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Do you get recurrent headaches so intense that they disrupt your normal activities, such as work, school, and time with family and friends? And do you find that over-the-counter pain medications such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil), and extra-strength medications (Excedrin-Migraine, Advil-Migraine) do little or nothing to help?
If so, your headaches may be more than just bad headaches -- you could have a condition called migraine. Migraine affects roughly 28 million Americans, nearly four out of five of them women. But the condition often goes undiagnosed because people have a wrong understanding of what migraine is, says Merle Diamond, MD, director of the Diamond Headache Clinic in Chicago.
"We estimate that fewer than 50 percent of cases have been diagnosed, and in large part that's because people think that if they're not nauseous and vomiting, or they're not sensitive to light, they can't be having a migraine," Dr. Diamond says. "It's as simple as this: if you have recurrent episodes of headache that prevent you from functioning normally, 97 percent of the time it's migraine."
"People also have a tendency to explain away recurrent headaches as 'my menstrual headache,' 'my sleep deprivation headache,' 'my tension headache,' or 'my hangover headache,'" Dr. Diamond adds. "And they don't think there's much that can be done to help, so they just keep taking the same over-the-counter medications."
For more than a decade, however, migraine sufferers have had another option: medications called triptans. Today there are seven different brands of triptans, but they all work by stopping the release of the chemical that leads to inflammation of blood vessels in the brain -- the root cause of migraine pain. Despite the availability of triptans, current estimates suggest that nearly 60 percent of migraine sufferers continue to self-medicate with over-the-counter pain relievers.
In a recent study of 110 migraine sufferers who were not helped by Excedrin-Migraine, Dr. Diamond and her colleagues found that 81 percent experienced significant headache relief (mild or no pain) two hours after taking eletriptan (Relpax), and 91 percent at four hours. They also experienced significant relief of migraine-associated symptoms at two hours, including nausea (76 percent), sensitivity to light (74 percent), and sensitivity to sound (80 percent). The study was published this March in the journal Headache and supported by a grant from Pfizer, the manufacturer of Relpax.
"The most important piece of information coming out of this study is that when over-the-counter medication does not work, there is something people can get that does work," Dr. Diamond says. "My concern is that there are so many people who keep using OTC remedies and failing. And the longer that migraine is poorly managed, the more headaches they are likely to get."
If you suspect you have migraine, talk with your healthcare professional. Try to get a sense for whether she can diagnose and manage the condition herself, or instead would like to refer you to a headache specialist. Dr. Diamond recommends the National Headache Foundation (www.headaches.org; 1-888-NHF-5552) as a resource for finding a specialist in your area.
It's also a good idea to start keeping a headache diary, in which you note when each headache occurs, how severe it is, any relief measures you use and how effective they are, impact on your life (missed work, activities, etc.), and what triggers may have caused it. Many people with migraine are able to identify specific triggers ranging from alcohol, caffeine, chocolate, and other foods, to stress and anxiety, to weather conditions, to skipped meals, to hormonal changes related to the menstrual cycle and/or oral contraceptives. The American Council for Headache Education Web site (www.achenet.org) features a sample diary that can get you started.
Based on that information, your healthcare professional can help you develop an approach for managing your condition. Dr. Diamond says she tells all of her patients to make certain lifestyle or behavioral changes such as eating regularly, sleeping regularly, avoiding any trigger foods, exercising, and regulating caffeine and alcohol. Some will find relief with these changes and with over-the-counter pain relievers.
But when these strategies don't work, or when pain is consistently rated as moderate or severe, a triptan is usually the best treatment option. Dr. Diamond notes that it's not uncommon for a patient to try more than one brand of triptan before finding one that works for her. Triptans are not recommended for people who have been diagnosed with coronary artery disease, or who have multiple risk factors for the condition. Triptans also cannot be taken with certain other medications. (Talk to your healthcare professional about the specifics of your situation.)
But for most people, Dr. Diamond says, "triptans are incredibly safe."
"I think people need to understand that we have an effective therapy that can get you relief as soon as possible," she says. "Go get diagnosed and treated, so that you can get back to normal functioning."
The National Migraine Association (www.migraines.org) recommends that any discussion of possible migraine should cover the following questions and be followed by a complete physical and neurological examination.
From the National Women's Health Resource Center. Copyright 2003-2004 by the National Women's Health Resource Center, Inc. (NWHRC). All rights reserved. Reproducing this content in any form is prohibited without written permission. For more information, please contact firstname.lastname@example.org.
Diamond ML, Hettiarachchi J, Hilliard B, Sands G, Nett R. "Effectiveness of eletriptan in acute migraine: primary care for excedrin nonresponders." Headache. 2004 Mar;44(3):209-16.