, the more susceptible they become to having more.
DR. ANDREW CHARLES: There seems to be this sort of tipping point where patients, you know, go from having episodic headaches to having them really continuously and being into the kind of state of constant sensory sensitivity.
NEIGHMOND: Which is why it's so important not to dismiss chronic severe headaches as just something to suffer through. Getting to the doctor, getting diagnosed and treatment, if necessary, is essential. Now, there's even some better news. At UCLA's headache lab, researchers like Charles Flippen are investigating a treatment that might someday become a cure.
FLIPPEN: We're looking at using low-level electrical currents to stimulate peripheral nerves - so the nerves that come out to your face and to the head, the surface of the head, and that stimulation feeding back to where those nerves originate in the brain and altering the workings of the networks within the brain in order to interrupt the pain transmission.
NEIGHMOND: It's called neuro-modulation and the hope is that it will change how the brain responds to pain. It's an extraordinarily promising therapy, says Flippen. But lots more research is needed. And that could take up to 10 years.
Patti Neighmond, NPR News, Los Angeles.
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INSKEEP: It's MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.