Migraines Big Headache For Science
Monday, August 1, 2011
Aired 8/1/11 on KPBS Midday Edition.
It's estimated that more than 10-percent of Americans suffer from migraine headaches. A brief survey of the KPBS newsroom came up with at least five chronic migraine sufferers.
When the story broke that Congresswoman Michelle Bachman was losing time on the campaign trail due to migraines, tens of thousands of Americans could feel her pain. It's estimated that more than 10-percent of Americans suffer from migraine headaches. A brief survey of the KPBS newsroom came up with at least five chronic migraine sufferers, including me.
Guest: Dr. Erik Viirre, neurophysiologist, UCSD Medical School
CAVANAUGH: When the story broke that congresswoman Michelle Bachman was losing time on the campaign trail due to migraines, tens of thousands of Americans could feel her pain. It's estimated that more than 10% of Americans suffer from migraine headaches. A brief survey of the KPBS news room came up with at least five chronic migraine sufferers, including me. Joining us to talk about what kind of health threat is posed by migraine headaches, my guest doctor Eric Viirre, physician and scientist in neurosciences at UC San Diego school of medicine. Doctor Viirre, thank you.
VIIRRE: Thank you for having me.
CAVANAUGH: If you get migraines, and I'm speaking to our listeners, and have a question or comment, you can join our conversation at 1-888-895-5727. Or send us a question or comment on twitter at KPBS midday. When you heard the news stories last month about congresswoman Bachman and her migraines, speculations that it made her unfit to run for office or unfit to be president, what was your reaction to that?
VIIRRE: Well, I was -- your description of how many people here in your own office really gives us the answer. So just based on statistics, my suspicion is we've already had 3 or 4 presidents who have had migraine headaches. We were discussing it earlier, and virtual, president Lincoln was reported to have terrible, terrible headaches. So it's a very, very common condition. And many, many people can do their jobs perfectly fine even though they have migraines.
CAVANAUGH: Do we know how many people in this country suffer from migraines?
VIIRRE: Well, the statistics from health surveys suggest that it's about one in six women, so about 16%, and one in 10 or 11 men, so about 10%, 9 or 10% of men have migraines.
CAVANAUGH: Now, I wonder if people who haven't experienced a migraine can understand what it's like, how bad it can get. You must have been asked this before. -- asked this benefit. Can you describe what happens?
VIIRRE: Sure. And that's a good question and important for people to understand about migraines. They can be quite uncomfortable and painful. On the other hand, some people have migraines without a headache at all. And in fact, that's many of the patients that I see at UCSD who have migraines and they have dizziness instead of headaches. And then there's a very, very common condition called an aura, which is a visual phenomenon, where people see strange lights or have blurred or holes in their vision. Sometimes that tells them that a headache is coming. Often though, they can come just on their own these visual auras. But I would say the large majority of migraine headaches are actually not that bad, in other words something that you could work through, go to school with, something like that. So it's not -- and this is something that patients need to be aware of is that they can have migraine without the vision of the migraine person who has to go and lie down in a dark room. So it's -- bad headaches are a part of it, but it's how common they are and a few other things that go along with migraine that make us get the diagnosis of a migraine.
CAVANAUGH: One of the hall marks of a migraine headache at least in common experience is that your regular Excedrin, dosage of Excedrin, a couple of Motrin, your regular over the counter headache medicines really don't do much to impact or take away a migraine headache. Why is that?
VIIRRE: Well, I might beg to disagree with you a little bit on that in that that's why there is a lot of Excedrin and Anna sin, and other drugs sold, which is aspirin plus caffeine. And so people take these medicines for their headaches unthinking or unaware that they really are treating their own migraines. But there are a large number of people who those kinds of medicines are insufficient, they really don't control the pain. Or again, by not understanding what's happening with migraines they don't have -- they're not handling them in the best way possible.
CAVANAUGH: Isn't it actually a physiologically a different kind of headache though? Aren't we finding out that the way that the pain is triggered and how it grows in the brain and so forth is different from, let's say your common ordinary headache because you skipped lunch or you had a long day?
VIIRRE: Well, although the common everyday headache that you skipped lunch or had a long day may well be a migraine headache. And in fact we believe that many, many headaches are again unrecognized migraines. That's perhaps part of the story here, that about half of people have migraines and are not really aware that they have the diagnosis. But yes, we are now learning what's happening. And that's part of the exciting part of being at UCSD is the access to so many amazing scientists and engineers. And what I hope to be -- what I'm doing with them now is working with technologies developed there to truly understand these enterses that are happening in the brain.
CAVANAUGH: Why does it seem to be so difficult to come up with a cure for migraines?
VIIRRE: Well, and again, an excellent question. And I think the answer is important in that we know that genetics are important. So many migraine patients will tell you, oh, yes, my mother had terrible headaches or my sister has headaches. So we know genetics are important. But unlike many genetic diseases, it has multiple genes involved. So these mixtures of genes are the hard part to nail down one specific treatment. So unlike, say, sickle cell disease which has one gene involved, and we know how to handle that, there are probably 20 or 30 or maybe even more genes involved in migraines. So that's what makes it more complicated to manage and understand.
CAVANAUGH: I'm speaking with doctor Eric Viirre of UC San Diego school of medicine. And we do have time for some calls or comments on twitter about the topic of migraines. Our number is 1-888-895-5727, or you can comment on twitter at KPBS midday. Heidi is on the line right now from Carlsbad. Hi Heidi, thank you for calling.
