Coping with Migraine Pain

by Food and Drug Administration (FDA)

In the first quarter of Super Bowl XXXII last January, Denver Broncos running back Terrell Davis was hit hard and walked off the field with a towel draped over his head. A developing migraine made the sunlight difficult to bear.

So how did a person suffering from migraine, a condition that can cause debilitating pain, return after halftime to score the winning touchdown and earn Most Valuable Player status? The answer: He recognized the early warning signs and immediately took an effective drug to control his pain.

Michael John Coleman, founder of Migraine Awareness Group: A National Understanding for Migraineurs, or MAGNUM, appreciates the challenges migraine sufferers face. Coleman has himself suffered with bouts of severe migraine headache pain since age 6. During an attack, he says, "I felt like I was being beaten up by a gang." Coleman's attacks used to last 72 hours or more; a couple lasted more than two weeks straight. "It was nightmarish, when I look back at it. I don't know if I could live through that again."

Not Your Usual Headache

More than 26 million Americans suffer from the neurologic disorder of migraine, according to the American Medical Association. No medical test exists for migraine, so the diagnosis is based on having some or all of the following symptoms:

• a moderate to severe throbbing pain for four to 72 hours that is frequently on one side of the head (the word migraine comes from the Greek hemicranios, meaning half a head)
• nausea, with or without vomiting
• sensitivity to light and sound

About 15 to 20 percent of migraine sufferers experience visual and other disturbances about 15 minutes before the head pain. These symptoms, collectively known as "aura," may include flashing lights, zig-zag lines, bright spots, loss of part of one's field of vision, or numbness or tingling in the hand, tongue, or side of the face. Migraines preceded by an aura are called classic migraines; all others are referred to as common migraines. According to news reports, the Broncos' Davis experienced an aura during the Super Bowl, allowing him to get early treatment to prevent a full-blown migraine.

Migraines strike some people about two or three times a year and others as frequently as twice a week or more. They appear to have a genetic link. According to the American Council for Headache Education, up to 90 percent of people with migraine have a family history of the condition.

While migraines usually appear in young adulthood, children aren't immune. In children, pain sometimes occurs on both sides of the head. Associated symptoms can include nausea, vomiting and diarrhea.

Professional and Personal Costs

Even normal physical activity tends to intensify the pain of migraine. "Migraines are unlike tension headaches in that they often interfere with people's activities to the extent of forcing them to stop what they're doing and lie down," says Randy Levin, M.D., a medical officer in the Food and Drug Administration's division of neuropharmacological drug products. Only 8 percent of migraine sufferers report that the headaches don't significantly interfere with their ability to function, says Fred Sheftell, M.D., the founder and director of the New England Center for Headache.

"A migraine is a hell of an enemy," Coleman says, "and you don't know when your next one's going to come. But you still have to pay the bills. You can be in an incredible amount of pain and put on a happy face, and then when people leave the room, you literally fall on the floor."

Coleman fears generalizations arising from the "Super Bowl migraine." Davis didn't win the Super Bowl with a migraine, he points out, but rather was lucky enough to have a relatively mild migraine that responded to early treatment and allowed him to play to his potential.

Coleman says that his own migraines interfered with every aspect of his life. As his migraines grew worse in the early- to mid-1980s, he gave up his job as an art director with the U.S. Navy, which he'd held for six years. He opened his own art studio, thinking that the hours would be more flexible. But he lost his studio, too, which he calls his "life's work," because he was unable to work enough hours each week.

And Coleman says his migraines also took their toll on his personal life, leading to a break-up of his seven-year marriage. Coleman's wife, a nurse, was "very supportive," he says, "but it wore her down."

Modern Medicine

The over-the-counter and prescription medications that are used to treat migraine pain fall into two general categories: those for use during an attack and those that help prevent attacks. A sufferer may need to take different medications to address distinct symptoms. For example, some drugs can help relieve the nausea and vomiting, while others may ease the head pain.

"It's important to have as many drug options as possible for migraine," says FDA's Levin, "because different people respond differently to medications, and what works for one patient may not help the next."

An over-the-counter drug may help some migraine sufferers with mild to moderate pain. In January 1998, a version of extra-strength Excedrin called "Excedrin Migraine" became the first over-the-counter medicine specifically approved by FDA for migraine.

People who want to use an over-the-counter migraine medication should see their doctor anyway, Levin says, to rule out more serious conditions.

For many years, Coleman struggled with his pain without professional medical help, treating himself with over-the-counter drugs. But as he kept upping the dosage in search of relief, he noticed his headaches were getting worse instead of better.

Like Coleman, many patients who take headache medicine more than a couple of days a week experience "rebound headaches," where the pain reappears as each dose of medicine wears off, leading patients to take even more medicine.

Coleman now treats his migraines with prescription drugs, including sumatriptan (Imitrex), a popular migraine drug since its approval by FDA in 1993. "It's night and day," Coleman says of his pain before and after Imitrex.

Other prescription drugs approved specifically for migraine include ergotamine tartrate (Cafergot, Wigraine, Ergostat), isometheptene mucate combinations (Midrin, Isocom), and dihydroergotamine (DHE-45). Some of the newest anti-migraine medicines are zolmitriptan (Zomig), naratriptan (Amerge), and a nasal spray form of dihydroergotamine (Migranol), which was reportedly used by Davis during the Super Bowl. At press time, companies were developing additional anti-migraine drugs.

Drugs to prevent migraine are sometimes recommended for those whose migraines are especially frequent or debilitating. Two of the many drugs that are tried for migraine prevention are approved by FDA for this use: Inderal (propranolol) and Depakote (divalproex sodium).

While a medical professional can help a patient choose the right treatment for his or her particular symptoms, patients themselves also play a critical role in controlling pain by observing what triggers their migraines and avoiding those things when possible.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.