Migraine is more likely in identical twins with the same genes than in fraternal twins. In cases of identical twins separated at birth, the likelihood of each twin getting migraine is almost exactly the same as in cases where they are raised together, supporting a more important role for heredity than for the environment. However, even sharing the same genes does not determine the emergence of migraine. If one identical twin has migraine, there is still only about a 1-in-3 to a 1-in-2 chance that the other twin will also get migraine.

Alvin E. Lake III, Ph.D. Excerpted from the Spring 1999 issue of Headache, the newsletter of the American Council for Headache Education (ACHE).

Personal Profile

According to Alvin E. Lake, III, Ph.D, in the Spring 1999 issue of ACHE’s newsletter, "When one person has a headache problem, often the whole family suffers. In a recent national survey of 4,000 households, 350 (9%) had at least one adult with migraine. In over 60% of these homes, migraine sufferers said that their headaches had a significant negative impact on family life, affecting activities, plans, and relationships." Following is a personal profile written by the husband of a woman who suffers from severe migraine headaches.

In my house of six, a migraine incapacitates one member and turns five members into caregivers. As caregivers, we tiptoe around the house, trying not to make noise and yet enjoy our day.

In my house, a migraine usually begins around 3:00 to 6:00 in the morning. My spouse awakens with a headache. Medication is taken. If we are lucky, the medication works. About 50% of the time, vomiting begins.

Now I get up, it is time for the trip to the hospital. Before leaving, we wake up the oldest child to inform her of our plans. Now she becomes a caregiver. It becomes her responsibility to wake up the other kids and get them ready for school.

Meanwhile I sit helpless in the hospital watching my spouse in pain. After hospital-administered medication, we return home. I put my spouse to bed, darken the room, and quietly get the kids off to school.

Depending on the severity of the migraine, I take a day off work. I now become the single parent. Although two of us remain at home, I am still lonely. I care to my spouse’s needs—a cup of coffee, a cracker. I sit and watch, again helplesly, hoping my spouse is feeling better; or worse, fearing a second migraine. As the day progresses, the migraine subsides. Yet my spouse remains out of action most of the day. I continue to chauffeur the kids, prepare dinner, help with homework, and put them to bed.

As a caregiver, a migraine disrupts the whole day. Missing work, herding the kids, and early morning hospital trips are all forgotten the next day.

1.) Keep a diary and record:

• The date and time of day each headache begins.

• How long the headache lasts.

• Any accompanying symptoms, such as nausea; vomiting; sensitivity to light, sound, or odor; or an aura.

• Any potential triggers that may have brought on the attack. Women should note the date on which their menstrual periods begin.

With this information, your physician can identify any patterns related to your headaches and recommend treatments that can help.

2.) Ask your partner, a family member, or someone close to you to help you identify any symptoms that precede your headaches by a few hours or even days. Such symptoms can take many forms, such as hunger, thirst, yawning, fatigue, depression, euphoria, irritability, restlessness, drowsiness, light or sound sensitivity, a stiff neck, a cold feeling, increased urination, diarrhea, constipation, or fluid retention.

3.) Always carry at least one dose of your medication with you, and take most prescribed treatments as directed for an attack.

4.) Take drugs only as recommended by your physician. Do not use them more often or in higher doses than your physician advises. Do not stop taking them without consulting your physician; some drugs must be gradually withdrawn to prevent unwanted effects.

5.) If you miss a dose, it is generally best to take it as soon as possible unless it is almost time for your next scheduled dose. In that case, skip the missed dose. Do not double dose.

Found on AMA Health Insight’s website, www.ama_assn.org. Information is sponsored by the American Medical Association.

Amitriptyline is included in a group of medications classified as tricyclic antidepressants. Amitriptyline is one of the first successful medications in this class to be developed. It was discovered in the late 1930’s before scientists had developed a concept of the chemistry of the brain. This drug was developed as a way to reduce anxiety. Frequently, people with depression are often very anxious. When amitriptyline was given to patients with anxiety, it also improved the depression. This result prompted further research and the development of newer agents to treat depression. As scientific understanding of the brain progressed, scientists discovered that amitriptyline and related compounds worked on a series of chemicals called neurotransmitters. The antidepressants influenced the production and efficiency of these neurotransmitters.

Subsequent work revealed that one neurotransmitter such as serotonin could be involved in a variety of body processes. Serotonin is involved in mood and emotion, pain regulation, and the regulation of the blood vessels in migraine.

Amitriptyline influences the body’s use of serotonin and thus can lead to improvement in depression and several types of headache. It is usually used to treat chronic tension-type headache (muscle contraction headache) as well as migraine headache.

This term applies to migraine that exhibits itself in a form other than head pain. A diagnosis of migraine equivalent is determined by a previous history of migraine attacks, no evidence of organic lesions, and the replacement of normal headaches by an equivalent group of symptoms. It is important that these patients be evaluated thoroughly, with attention to past and family migraine histories.

Characteristically, drugs used to treat migraine usually help the equivalent symptoms. Although not common, the most prevalent migraine equivalent is "abdominal migraine," which is characterized by recurrent episodes of vomiting and abdominal pain without headache. The bouts of pain can last for hours and occur more frequently in female children. Patients characteristically show other symptoms of migraine such as yawning, listlessness, and drowsiness during their attacks.