Migraine: The Future of Migraine Therapy (cont.)

Another is to fine-tune treatment for each patient. The goal is to take fewer drugs, avoid many side effects, and have better control of the beast. For example, you become aware of your pattern of getting a migraine headache, learn what triggers it, and take certain drugs during your own window of vulnerability - that is, the brief window of time you can most benefit from a drug.

Stephen Silberstein, MD, professor of neurology and director of the Thomas Jefferson University Headache Center in Philadelphia, has led pioneering studies into this "window of vulnerability" during a migraine headache.

For certain people, especially women with menstruation-related migraines and others whose triggers are well-defined and predictable, this pre-emptive approach is indeed the future, he tells WebMD. "More studies are looking at taking preventive drugs during that brief window. For patients, it's a matter of getting tuned into your particular pattern."

For those who can't take medications or aren't happy with them, a few supplements also show promise for preventing migraine headaches. "In my own practice, I recommend these if there are at least two well-controlled clinical trials showing benefit," says Sarah DeRossett, MD, a neurologist and migraine specialist in Atlanta. "Magnesium, riboflavin (vitamin B-2), and coenzyme Q10 all fit those criteria."

Migraine Headaches Connected to Hormones, Lifestyle

To understand how all this works, it's helpful to know how migraine headaches develop. The tendency to get them is inherited. They plague teen girls and adult women especially, although a small number of young boys and adult men get migraines as well, researchers say.

Female hormones such as estrogen influence migraines, though it's not clear why. The drop in estrogen levels that occurs a few days before a normal menstrual period seems to increase the chances of a migraine, possibly by priming blood vessels in the brain.

If a woman is taking birth control pills, her headaches are most likely to occur during her "off week," when estrogen levels drops. Some women start getting migraines only at menopause, when their period stops. For others, menopause is the first real relief from migraines.

Lifestyle and environment can also trigger migraines. Weather changes, altitude changes, bright lights, sleep problems, stress, smells, cheeses, caffeine, monosodium glutamate (MSG), nitrates, or aspartame are just some of a long list of potential triggers. Every migraine patient has his or her own headache trigger pattern.

The evolution of a migraine starts with this trigger: When your brain perceives the trigger, it begins a cascade of events. The headache will start developing within two hours or two days. In the beginning, blood vessels in your forehead start to swell up. This causes nerve fibers, which are coiled around the blood vessels, to release chemicals causing pain and inflammation.


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