Heading Off Migraine Pain

Migraine sufferer, artist and studio owner Michael John Coleman provided these works for an exhibit at the D.C. law offices of Covington & Burling. Mr. Coleman, who also founded a migraine awareness group, says the severe pain he and other migraine sufferers experience sometimes can be expressed better through art than words.

Photos by Gerald Herbert/The Washington Times

By Karen Goldberg Golf

The Washington Times

Michael John Coleman was in first grade when he felt the first migraine headache that made him feel as though he was being hit by a baseball bat. The headaches continued into adulthood, occurring several times a month and lasting a few hours to more than two weeks.

"I remember sitting in class and seeing lightning bolts before my eyes," says Mr. Coleman, an Alexandria artist in his late 30s, of the migraine "aura" that often precedes the headache. "It makes you unemployable. Looking back, I don't know how I have lived through migraines."

Twenty-six million Americans suffer from migraines, according to the American Medical Association. Migraines can strike men, women and children, but they remain something of a mystery because symptoms differ and a variety of triggers can bring on the pain.

What migraines have in common is severe pain that lasts for four to 72 hours and is often on one side of the head; nausea and, often, vomiting; and sensitivity to light and sound.

"It is a severe, pounding headache and a misunderstood, mistreated and misdiagnosed condition," says Dr. Seymour Diamond, executive director of the National Headache Foundation and a headache specialist in Chicago. "About 30 percent of patients get a warning - an aura - before the headache, which can be seeing jagged lines or bright stars or having numbness in arms and legs.

"A migraine is caused when the brain sends an impulse to certain receptors that control the blood vessels," he says. "The blood vessels then constrict and dilate."

A key element in controlling migraines is understanding what triggers them. Seventy percent of migraine sufferers are women, and in more than half of female sufferers, the headache is linked to hormonal changes in the menstrual cycle, says Dr. Diamond, author of the book "The Hormone Headache" (Macmillan, 1995).

As often as 90 percent of the time, a migraine sufferer is genetically predisposed to attacks. Pinpointing what may trigger an individual's attack, whether it is the low-pressure weather system prior to a rainstorm (as in Mr. Coleman's case) or other common culprits, such as alcohol, aged cheeses, chocolate or onions is important.

Living with Migraines

Michael John Coleman with one of his artworks at the Covington & Burling law offices in the District. Mr. Coleman, owner of an art-and-photography studio, was in the first grade when he got his first migraine. He has been helped by Imitrex, approved in 1993.

Ellen Blau was 16 when the pounding headaches began.

"They got progressively worse," says Mrs. Blau, 49, of Detroit. "I was in bed for half the week."

Then the parade of drugs began. Mrs. Blau tried antidepressants, beta blockers and a class of prescription headache drugs called ergots.

"I still wasn't getting a lot of relief," she says.

After suffering for more than 20 years, Mrs. Blau finally traveled to see Dr. Diamond and tried different anti-depressants and anti-inflammatories.

Finally, she learned what might be triggering her pain and how to listen to her body. Mrs. Blau, whose mother also suffered from migraines, avoids common trigger foods that contain tyramine, which is found in raw onions and smoked foods.

She also became a believer in relaxation techniques. "I am a big believer that the mind and body are intricately connected," she says. "The pain is real. People have real pain. But I give full credit to feeling better to behavioral changes, I have trained myself to be very body aware. I set an egg timer for 15 minutes, and I check my body. I listen to my body before I get a headache. This has given me a coping method. I still need medication, but now I get a headache a couple of times a month. It used to be every day."

Mr. Coleman has been helped by Imitrex (generic name sumatriptan), a drug approved in 1993 by the U.S. Food and Drug Administration for migraine pain.

When he feels a migraine coming on Mr. Coleman injects himself with a dose of the medication, which he says gives him immense relief.

Before Imitrex was approved, migraines controlled much of Mr. Coleman's life. A former art director with the U.S. Navy, he had to give up his job a decade ago, when his pain was too severe. He opened his own art and photography studio, believing the hours would be more flexible. He says migraines also played a part in the breakup of his seven-year marriage.

Mr. Coleman's new passion is running MAGNUM - Migraine Awareness Group: A National Understanding for Migraineurs, a nonprofit group that seeks to educate the public about the headaches and to change federal legislation to include migraines as a disability.

He also has held exhibits of artwork by himself and other migraine sufferers, hoping the pain they feel, which often cannot be put into words, may be better expressed through that medium.

"Art has always been my life's drive," Mr. Coleman says. "It has allowed me to deal with the pain. Due to the episodic nature of the disease, what you learn to do is work like a banshee because you know at any time the migraine is going to attack you."

