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HindustanTimes Fri,22 Aug 2014
Fixing your achy-breaky head
Sanchita Sharma, Hindustan Times
August 24, 2013
First Published: 23:58 IST(24/8/2013)
Last Updated: 00:05 IST(25/8/2013)

The International Headache Genetics Consortium sounds almost too grand a name for a bunch of people spending millions to find a cure for a non-life-threatening pain that can be fixed with an inexpensive painkiller. Some don’t even want a cure found for this super-convenient excuse to shirk and defer almost everything unpleasant and unavoidable.

This week, the Consortium with the pretentious name announced there may be a potential cure for migraine, the debilitating headache that affects roughly one in eight adults, mostly women.

Since I occasionally get migraines, I perked up at the thought of flushing away my migraine pills for good. About 60% of women affected have migraines linked to their menstrual cycle and, in these cases, the debilitating, throbbing headaches disappear after menopause. Since I don’t fall in that category — stress, heat, tiredness, dehydration and yucky, rich food are my triggers — a definitive cure is my only hope at the moment.

A closer look at the findings, however, revealed I need to hang on to my precious pills a bit more. What the super-duper Consortium has done is identified five regions of DNA containing genes that trigger migraines.

Since seven regions have already been identified, the genetic clusters that could be affecting the chemistry of brain cells and triggering migraines are now 12. But with many more yet unidentified “migraine” genes, all scientists have are some biological clues. The actual cause of a migraine is still a mystery.

For a disorder that is among the top 20 causes of adult disability, migraines are still poorly understood, largely because this searing pain is sporadic and the symptoms and intensity vary. Aside from throbbing pain, which may or may not be one-sided, some experience auras before it starts.

Others may have to deal with nausea, vomiting, chills, sweating, and/or sensitivity to light, sound, and smells. I’ve met people complaining of experiencing blackouts, blind-spots and/or seeing spots or wavy lines along with the pain, which can make driving a car or an airplane in the middle of an attack a bit tricky.

While the triggers — extreme weather, emotional and physical stress, food sensitivities, etc — are easy to identify by a simple cause-and-effect analysis after an attack, why the extreme pain kicks in is more difficult to decipher. New research shows blood flow increases by nearly 300% before a migraine attack, but despite that, circulation appears normal or even slightly reduced during an attack, which typically lasts from six to 48 hours.

Studies using magnetic resonance imaging have shown that people with migraines have a different blood vessel structure in the brain, which causes asymmetry in hemispheric cerebral blood flow within the brain. Focusing on a system of arteries called “circle of Willis”, they found that an incomplete circle of Willis was more common in those who get migraines, compared to healthy people.

The abnormalities in both the circle of Willis and blood flow are most prominent in the back of the brain, which is home to the visual cortex, which explains why the most common migraine auras are visual distortions.

Other theories suggest that the throbbing pain that is the hallmark of a migraine may be due to overactive pain-signaling from sensory neurons in the brain or a disorder of the nervous system, most likely in your brain stem.

Till a cure is found, you have to find your own trusted pill. For mild attacks, over-the-counter painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as disprin, ibuprofen and naproxen work well. Acute attacks can be treated using anti-inflammatory medicines with antiemetics or trip tans, such as sumatriptan, rizatriptan or zolmitriptan.

If taken just before the pain sets in, triptans can abort an attack within a couple of hours. Still stronger are ergotamines, but since they constrict blood vessels of the heart even more, they should be had under close medical supervision.


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