The first time it happened, Paige Bayes lay in bed for two days, fearing that she had a brain tumor. At age 20, she had weathered an occasional headache, but never one so excruciating. "I thought my head was going to explode," says Bayes, now 36.

Life has never been the same for Bayes, a hair stylist in Lexington, Kentucky. Today she might live pain free for a few months at a time, then have six migraine attacks within a few weeks. Occasionally, she's able to struggle through work despite throbbing pain and nausea, both of which can last several days. But more often, she has to go straight home, curl up in a dark, quiet room, and wait -- and hope -- for the medication to work.

Bayes is among 28 million Americans whose lives are frequently disrupted by migraine headaches. Unlike other headaches, which are usually caused by muscle tension, allergies, sinus congestion, high blood pressure, or underlying infections, migraines are thought to be caused by disturbances of blood flow through arteries in the head. Migraines tend to be located on one side of the head, and are often -- as illustrated by Bayes' case -- severe.

According to a study conducted for the National Headache Foundation, there's a "migraineur" in one out of four households in this country. Unfortunately, thanks to lingering misconceptions about migraines, roughly half of sufferers receive inadequate, inappropriate, or no treatment. For example, experts say that some doctors mistake migraine symptoms for sinus headaches -- and end up prescribing medicine that does nothing to relieve the pain.

"There was a time when migraines were thought to be a sign of a weak constitution," says Jeanetta Rains, a psychologist with the American Headache Society. That perception may have been fueled at least in part by a key statistic: Nearly three-fourths of migraine patients are women. Rains says the message that migraines are a legitimate biological disorder -- some experts consider them to be a disease -- has reached most doctors in the United States. "But," she adds, "there are still practicing physicians who dismiss headache complaints in women."

Researchers say a predisposition to migraines tends to run in families. And the prevalence of the headaches among women suggests that hormones are somehow involved, though no one is sure how. "The peaks in headache frequency appear to occur around changes in hormones," Rains says. For example, many women get their first migraines after reaching puberty. Some women develop the headaches only during their periods -- so called menstrual migraines -- when estrogen levels drop. But other occasions when levels of estrogen and other hormones shift -- taking birth control pills, pregnancy, menopause -- produce mixed results. Some migraines worsen, others get better.

But there is encouraging news for migraineurs. Although no one knows for sure how these headaches start, scientists have learned a great deal in recent years about what occurs during an attack. Using that knowledge, pharmaceutical companies have created medications that help quash the pain of a migraine -- unthinkable just a few years ago.

For years scientists have known that migraine pain occurs when blood vessels on the surface of the brain dilate, says neurologist Christina Peterson, MD, of the Oregon Headache Clinic, and author of The Women's Migraine Survival Guide.

Scientists continue to find out more about the brain, though. "We've discovered that the headaches begin at the brain stem," Peterson says. And researchers have proposed various theories about the how the pain starts -- almost all of which have to do with changes in brain chemistry.

It's now believed that a migraine occurs when a person with a susceptibility for the headaches is exposed to a trigger, which can be anything from stress to certain foods. This trigger causes cells deep in the brain to emit chemicals that make blood vessels on the surface expand. As the blood vessels widen, they stimulate nerve fibers, causing throbbing pain.

Fluctuations in levels of one brain chemical in particular, the neurotransmitter serotonin, appear to play role in migraines. A new class of drugs called triptans apparently works by mimicking serotonin, which is believed to help control pain and emotions.

"The triptans have been a fantastic discovery. They actually reverse the process [of a migraine] if they're taken early enough," says Seymour Diamond, M.D., founder of Chicago's Diamond Headache Clinic, and co-author of Conquering Your Migraine.

According to Diamond, when a triptan drug is ingested early enough in the course of a migraine, it can relieve up to 85 percent of symptoms in just an hour or two.

Of course, the dream of anyone plagued by these mind-blowing headaches is a pill to prevent them in the first place. Doctors say that some existing drugs -- including certain antidepressants, as well as anticonvulsive and hypertension medications -- appear to reduce the occurrence of migraines for some sufferers.

"People with severe migraines need to be ready to work closely with their doctors," says Michael Potter, MD, an attending physician at the UCSF Medical Center. "My first approach in treating migraines is to find out what the triggers are and to help the patient avoid them. Caffeine, Excedrin Migraine, and ibuprofen can often work to abort a migraine if they're taken at the first signs of symptoms. But other drugs like triptans are useful when these over-the-counter remedies don't work."

"When people are truly debilitated by migraines that occur more than two or three times a month, medications such as antidepressants and anticonvulsants, taken prophylatically, can be very helpful," Potter adds. "It often takes a lot of trial and error to find the drug that works best at the lowest cost -- and with the fewest side effects -- for any individual."

Paige Bayes has begun taking a triptan drug, and reports that it can cut the duration of her migraines in half -- even stop them cold -- if she takes it in time. Her doctor, Lexington-based family physician Rondal Goble, MD, who is also a migraine sufferer, says that patients who complain of severe head pain a few times a month or more need aggressive treatment, since these occasional flare-ups can degenerate into chronic daily headaches.

That's an important change in medical philosophy, especially if you're part of the long-suffering masses. "We used to rule out everything else, then say 'Well, it might be a migraine,'" Goble says. "Now, we think migraine first."

-- Freelance writer Timothy Gower writes on health issues for Health, the Los Angeles Times, and many other news outlets. This piece was adapted from his "Healthy Man" column for the Times.

More on migraines

Click here to see what triggers migraines.

Warning: Even if you suffer regular migraines, a severe headache of the "worst in my life" variety, when accompanied by symptoms you've never experienced before, may signal something more serious.

If you have excruciating head pain accompanied by vision loss, nausea and vomiting, and the inability to move an arm or leg, or a headache that lasts for several days and gets progressively worse, call your doctor: in rare cases, these could be signs of a stroke or possibly a brain tumor. (These can be more difficult to diagnose in people with symptoms of the "classical migraine" -- head pain, a sensation of flashing lights in your peripheral vision, and nausea or vomiting).

References

First published December 4, 2003
Last updated May 6, 2008
Copyright © 2003 Consumer Health Interactive