A New View of the Source of Migraines

The patients may feel a disconcerting tingle travel up their arm and settle on their tongue. Or they may smell something that isn’t there, or inexplicably experience the taste of salt or lemon. Sometimes, even the weight of their clothes becomes unbearable.

These are some of the hidden agonies that sufferers of migraine headaches usually do not talk about, said Dr. Rami Burstein, associate professor of neurobiology and anesthesiology at Harvard Medical School and Beth Israel Deaconess Medical Center.

“Patients are afraid to tell me of these symptoms because they are afraid I will think they are crazy,” said Burstein.

But new headache research conducted by Burstein and others has shown an estimated 25 million migraine sufferers that they are not losing their sanity but experiencing a kind of neurological uprising.

Research during the past five years strongly suggests that migraines are not primarily caused by changes in blood flow within the brain, as previously suspected, but by a series of misfiring neuron clusters, Burstein and other researchers say.

“Migraines are a neurological disease. That’s pretty much a done deal,” said Dr. Stewart Tepper, director of the New England Center for Headache in Stamford, Conn.

Migraine headaches are characterized by severe, throbbing pain, often accompanied by nausea, vomiting and sensitivity to light and sound. Three out of four sufferers are women.

The new view of migraines as a neurological disorder is changing the way people are treated.

One of the key lessons of the new research is that people with migraines should not try to bear the pain but should take new pain medicine quickly, Burstein said. That’s because migraine is a kind of rolling tidal wave of pain that, if left unchecked, moves into other areas of the brain, and engulfs the person in excruciating agony.

In research recently published in the Annals of Neurology, Burstein’s lab showed that during a migraine attack, the skin of 79% of sufferers became so sensitive that even running a comb through the hair could cause excruciating pain.

Burstein believes that type of pain is the end result of a molecular chain reaction. At some point after the first cluster of neurons in the brain becomes abnormally sensitive to pain, a second set of neurons also becomes sensitized. Most migraine drugs now in use target the first cluster, Burstein said. Studies on rats suggest that when the second cluster of neurons becomes sensitized, the sufferer gets little or no relief from existing medications.

“Once the pain has migrated to the second location, drugs have no or minimal influence,” Burstein said. “The work shows that you have to treat headaches in the first 20 minutes to an hour to be effective.”

Tepper said intervention within 90 minutes with the class of headache medicines known as triptans is the recommended course of treatment for severe migraine pain. Drugs such as zolmitriptan and rizatriptan block the neurotransmitter serotonin, and have proved effective in treating severe pain.

Doctors no longer regularly prescribe daily preventive treatments with antidepressants, which have side effects, Tepper said. “Most cases of episodic pain we can treat today,” he said.