NEW SPEAKER: Thank you for take my question. I've been suffering marine migraines for over ten years now, and I've been taking Topamax, that has been amazing. And I just have two questions that came to mind. I recently noticed that it was reclassified as a pregnancy category D drug. When I asked my neurologist about it, he explained that with patients a lot of neurologists didn't actually know its mechanism of action. So I was wondering if you had any thoughts on that specific drug, its mechanism of action, and why it's its reclarification of the pregnancy category D.
CAVANAUGH: Thank you for that. And Topamax is one of the drugs that you take, I imagine, on a daily basis to try to stop that trigger syndrome that leads up to a migraine; is that correct?
VIIRRE: That's correct. And in fact as Heidi's experienced, Topamax is a very effective medication, but it has possible side effects like all medications do. And it also has the possibility of affecting a fetus. So we have to worry about medications and pregnancy in all cases. We have to watch what's going on with her and decide how severe the headaches are and how much going off the medication would be versus the risk associated with it. So it depends on your individual circumstances. Another interesting little tid bit is that many women find out that during the term of their pregnancies, their headaches can actually go down. Because we know hormones are a big, big part of the migraine story as well. So again, in class action with your doctor, Heidi, you need to look at the specifics of your circumstances, what you should do, and whether you should stay on the medication during your pregnancy.
CAVANAUGH: Paula from San Diego has a quick question for us.
NEW SPEAKER: Hi thank you. I'm curious about migraines in which. My seven-year-old son just in the past few months has had some specifically left sided headaches coming down his eye, difficulty with light and sound. And I -- he always gets every single ailment my husband and I had. And my husband does get migraine. So I'm wondering how much -- I know one of them definitely was a serious headache. I'm wondering how many or how often it can be possible for children to get those.
CAVANAUGH: Thank you, Paula. Can kids get migraines?
VIIRRE: A very good question. And yes, certainly children can have migraines. And it sounds like your son is a very articulate individual to be able to describe all these things. Sometimes it's hard to tell with children. So I would again certainly be checking with your doctor to see whether they would agree that this could be something that just could be migraines. Migraines are very common in children, yes.
CAVANAUGH: Does migraine indicate a deeper health issue, doctor?
VIIRRE: Well, that's a good question. Remember I mentioned sickle cell disease a few moments ago. And you know the story about that is that why is sickle cell around? It's a genetic condition that can affect your healthy. But we found out that in Africa, people with sickle cell actually have a lower risk for malaria. So there's some thought that this funny thing that -- genetic thing called migraines has something -- is it doing something good for us? We don't know what the answer for that is. But something that's so common that's genetic should really disappear over time if it's really having an overall negative impact. So maybe there's something positive to that. So we don't know what the risks are, pluses and minuses.
CAVANAUGH: I have heard people say not a doctor, but I have heard people say that there's a possibility that it makes someone more susceptible to stroke. Is that true?
VIIRRE: And that's true. So especially young women who are taking the birth control pill, they have a higher risk of stroke associated if they have migraines.
CAVANAUGH: If someone feels a migraine coming on, is there anything that that person can do about it?
VIIRRE: Well, so there's -- beyond remembering the next time and that they should go to the doctor and look into that, an important thing is that -- we talked about some of the kinds of medicines that can help. Once somebody has the diagnosis of migraine, and again with your physician to do that, taking your medications early is important. So that's the trick. So not to let the headache go on and on and on to try and power through it, you know, be strong. If you have medications that you know that will work and you know a migraine is coming, the trick is to take your medications early.
CAVANAUGH: Because it isn't just in your head, so to speak.
CAVANAUGH: It is something that actually does progress.
VIIRRE: Oh, absolutely.
CAVANAUGH: And become more and more severe.
VIIRRE: Yes. And again with our brain recording technology, we can see these things happening. They've made recordings while people have had migraine attacks and we can literally see the different activity that's going on in the brain while that happens.
THE COURT: Let's squeeze in a call. Kim is calling from Spring Valley. Hi Kim.
NEW SPEAKER: Hi. Okay, I have migraine every year. I was -- and the preventive, and he helped me for about five-year it is. And recently my pressure build up so badly. And my doctor increased my nortriptyline. I still have the pressure built up. I cannot take anything. Is there another preventive medicine a way I can prevent it?
CAVANAUGH: And Kim's question leads me really very nicely to new advances that might be coming down the pipe for migraines.
VIIRRE: And an excellent question. Nortriptyline is a good, commonly used medication for migraines. And there are other medicines that are commonly used for it. We've heard about some of them already. The one that I'm kind of excited about, and in fact we're establishing -- I am establishing a special clinic at UCSD to treat migraines with blotch linin toxin. This is --
VIIRRE: Yeah, so you've heard about that. And it's one of these classic medical stories that people were getting their wrinkles treated around their foreheads and crow's feet by having the Botox, and the way it works for wrinkle system to relax the muscles around the head. And they came back to their doctor and say, gee, my wrinkles are better, but my headaches are also gone. And so just in the last little -- the last year or so, the FDA has approved Botox injections for control of migraines. And so that amazing thing, Botox lasts about 90†days. You put these injections in, and a good half of people, their headaches go away. It's an amazing, amazing follow phenomenon.
CAVANAUGH: I think you're going to have a very busy clinic there, Doctor . I've been speaking with doctor Eric vir, he is physician and scientist of neurosciences at the UC San Diego school of medicine. Thank you so much.
VIIRRE: My pleasure.