What is a Migraine Headache?
Various types of headache are related to each other as a continuum of cerebrovascular disorders; different types of migraine headaches occupy a sub-region of these maladies. The name migraine refers to the frequent occurrence of headache on one side (hemi-half) of the head (cranium).
Another characteristic of some types of migraine is the presence of a preliminary or warning phase, the aura, which may yield unusual sensory-related phenomena such as colors or sounds. Additionally, migraine sufferers often experience severe nausea or vomiting during the headache, and extensive muscle aches during and after the attack. Migraine sufferers are often acutely sensitive to light (especially flickering or strobing light), sound, various foods and any of a number of environmental stimuli. In a particular individual, one or more of these stimuli may trigger a headache.
Although the exact characteristics of migraine headache differ from one sub-type to another and between one individual and another, the outcomes are common. Worldwide and in the United States about 10% of the population suffers with migraines, with women outnumbering men.
The magnitude of suffering and disability is substantial. Recently, the Bureaus of Census and Labor Statistics has estimated that more than 110 million migraine-related bedridden days occur each year in the United States. This results in significant absenteeism from work with an estimated $13 billion loss to employers annually. The direct costs of medical treatment of migraine are in the range of 1 billion dollars per year in the United States alone.
From these figures, it is not surprising that considerable attention is paid to drug intervention, both acutely and prophylactically. Nonetheless, therapeutic approaches, drug and otherwise, have been problematic because the underlying origins of migraine headache are elusive. In recent years, however, migraine etiology has started to be unraveled. While early theories centered on the brain’s vascular system, recent concepts have been more holistic in emphasizing neurovascular and inflammatory pathologies.
For about a decade, the neurotransmitter serotonin (5-hydroxytryptamine; 5HT) has been recognized as an important component in both the genesis and extension of migraine headache. Within the last five years, abnormalities associated with calcium and its movement has been recognized in certain types of migraines. Not surprisingly, drugs that intervene in these two areas have been prominent. For example, sumatriptan, a drug currently high in use for acute treatment is a serotonin analogue. Historically important anti-migraine drugs like the ergot alkaloids, dihydroergotamine (DHE) and ergonovine are active at various types of serotonin receptors. The calcium channel antagonists such as verapamil target the problems with calcium. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and especially ibuprofen are useful in treating the inflammatory components of migraine.
By far the greatest void in migraine pharmacotherapy occurs in the realm of prophylaxis. No single agent has proven completely satisfactory. Typically, a particular drug may be useful, but only in a small percentage of the population, or if widely useful, has too many adverse effects to be acceptable. Examples of drugs that have been and continue to be used in prevention include: the calcium channel antagonists; beta-adrenergic blockers such as propranol; and ergot drugs such as methysergide (Sansert). Methysergide is a serotonin receptor antagonist, and is quite effective. However, serious toxicity limits the utilization of this drug. It is in the realm of preventative treatment that feverfew plays a role.
Over millennia, feverfew has been used to treat fever, headaches, arthritis, menstrual irregularities and other ailments. Early Greek and European herbalists derive its common name from its use to reduce fever.
Gerard in the seventeenth century considered it, “very good for them that are giddie in the head, or which have the turning in the head.” In the eighteenth century, Culpepper stated, “it is very effectual for all pains in the head of a cold cause, the herb being bruised and applied to the crown of the head; as also for vertigo, that is a running and swimming of the head.” Culpepper also recommended that a decoction of the flowers with nutmeg and mace “is an approved remedy to bring down woman’s curses speedily, and help expel death birth.”
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