Controlling the Pain

A vast majority of migraine patients respond well to over-the-counter pain medication, such as aspirin or ibuprofen, says Dr. Joseph Scheller, a pediatric neurologist and co-director of the Headache Program Clinic at Children's National Medical Center in the District.

However, when migraines occur frequently or include vomiting, something stronger might be indicated, he says.

The triptan class of drugs, which includes Imitrex as well as Amerege, Zomig and Maxalt, acts on specific seratonin receptors in the brain and relieves the headache, nausea and light sensitivity soon after onset. To ensure they are not vomited, triptans can be found in nasal spray or injectable form as well as in pills.

Greg Groesch/The Washington Times	Source Glaxo Wellcome Inc.

Another effective remedy is the ergotamine class of drugs, newer forms of a drug that has been used to treat migraines for 50 years, Dr. Scheller says. Ergotamines are combined with caffeine to constrict blood vessels to relieve the throbbing and pain.

The FDA also has approved two drugs, the beta blocker Inderal (generic name propranolol) and Depakote (divalproex sodium) as daily preventive measures against migraines.

Because the nerves in the face and head are affected by the neurotransmitter seratonin, some migraine sufferers are often helped by seratonin-boosting anti-depressants such as Prozac (fluoxetine), Zoloft (sertaline) or Elavil (amitriptyline).

More controversial approaches to migraine pain also exist. A recent study by the New York Headache Center suggests that a magnesium deficiency may contribute to or cause migraines.

In trials, sufferers responded to a daily dose of 400 t o 600 milligrams of magnesium.

Finally, there is biofeedback, the relaxation training that has helped Mrs. Blau. Dr. Diamond says someone who suffers more than four headaches a month might want to look into this form of treatment, which is approved by the American Medical Association for the treatment of headaches.

"It is a method that teaches subjects to control specific target functions of both the central and automatic nervous systems, such as heart rate, blood pressure and muscle tension," he says.

"We teach you to relax the blood vessels that are causing the headache."

Migraines hit children hard but can be outgrown

By Karen Goldberg Golf

The Washington Times

Michael Smuck of Accokeek was 11 years old when he got a migraine that lasted more than a month. For 40 days, he remained at home, bothered by light and sound but soothed and distracted by watching movies.

Michael's migraine, one of about a dozen he has suffered in the past two years, was unusually severe. When children get migraines, the headaches usually last one to 12 hours rather than the four to 72 hours adults usually endure, says Dr. Joseph Scheller, a neurologist at Children's National Medical Center.

About 3 percent of American children suffer the debilitating effects of migraine headaches, Dr. Scheller says. Though he has seen patients as young as 3, most sufferers are about 10 when they get their first attack. About half of childhood migraine sufferers eventually will "outgrow" their symptoms, he says.

While it would seem that migraines would be difficult to diagnose in young patients, the severity of the symptoms -pain, dizziness, weakness and vomiting - makes it obvious to a parent that something is very wrong, even if the child is too young to articulate exactly what is happening.

"With children, it is very clear when they are sick," says Dr. Scheller, co-director of Children's Headache Program Clinic. "They like to play and have a good time, and when they are that sick, they stop what they are doing."

Most children who suffer migraines have a parent who also is predisposed to headaches, he says.

"There seems to be a genetic predisposition to migraines if the triggers are right," Dr. Scheller says.

Common triggers for children's migraines include too much or too little sleep, missed meals, emotional stress, too much chocolate or caffeine withdrawal. However, in half his patients, Dr. Scheller does not know what the trigger is.

The trigger to Michael Smuck's headaches remains a mystery. He has been tested for several allergies. He has seen three neurologists and has had a CT scan. He has taken a variety of drugs, including cortisone, over-the-counter Aleve, ergotamines, the beta blocker Inderal and Imitrex, and effective medication that made him vomit.

Michael, now 13, also has tried acupuncture and biofeedback, says his mother, Joan Smuck. Both alternative treatments worked a bit but have been discontinued because insurance did not cover them, she says.

"It is like night and day when he gets a migraine," Mrs. Smuck says. "When he feels good he cannot contain himself. When he is sick, he lies so still."

The class of drugs called ergotamines help ease the length and intensity of Michael's migraines, which occur every few months, she says.

All of the treatments Michael has tried are viable ways of treating migraines in children, Dr. Scheller says. Other children may benefit from preventive measures such as daily doses of high-blood-pressure medication or antidepressants, he says.

"Children can absolutely benefit from prescription migraine medications," Dr. Scheller says. "But many patients will also benefit from simple over-the-counter medications such as ibuprofen."

If a child is exhibiting migraine symptoms, parents often worry it is something more severe, such as a brain tumor. Dr. Scheller admits that is a possibility but says brain tumors are rare.

He would consider a brain tumor a possibility if the child were displaying other symptoms, such as lack of coordination or double vision, he says.

©1999 The Washington Times