The East Bay Headache Support Group held a "Talk It Over Night" on October 13, 1998 at John Muir Medical Center with 15 people in attendance. The Planning Committee was excited to report that Glaxo-Wellcome, a pharmaceutical company, recently gave our non-profit organization a substantial donation (grant).

Dr. Stephen Peroutka was originally slated to be the speaker for this meeting, but unfortunately he had to cancel. It was also learned that Dr. Peroutka is giving up on his quest to find a single gene associated with migraines. Dr. Michael Stein, our advisor, made some comments about this:

* Migraines may be caused by multiple genes rather than a single one, and it is very difficult to isolate many genes.

* Headache is so diverse.

* Headache predominates in women 3 to 1.

* It is probably multi-factored.

* Scientists may never be able to predict who is susceptible to migraine headaches.

The search for the migraine gene(s) began when a condition known as familial hemiplegic migraine was studied. This migraine is like a stroke—it causes paralysis on one side. Scientists found a genetic marker in these people, and thought maybe a gene could be found for regular migraine.

There is no test for migraine (like a blood test or a scan). It is only defined by symptoms described by the patient. Dr. Stein predicted, however, that someday there will be a test.

Dr. Stein said that vascular implies that blood vessels are involved, but actually the blood vessels are bystanders that get caught in the event. Some theorize there is a migraine generator that provokes this—a neural event in the brain. He noted that migraine sufferers have a slight increased tendency to having strokes. And women who take birth control pills and have migraines have a higher incidence of stroke.

Dr. Stein made the statement that migraine headaches tend to peak at about age 40 and then start to drop off—and stroke starts to occur in people in their 50’s and 60’s. When you look at an MRI (magnetic resonance imaging) of a person who has had lots of migraines it looks the same as if they had had a lot of little strokes. He said an ischemic stroke is one where the blood vessel plugs up, whereas a hemorrhagic stroke is where the blood vessel ruptures.

Some people who have migraine don’t have a family connection, i.e., none of their relatives suffer from migraine.

How will it be beneficial to find the gene for migraine? Dr. Stein said that if you can find the gene that makes a protein that is found in a migraineur, perhaps it will be possible to alter the protein.

How is migraine diagnosed? In most cases, the cause is unknown. Some people are able to identify their headache triggers, while others cannot. Of course, head injury is an identifiable cause.

Has there been a connection between Viagra and headache? Dr. Stein explained that headache is listed as a side effect in 2% to 3% of the patients involved in the study of Viagra before being approved by the FDA, but said that you have to take that percentage with a grain of salt.

Dr. Stein was asked to explain the difference between a CT (CATSCAN) and an MRI (Magnetic Resonance Imaging). He orders these tests for his patients only if there is something about the patient’s history that is unusual, or if the patient hasn’t responded to any headache treatment.

It is important for the headache sufferer to keep a diary of his/her headaches, which can help him to look for a pattern, or a trigger. One trigger for headaches is not getting to bed at a regular hour.

GABA: Depakote (an epilepsy medicine) has something to do with receptors. It changes the chemistry in the brain.

Neuronton is another anti-epileptic medicine that is coming out.

If your doctor prescribes a preventive medicine, it must be taken for awhile (at least a month) before it works. Also, combining preventive medications can help.

One member of the group asked just how much headaches have affected the lives of others in the group, as almost constant headaches have really altered his lifestyle over the past four years since he suffered a head injury as a result of a car accident.

Dr. Stein explained that a chronic daily headache is one that is never gone, as compared to an episodic headache which comes and goes.

Imitrex in an injectable dosage form has been available in the U.S. for five years now. Dr. Stein said it seems to work four out of five times. Now there are four medicines available to be used as abortives (once you get the migraine headache). They are Imitrex, Zomig, Amerge and Maxalt. And Eletriptan and another one are due to be approved in the next year or two.

Dr. Stein explained the term co-morbidity—more than average associated with depression. Is depression really a reaction to chronic pain, or is the patient depressed first? He said a woman with migraine tends to feel super great when pregnant (in a good mood). She is energetic, even though not necessarily headache-free.

Kaiser is now referring all migraine patients to a Primary Care Physician—patients can no longer go to a neurologist for treatment for their migraines. One participant in the group was told she is allowed only two Imitrex injections per month.

MSG was discussed as a common trigger for headaches.

Tracy Titus said that a low tyramine diet is good. She told us about the Migraine Cookbook by Seymour Diamond of the headache clinic in Chicago. MAO inhibitors were used in the 1940’s as anti-depressants, but it was discovered they help if on a low-tyramine diet.

Barry Harrington mentioned the Zone Diet, and Reggie Fong also mentioned that Alternative Medicine is a good book to be read by headache sufferers.