Research Widens Range of Therapies To Treat Migraines
by Marilyn Chase
from The Wall Street Journal
Migraines aren't for sisies. Yankee catcher Joe Girardi was hammered by a headache so bad that he ended up in the hospital after a recent winter workout in Tampa, Fla.
They're the 1812 Overture of headaches, with pulsating percussion and cerebral cymbals that make you fell like your head will all but explode. But after centuries of myth and mystery, the science of migraine only now is expanding our knowledge of its causes and treatment options.
For an estimated 11 million to 23 million Americans, the debilitating condition features pulsing pain (often one-sided) with nausea and sensitivity to light and sound. A visual "aura" sometimes precedes the headache with a shower of colored stars, or images fractured into herringbone or cubist patterns.
Women outnumber men among sufferers, but migraine isn't an exclusively female condition. Thomas Jefferson and Sigmund Freud were among male sufferers.
History records heroic and desperate efforts at cure. in the sixth century A.D., the emperor Justinian pressed his pounding head to a watery stone called the "column of tears" in the cisterns of Istanbul. Other failed remedies included purging, bleeding, encircling the head with a hangman's noose and drilling a hole in the skull.
Long observed to run in families, migraines now claim a gene of their own. An international team recently identified a gene on chromosome 19 that causes familial hemiplegic migraine, a severe form coupled with paralysis. Genes for more common migraines are expected to follow.
What Causes migraine? A region in the brain's core - the brain stem
- becomes abnormally activated. Chemical messengers provoke inflammation
and pain in fibers surrounding vessels. Reduced blood levels of key
brain chemical serotonin may also play a role. Such insights have helped
spawn specific designer drugs, beginning with Glaxo Wellcome's sumatriptan
(Imitrex), an injection which mimics serotonin. Now five or more similar
compounds are in the pipeline. But sumatriptan's cardiac side effects,
which rule out anyone with heart disease, remain a factor.