MARCH 1996 MEETING NOTES

TOPIC: "HEADACHE AND GENETICS"

Dr. Stephen Peroutka of Spectrum Biomedical in Menlo Park was the guest speaker for the March 12th meeting of the East Bay Headache Support Group. The meeting was held in the Ball Auditorium of John Muir Medical Center from 7:30 to 9:00 PM and approximately 60 people attended.

Dr. Peroutka: 4,200 persons have been interviewed so far in a study of migraine sufferers. One out of every six persons has migraine headaches.

There are susceptability genes. It is a genetic, metabolic problem. We need to monitor it like persons with diabetes are monitored.

One way to avoid migraines is to establish a set sleeping pattern, i.e., go to bed at the same time each night (within an hour) and wake up at the same time each morning.

91% of persons with migraine have a parent with migraine.

When a mother has migraines, it is passed to daughters more than sons (45% of daughters vs 25% of sons). When a father has migraines, it is passed to daughters and sons (50% of the children).

When common migraine (without aura) is passed down from generation to generation, the onset of migraine seems to occur earlier in each succeeding generation. Dr. Peroutka mentioned that his mother was approximately 42 at onset, he was 27, and his daughter was a teenager. Also, in each generation, migraines seem to occur more frequently.

Classic migraines (with an aura, i.e., shimmering zigzag lines in eyes) tend to be 3-4 hours in duration, and are more painful than common migraines. The average length of a common migraine is 18 hours.

People who have migraines tend to have them over a period of 20-30 years and then they go away. They appear to peak at 10-15 years and gradually subside.

"Women go to the doctor when something is wrong. Men go to the doctor 5 years after something is wrong."

Sumatriptan (Imitrex), an abortive medication, works for 70% of migraineurs.

Depression causes increased secretion of serotonin in the brain (as does migraine).

There seems to be a correlation between barometric pressure and migraine, i.e., when the weather changes and there is a sudden drop in barometric pressure, migraineurs tend to have more headaches. This is more common in people who are diagnosed with common migraines rather than classic migraine.

Sumatriptan is used for common and classic migraine headaches (after the aura subsides), but not cluster or hemiplegic or basilar migraine.

A good combination for the relief of migraine recommended by Dr. Peroutka is Advil and Sumatriptan (Imitrex) together.

One Advil a day is a good heart and anti-migraine regimen.

Sumatriptan constricts blood vessels in the brain and the heart. Ergots constrict blood vessels throughout the whole body.

Peroutka’s theory: Migraine is an inflammatory process, and blood vessel changes are secondary. He thinks that migraine tends to be a wave of pain, not a pulse, so therefore it is inflammatory.

Spectra Biomedical has three sources of money. They have spent the past three years looking for the gene which causes migraine.

Adolescent males sometimes have a post-exercise migraine. This tends to disappear later as the teen matures (by 19-20).

Sumatriptan can take away the pain of a migraine headache, but your body is still experiencing the migraine, i.e., you still feel different. When people take Sumatriptan, one-half of them report that the pain comes back within twelve hours.

Dr. Peroutka wants to start a migraine management organization.

Migraineurs are the #1 dissatisfied customers of medication.

15% of the people in the Bay Area suffer from migraine headaches. There are only four doctors in the Bay Area who specialize in treating migraineurs: Dr. Stephen Peroutka, Menlo Park; Dr. Neal Raskin, San Francisco; Dr. Jerome Goldstein; San Francisco Headache Clinic Dr. Michael Stein, Walnut Creek.

The most respected professions in the United States are: #1 Pharmacist, #2 Clergy, #3 Physician.

Dr. Peroutka told us that Tylenol is not an anti-inflammatory medication. Caffeine (as in Excedrin) is not good for you, is addictive, and can cause rebound headaches. Therefore, take no Tylenol and no caffeine when trying to get rid of a migraine.

Dr. Peroutka also said that Aleve is great for arthritis, but if you have a migraine, he recommends an ibuprofen, like Advil. Aleve has the longest half-life, but is the slowest to work.

Persons under age 40 have 80% of the migraines.

Hemiplegic migraine—very rare, causes complete paralysis for 3-12 hours, with almost no headache.

Hormones—it’s is the rate of change, not the actual hormones that cause the migraine. Therefore, Dr. Peroutka thinks if we can smooth out the hormonal cycle, women would suffer fewer migraine headaches.

Dr. Peroutka’s organization, Spectrum Biomedical, is researching genetic factors responsible for headaches, i.e., they’re trying to isolate the gene responsible for migraines. To accomplish this they are looking for two categories of people interested in being a part of their studies:

• Families with a history of migraines.

• Individuals with a history of migraines, but no living family members who had migraines.

Call (800) 245-6867 for a brief telephone interview to establish your qualifications to participate in one or both of the studies. If you qualify, you will be sent a questionnaire and also contacted by a local medical group who will draw a blood sample for processing. The sample will then be sent to Dr. Peroutka’s office for genetic analysis.

The intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician.