Coping with Migraine

More Than a Headache
by Food and Drug Administration (FDA)

Flying overseas to wine and dine clients may sound like a glamour job, but Terri Burchfield didn't feel very glamorous when her head was throbbing and she was running to the bathroom to throw up. "I was expected to go to dinner with associates and clients," says the 41-year-old McLean, Va., resident and former Wall Street investment banker. "I was in such pain and so nauseous. The last thing I wanted to do was eat and converse for hours with important clients. But I had no choice, I just had to get through it."

Burchfield is one of about 30 million Americans who suffer from migraines. According to the American Council for Headache Education (ACHE), 1 in 4 U.S. households has at least one person who has migraines. And 3 out of 4 people with migraines are female.

Although there is no cure, "today, there are great new medications and a better understanding of migraines," says Lisa Mannix, M.D., neurologist and medical director of Headache Associates in Cincinnati. "You don't have to suffer."

In the past 10 years, the Food and Drug Administration has approved more than 10 new drugs for migraine, and more are under development, says Eric Bastings, M.D., a neurologist in the FDA's Division of Neurology Products. Migraine medications, combined with lifestyle changes and avoiding migraine triggers, can make a tremendous difference to people who have migraines.

More Than a Headache

Migraine is a physical illness, and people who have it are called migraineurs by health care professionals. Although headache is the most recognized symptom of migraine, nausea, vomiting, distorted vision, and sensitivity to light and sound are other common symptoms that accompany the headache. The headache is typically pulsating or throbbing. The pain usually occurs on one side of the head, but it can be on both sides.

Burchfield describes one migraine that landed her in the emergency room: "I was doubled over in pain. The head pain was so severe, it was emanating throughout my entire body. I've never had pain that even comes close."

A migraine attack, left untreated, can last from several hours to several days, or even longer. Attacks can strike as frequently as several times a week or as rarely as once a year.

According to the ACHE, about 1 in 5 migraineurs has warning symptoms, known as an aura, that occur 15 to 30 minutes before the head pain begins. The aura may consist of flashing or shimmering lights, a graying out of vision, tingling sensations in an arm or leg, or difficulty talking.

Migraineurs without aura may experience vague symptoms before the headache, such as mental fuzziness, mood changes, and fatigue.

Misunderstood Migraines

"Migraines are often unrecognized and are treated as ordinary headaches," says Robert Temple, M.D., director of the FDA's Office of Medical Policy in the Center for Drug Evaluation and Research. Without a proper diagnosis, people with migraine may be treated with simple pain medications instead of the migraine treatments now available, Temple says.

In addition, many health providers may not be aware of the benefits of the newer preventive treatments, says Richard Lipton, M.D., professor and vice chairman of neurology at the Albert Einstein College of Medicine in New York. "Consumer education and physician education are both needed."

There's a lot of misinformation about migraines, and blame is often placed on the person instead of the disease, says Michael John Coleman, co-founder of Migraine Awareness Group: A National Understanding for Migraineurs (MAGNUM). "Some people are still inappropriately being told 'it's all in your head,' and that they're manifesting this behavior to get out of responsibility at work or to avoid personal or social situations. They're being sent to psychiatrists instead of neurologists or headache specialists."

Those who don't get migraines don't understand the pain and disability, says Burchfield. Like many migraineurs, she tried to hide her migraines. In college, she used bathrooms on different floors of the dormitory when she was in pain and felt nauseous, she says. "I didn't want to be seen running out of the same bathroom all the time." Once she graduated and landed a job that required a lot of traveling, the migraines became more frequent and more disruptive. And sometimes, her symptoms were misinterpreted by others. "I'm sure I looked pale and sweaty and I couldn't talk much," she says. "I would run to the bathroom quite a bit to hide the pain and nausea. One of my associates pulled me aside one day and asked if I was bulimic."

Even Burchfield's family didn't understand at first. When visiting her sister and her children out of town, Burchfield's migraines often forced her to retreat to the quiet of a dark room. "My sister said, 'If my kids are too loud, you can stay in a hotel.'"

Today, Burchfield often tells people when she has a migraine, but sometimes reluctantly. The word "migraine" is often misused for any bad headache, she says, "so I never know how someone is going to take it. If I had another condition, such as epilepsy, it would be different. People would believe that, but they don't always believe that you have a migraine that's incapacitating."

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