2007: Issue 1

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2007 > Aches and Pains > Signs of Progress in the Battle Against Migraines

Signs of Progress in the Battle Against Migraines


Progress is being made to help the nearly 1 in 10 people who suffer the extreme pain of migraine headaches.

Excruciating! Unbearable! Total and utter helplessness!
Ask a migraine sufferer what it feels like, and those are just a few of the words they may use to describe the intensely painful condition. Migraine headaches are among the most painful of medical conditions and one of the least understood.

But the future appears brighter for the estimated 1 in 10 people who live with the debilitating neurological condition that can last from a few hours to a few days. While there is no accepted cure for migraines, medical research has led to more effective medications and treatment options to relieve the symptoms, a major improvement on the age-old remedy of taking two aspirin and hiding in a dark room.


Migraines are the most common form of a vascular headache, an intense throbbing in the head caused by an abnormal function of the brain’s blood vessels. During a typical migraine “attack,” the sufferer experiences intense pain at the front of the head, around the temples, or behind one eye or ear.

Beyond the pain, migraine headaches can cause nausea, vomiting and blurred vision. A person suffering a migraine often becomes highly sensitive to light, sound and odors, feels lightheaded, cold and sweaty, and suffers from fatigue and loss of appetite. Migraines can strike at any time, though morning appears to be the most frequent time for their onset.

Women are three times more likely to get migraines than men. The headaches tend to start between the ages of 10 and 55 and may run in families. At least 60 percent of women with a history of migraines have fewer migraines during their 2nd and 3rd trimesters of pregnancy.


There are many theories about what causes migraines, but none have been proven with certainty. One theory traces migraines to irregular blood vessel activity in the brain and the release of the chemical serotonin. When serotonin levels are high, blood vessels constrict, which leads to vision problems or dizziness; when serotonin levels are low, blood vessels expand, pressing nearby nerves which causes pain.
Another theory focuses on chemical changes in the brain; when chemicals in the brain responsible for sending messages from one cell to another are interrupted, migraines occur. More recent studies suggest a genetic component. People who suffer from migraines may have inherited abnormal genes that control the functions of certain brain cells.


Research efforts have been complicated by the fact that not all migraines are the same. The signs and symptoms vary among patients, and so does the degree of pain. The two types seen most often are classic and common migraines.

The major difference between the two is the appearance of neurological symptoms 10 to 30 minutes before a classic migraine attack. These symptoms are called an aura; during an aura, the sufferer may see flashing lights or zigzag lines and may experience a temporary loss of vision. Other classic symptoms include speech difficulty, numbness in an arm or leg, tingling of the face or hands, and confusion.
A common migraine is not preceded by an aura. Prior to a common migraine attack, people experience a variety of vague symptoms such as mood changes, fatigue or an unusual retention of fluid. In general, a common migraine tends to build more gradually than a classic migraine, but lasts longer and consequently proves more disruptive to everyday living.


Though there is still no definitive proof of what causes a migraine, research has shown links between certain types of foods and the onset of migraines. The link is based on the view that chemical substances in certain food items cause the arteries to constrict, which acts as a trigger for a migraine attack. Other experts contend that foods may cause headaches by setting off allergic reactions in susceptible people.

Migraines are believed to be triggered by one or more of the following:
  •  Hormonal changes during a woman’s menstrual cycleBright lights or loud noises
  •  Certain foods or drinks such as alcohol, chocolate and aged cheeses
  •  Food additives such as monosodium glutamate (MSG), nitrates and soy sauce
  •  Nicotine
  •  Skipping meals
  •  Stress, over-exertion, lack of sleep
  •  Weather changes
  •  Certain medications.


Years of research have led to more and better treatment options for migraine sufferers. New medications and the introduction of innovative procedures such as patent foramen ovale (see adjacent article) are providing greater relief for millions of patients.

Reducing stress and eliminating certain foods from the diet are among the most common preventative steps recommended by doctors to help control migraines and other vascular headaches. Regular exercise has also proven effective in reducing the frequency and severity of migraine headaches. Alternative therapies such as biofeedback and relaxation training have also helped some patients reduce the frequency and intensity of attacks.
Many migraine sufferers remain undiagnosed despite the intense pain they encounter and loss of productivity in their lives. If you have had migraine symptoms, it’s important to consult a medical professional for a thorough evaluation and diagnosis.

PFO: Migraine Relief from an Unexpected Source

A non-invasive procedure to repair a heart defect is yielding a surprising “extra” benefit for migraine sufferers – a significant drop in the frequency and intensity of migraines soon after undergoing the procedure. Research studies have shown that the procedure to treat the heart defect  called patent foramen ovale (PFO) a small hole in the wall between the two upper chambers of the heart reduced the severity and frequency of migraine headaches for many patients.
“The results are positive, but most migraine sufferers don’t even know the procedure exists,”said Dr. Sureerat Panyarachun, a cardiologist who regularly performs the PFO procedure. About one in five people are born with the PFO defect, which usually proves harmless. Few people even know they have the condition, which is usually detected by an ultrasound test. The PFO procedure was introduced more than 10 years ago. As it became widely used, many patients with a history of migraines noticed significant improvements in their migraine condition soon after undergoing the procedure.


While there are many theories about what causes migraines, doctors believe that the benefits seen after the PFO procedure are probably related to the change in blood flow after a patient has undergone the procedure. When blood passes through the lungs, the lungs act as filters to process and remove a variety of chemicals. In patients with the PFO hole, some blood insteadpasses through the PFO hole and enters the body’s bloodstream without being filtered by the lungs. It is believed that the “unfil-tered” blood triggers mini-strokes and migraines when it reaches the brain.


Dr. Sureerat explained that the PFO procedure appears to show the greatest improvement in people who have migraines with auras. “Patients with a higher severity of attacks, and attacks that are more debilitating, stand to benefit more from the PFO procedure,” Dr. Sureerat said.

The procedure takes about one hour and is usually conducted with the patient fully sedated. A tiny tube called a catheter is inserted through a vein in the groin area until it reaches the right side of the heart, with X-ray and ultrasound technology used to help guide the surgical instruments to the precise location. A second catheter with an “umbrella” closure device is inserted until it reaches the left side of the heart, where the closure device is placed to seal the hole. Most PFO patients spend one night in the hospital and usually return to work in one or two days.

All surgical procedures including PFO involve some level of risk. Your doctor is best able to explain these risks and recommend the best treatment options for your individual situation. “The results are very promising,” Dr. Sureerat said. “This type of interventional cardiology is providing hope for the future for many migraine patients.”

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