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Vol. LXII, No. 5
March 5, 2010
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Migraine in the Spotlight
STEP Forum Explores Headaches


Dr. Peter Goadsby
Dr. Peter Goadsby

Millions of Americans suffer from migraines and NIH wants to help. A panel of experts recently convened in Lister Hill auditorium for a STEP forum on the science and management of headaches.

“Right now, today, on average,” said the University of California, San Francisco’s Dr. Peter Goadsby, “around 1.1 million Americans have a migraine and are out there just trying to get on with life.”

Migraine, the most common kind of headache, strikes up to 18 percent of women and 7 percent of men, as well as 8 percent of children/adolescents.

“However,” Goadsby continued, “today we will spend one-tenth of one penny on each American [who gets] migraine each day…making headache research perhaps a little under-resourced.”

The forum focused on headaches that are primary (without any underlying disorder) rather than secondary (produced by something else).

The vast majority of people get headaches at least occasionally, said epidemiologist Dr. Ann Scher of the Uniformed Services University of the Health Sciences.

“The most common types of primary headaches are tension-type headache, migraine and chronic daily headache,” said Scher.

Tension-type headache, by definition, is less disabling than migraine headache. As for chronic daily headache, “it’s prevalent in about 3 to 4 percent of adults, 2 percent of children/adolescents and is about twice as common in women as men.”

Migraine typically affects only one side of the head, although not always. It is more than a headache and may include nausea and vomiting as well as weakness and sensitivity to light and sound. It may also be preceded by an aura: transient neurological symptoms that are usually visual, such as seeing stars or spots or partial loss of vision. Less common aura symptoms include transient numbness, motor or speech problems. About one-third of migraine sufferers experience an aura at least occasionally. Migraine attacks, which can be episodic or chronic, can last up to 72 hours.

STEP forum headache experts include (from l) Goadsby of the University of California, San Francisco; Dr. Ann Scher of the Uniformed Services University of the Health Sciences; Dr. Stephen Silberstein, director of Thomas Jefferson University’s Headache Center; and Dr. Elizabeth Loder of Harvard Medical School and Brigham and Women’s/Faulkner Hospitals.
STEP forum headache experts include (from l) Goadsby of the University of California, San Francisco; Dr. Ann Scher of the Uniformed Services University of the Health Sciences; Dr. Stephen Silberstein, director of Thomas Jefferson University’s Headache Center; and Dr. Elizabeth Loder of Harvard Medical School and Brigham and Women’s/Faulkner Hospitals.

“Migraine is the most common neurological disorder in both women and men,” Scher said.

There are almost 30 million migraine sufferers in the U.S., but up to 50 percent of migraineurs (folks who get migraines) do not consult physicians. Yet the 1997 Global Burden of Disease Study ranked severe migraine in the same class as active psychosis and quadriplegia (paralysis of the arms and legs).

Another study showed $1 billion per year in direct costs (physician visits, etc.) and $13 billion in indirect costs, as in missed work and “presentee-ism,” when you come to work but can’t perform well.

Dr. Elizabeth Loder of Harvard Medical School and Brigham and Women’s/Faulkner Hospitals reviewed differential diagnosis.

Doctors diagnose migraine by a physical examination, patterns of symptoms and a thorough patient history to distinguish it from other headaches, whether tension, cluster or “primary stabbing headache.”

She said that “as clinicians, we have very poor treatment therapies for most of these people; it’s an area of significant unmet need.” Migraine is often refractory—stubbornly resistant—to treatment.

“Current treatments work well for people who have occasional headaches,” she said, “but the treatments we have for people with daily or almost daily headache problems are limited and for many people are not especially effective.”

Goadsby, who heads UCSF’s headache group, returned to discuss migraine pathophysiology (changes in normal function).

“While it’s common to have a first degree relative with migraine,” he said, “the genetics [have] yet to be worked out…

“Migraine is a dreadful phenomenon,” he said, “and one of the greatest unmet needs is prevention.”

Dr. Stephen Silberstein, director of Thomas Jefferson University’s Headache Center, spoke of integrated therapies: medications, both prescription and over the counter, as well as quiet, rest, cold compresses and behavioral interventions such as stress management.

He suggested a “headache calendar” to help patients identify and remove triggers such as hormonal factors, stress and certain foods.

There is no cure for migraines.

“Depakote—we’re talking about the best drug we have—is barely able to break the 50 percent barrier,” he said.

“Migraine may be progressive [going from bad to worse] within an individual attack and within the disorder.” There is nothing to be gained by delaying treatment. “If you see a patient with migraine, treat early,” he advised.

The good news, he said, is that “some preventive meds are coming down the pike.” NIHRecord Icon

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