(2 of 5)
The revolution in migraines was very much in evidence last week in London as more than 600 scientists from 32 countries gathered for the biennial symposium of the Migraine Trust (whose patron, the late Princess Margaret, suffered from migraines). A ripple of excitement followed reports of progress in blocking a key neuropeptide called cgrp (more on that later). But the biggest headlines came from a seemingly unlikely source, the anti-epilepsy drug topiramate. Dr. Stephen Silberstein of Thomas Jefferson University in Philadelphia presented a study of nearly 500 patients showing that topiramate significantly reduced both the occurrence and duration of migraines--offering hope that a whole class of existing antiseizure drugs could someday help migraine sufferers put an end to attacks before they occur.
Much remains to be determined. Researchers aren't sure whether they have identified all the pieces of the puzzle or if they know the order in which those pieces fall. "Does it all fit together in a cogent picture?" asks Dr. K. Michael Welch, a migraine researcher at the University of Kansas Medical Center in Kansas City. "I don't know. But we know a hell of a lot more than when I started in this field 25 years ago."
First, let's define a few terms. Doctors divide headaches into two broad categories: those that are self-contained (primary headaches) and those that result from another illness or accident (secondary headaches). The best treatment for a secondary headache depends on its origin. For example, an antibiotic may be prescribed for a headache caused by a bacterial infection.
The most common type of primary headache is the familiar tension headache, which is usually stress related. (Doctors now label it a tension-type headache to counter the idea that knotted muscles are the principal cause.) In most cases, a couple of aspirin and a good night's sleep are all that's required to get rid of one.
Not so the mercifully uncommon cluster headache, so named because an attack typically repeats itself, often daily, with each episode lasting anywhere from an hour to an hour and a half. Cluster headaches usually strike their victims, generally men, at fixed times of the year. The pain is so searing that they are also known as suicide headaches. Immediate treatment with oxygen and migraine drugs given intravenously can sometimes provide relief.
Somewhere between tension and cluster headaches are migraines. Typically, the pain from a migraine is a throbbing one, restricted to one side of the head, that gets worse with movement and lasts from four hours to three days. Migraines are usually accompanied by either nausea and vomiting, as they were for TV producer Schipper, or extreme sensitivity to both light and sound. By contrast, patients suffering from tension-type headaches may react badly to either light or sound but not both.
It is a mistake, however, to stick too rigidly to these definitions. "At one time people thought that migraine was a disorder all its own and that tension-type headache was totally separate," says Dr. Ninan Mathew, director of the Houston Headache Clinic. "Now we realize that headaches are not that clear cut." Indeed, Mathew says, nearly any recurring headache that is debilitating enough to keep you away from work or the things you enjoy is probably a migraine.