Battle Against Migraine

It strikes with jackhammer fury and lasts from a few minutes to several days. Along with the throbbing pain, eyes tear, vision blurs and there are waves of nausea. The slightest disturbance--the closing of a door, a sudden aroma, the switching on of a light--can be devastating. As Dr. John B. Brainard explains, "The ache becomes an intolerable, overwhelming force, driving you to bed, away from people, away from the world, away from everything except the hideous pain inside your head."

Brainard should know. The St. Paul surgeon is one of millions of Americans who chronically suffer from that most severe of headaches: the migraine (from the Greek for "half skull").-Virtually everyone has an occasional headache, and it can usually be treated by nothing more sophisticated than aspirin. But the migraine is different. This violent cranial storm was for a long time medicine's stepchild. Few drugs were useful against it, and doctors could offer little help in relieving it.

Now there is new hope for the afflicted. While no sure cure yet exists for migraines, increased research into headaches of all kinds is finally yielding both new understanding and treatment of this worst of the lot.

Most headaches are brought on by anything from simple, tension-induced tightening of the muscles in the head or neck to more serious injury or illness, such as a blood clot or tumor. But migraines belong to a different and puzzling category known as vascular headaches. They seem to stem from a swelling of cranial blood vessels, which may be accompanied by some local inflammation. Some doctors also implicate bodily chemicals, notably histamine and serotonin. Investigators at Baylor University have even reported that over a prolonged period of time migraines may damage some brain cells--apparently without any noticeable mental impairment. Migraine sufferers have included such intellectual stalwarts as Jefferson, Freud, Nietzsche and Darwin. Lewis Carroll is thought to have conceived the more bizarre scenes in his Alice's Adventures in Wonderland during the hallucinatory "auras"--flashing of lights before the eyes --that often precede the headaches.

Occurring anywhere from one to eight times a month, migraines usually begin in the teens or early 20s and can recur for the remainder of the victim's life. Women seem about twice as vulnerable as men, yet a related headache called the cluster (because it strikes repeatedly over several hours) most often affects tall, hard-driving men. For years the standard treatment for chronic headaches was a combination of the drug ergotamine tartrate and caffeine (Cafergot), which acts to constrict the expanded blood vessels.

But the medication does not help everyone, and in the 1960s physicians began turning to a more powerful weapon--me-thylsergide maleate (Sansert), a chemical kin of LSD. One drawback: it must be used cautiously because of its occasionally serious side effects (hallucinations, nausea, vascular disease).

In their search for new and safer therapies, doctors have experimented with a wide variety of alternatives. Some are admittedly controversial and are even scorned by many physicians. Yet for all the skepticism, they appear to work at least some of the time for some people. In his new book Control of Migraine (Norton; $7.95), Brainard reports, for example, that he has had great success in coping with his own and his patients' migraines by changing both diet and lifestyle. Among other things, he advises reducing salt intake; avoiding such foods as ripened cheese, chocolate, nuts and ham; staying out of crowded, smoke-filled rooms; getting ample rest; shunning alcohol, especially red wines and brandy. Other doctors downgrade the importance of diet. Says Dr. Arthur H. Elkind, director of the headache clinic at New York's Montefiore Hospital: "Occasionally we tell patients to avoid certain foods, but counseling is always required to find out what the problem is and what the correct treatment should be."

Turning to another unorthodox tactic, a Chicago doctor, Seymour Diamond, is treating migraines with biofeedback. Using machines that signal physical changes in the body with beeps or flashing lights, Diamond has been able to train some patients at his headache clinic to raise temperatures in the hand by as much as 10DEG to 15DEG. As he explains in his recent book More than Two Aspirin (Follett; $8.95), higher temperatures mean an increased flow of blood there--and presumably a reduction elsewhere, including the head. Almost invariably, he reports, the technique stops headaches. Still another imaginative treatment has been introduced by Dr. Howard Kurland at Northwestern University (Quick Headache Relief Without Drugs; Morrow; $7.95). He applies strong pressure at four sets of points on the body (wrists, temples, hands and neck). The object of Kurland's "acupressure": to overload the nervous system's pain centers--in effect, jamming the signals from the headache. While Kurland's results have not been widely duplicated, his own patients insist that acupressure works.

Kurland's experiences, as well as Diamond's, underscore what seems increasingly clear to many investigators: there is a strong psychological component to both headaches and their treatment, and the patient's confidence in the doctor may play a crucial role. Says Elkind: "The better the relationship is, the more successful the results are likely to be." -

-So called because it often seems to occur in only one side of the head.

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