2006-08-22
Dawn/The New York Times News Service

Everything you thought you knew about migraine headaches may be wrong. At least that's what headache researchers now maintain. From long-maligned dietary triggers to the underlying cause of the headaches themselves, long-standing beliefs have been brought into question by recent studies.

As if that were not enough dogma to overturn, there is growing evidence that almost all so-called sinus headaches are really migraines. No wonder, then, that the plethora of sinus remedies on the market and the endless prescriptions for antibiotics have yielded so little relief for the millions of supposed sinus sufferers.

Surveys have indicated that only about half of the “classic” migraine sufferers are reaping the benefits of what modern medicine offers. If those presumed to have sinus headaches are included, the numbers of underserved migraine sufferers could easily be doubled.

The World Health Organization ranks migraines among the most disabling ills. About 28 million Americans suffer from severe migraines that leave them temporarily unable to function at work, at home or at play. Many more millions have them in milder forms. All told, they cost employers about billion a year in lost productivity, with another billion spent on medical care.

A migraine is more than a headache. The throbbing pain of a migraine, which typically occurs on one side of the head, is often accompanied by nausea, vomiting and extreme sensitivity to light and sound. A person feels sick all over.

Symptoms may include nasal stuffiness, blurry vision, diarrhea, abdominal cramps, abnormal sensations of heat or cold, anxiety, depression, irritability and inability to concentrate.

Without effective treatment, those most severely affected are unable to cope with even the simplest of tasks and must take to their beds until the attack ends. Afterward, people often feel tired, irritable, listless or depressed, though some feel unusually refreshed and energized.

Though long believed to be primary vascular headaches, the result of constriction then expansion of blood vessels in the head, migraines are now recognized to stem from neural changes in the brain and the release of neuroinflammatory peptides that in turn constrict blood vessels. The headache often begins before these vessels dilate. The inflammatory peptides sensitize nerve fibers that then respond to innocuous stimuli, like blood vessel pulses, causing the pain of migraine.

In some people, the headache is preceded by an aura of visual, sensory or motor symptoms that last for less than an hour. They include seeing flashing lights or specks, numbness in the hand, dizziness and an inability to speak. People who experience these have a doubled risk of cardiovascular diseases, according to findings published last month in The Journal of the American Medical Association.

Although hard to mistake in their classic form, migraines can be – and apparently often are – misclassified as sinus or tension headaches, probably because they can cause nasal congestion, pressure or pain in the forehead or below the eyes, and discomfort on both sides of the face.

In one study by Dr. Eric Eross of Scottsdale, Ariz., 90 of 100 people with self-diagnosed sinus headaches were found to have migraines. On average, they had seen more than four physicians for their headaches before getting the correct diagnosis and significant relief.

Migraine sufferers have long been cautioned to avoid certain foods believed to bring on attacks, especially chocolate, alcohol (red wine in particular) and aged cheese. But the evidence supporting this notion is meager. More common causes include stress (positive or negative), weather changes, estrogen withdrawal, fatigue and sleep disturbances (hence, perhaps, the association with alcohol, which can disrupt sleep), as well as overuse of over-the-counter pain medications.

To determine what may set off your headaches, keep a calendar to record occurrences, noting foods you ate or the circumstances preceding each one. If you are a woman of childbearing age, record the stages of your menstrual cycles. If necessary, to uncover foods that may cause your headaches, try an elimination diet, cutting sharply on various foods, then reintroducing them one at a time.

Preventives and treatments are numerous. If one doesn't work, try another. If your migraines are rare, using a drug in triptans class at the very onset of a headache can usually abort it or reduce its severity and duration. Frequent migraines are best treated preventively, with rescue medication – like a triptan or an opiate, perhaps combined with aspirin, amphetamine and caffeine to relieve a breakthrough headache.

Some people are helped by relaxation therapy, biofeedback or stress management. Several good studies have shown benefits from supplements of the B vitamin riboflavin (400 milligrams a day) or the herb butterbur (50 to 75 milligrams twice daily).