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Migraine headaches

This week, reports revealed that Minnesota State Representative and aspiring Republican presidential candidate Michele Bachmann suffers from migraine headaches so severe that they’ve led her to seek emergency medical treatment. Detractors say it’s proof she’s not fit to lead. Bachmann and staff have protested, even offering up a physician’s letter as evidence that, as she stated, her “ability to function effectively has never been impeded by migraines.”

Is chronic migraine truly debilitating or just a mere nuisance? Here’s what you need to know:

1. It’s misunderstood.

The American Migraine Foundation defines migraine as “an inherited neurological disorder that is characterized by hyperexcitable brain networks that may be triggered by a variety of stimuli.” The difference between migraine headaches and “regular” headaches is there is no single cause for migraine. There is also no cure.

There’s also the severity factor: migraine is accompanied by searing, excruciating pain, starting with symptoms like extreme light sensitivity, nausea, vomiting or severe fatigue. A third of migraine sufferers also experience an aura phase, which might involve visual hallucinations like flashing lights, sparks or lines (followed by dark spots), as well as facial tingling or numbness. Aura occurs from cortical spreading depression, a wave of hyperactive nerve activity followed by a prolonged state of suspended inhibition in the neurons.

According to a 2008 article in Scientific American, records of migraine date back at least 7,000 years, “yet it continues to be one of the most misunderstood, poorly recognized and inadequately treated medical disorders.”

Previous explanations for migraine’s cause include “vapors” in ancient Greece – the modern term “migraine” is derived from the Greek term “hemicrania,” an affliction involving half of the head – and swollen blood vessels in the 17th century. Now, migraines are understood to be related to the brain stem. Another possible culprit may be a drop in serotonin or other brain chemicals, which can trigger a major sensory pathway.

2. It’s not uncommon.

Thirty-six million Americans, or about 12 percent of the U.S. population, suffer from migraine. One in four households in the U.S. has a member with migraine. There’s a genetic link, too. Although no single migraine gene has yet been identified, up to 90 percent of migraine sufferers have a history of migraine in their family.

The World Health Organization ranks migraine as the 19th top cause of disability worldwide, affecting sufferers’ social and work capacities and also predisposing them to other illnesses such as depression, anxiety and sleep disorders. Untreated migraine headaches typically last from four to 72 hours, and a full attack can even last for several days or more. Most migraine sufferers only have a few attacks each month, but 3 percent of Americans have chronic migraines, or at least 15 days of headache each month for at least six months. Most migraine sufferers experience their first attack during adolescence, and experience fewer attacks as they age.

Medical expenses and loss of productivity due to migraine cost the U.S. more than $20 billion each year. But migraine research is underfunded compared to that for other illnesses. In 2007, the National Institutes of Health allocated $13 million for migraine research, while giving $294 million for asthma research and $1,037 million for diabetes research.

3. There’s a gender gap.

Questions about Bachmann’s ability to serve as president have an undeniable gender component, as three times as many women suffer from migraine than men in the U.S.  A 1991 study found that 18 percent of American women had migraine, compared to 6 percent of men. Thirty percent of women suffer from migraine during their lifetimes.

One reason for this gender imbalance is that decreased estrogen levels, which normally occur before a woman’s menstrual cycle begins, have been associated with migraine. Girls and boys have the same occurrence of migraine prior to puberty, but starting in adolescence, when hormones also start fluctuating more, the gender disparity widens. Two-thirds of pre-menopausal woman suffering from migraines have reported regular migraines or “menstrual migraines” immediately before or during the start of their periods, which is when estrogen levels drop.

4. There’s some hope.

According to the American Headache Society, there’s no cure for migraine. Instead, treatments are aimed at reducing headache frequency and stopping individual headaches when they occur.” Bachmann described her headaches as “easily controlled with medication.”

Migraine sufferers can take regular preventive medications to reduce the frequency and severity of their headaches, but such medications are only successful for half of the patients that take them, and only for half the time. Preventative medications include beta blockers and some anti-seizure drugs, antidepressants and antihistamines. Injecting Botox into face or neck muscles has also been approved by the FDA for chronic migraine treatment.

Abortive or acute medications are taken when a headache occurs. These include pain relievers and triptans, drugs which also relieve light sensitivity and nausea. Many migraine sufferers also try relaxation techniques, acupuncture and vitamin supplements.

Maintaining regular sleep and eating patterns and exercise, as well as reducing stress and avoiding known triggers, have all been known to reduce the frequency of migraine. Common triggers include caffeine, alcohol, chocolate, aged cheeses, artificial sweeteners, MSG, chemical exposure and other environmental stimuli such as bright lights, loud sounds or strong odors.

5. Migraine sufferers, you’re in good company.

Migraine hasn’t prevented people from excelling in their fields. Famous migraineurs include Thomas Jefferson, Kareem Abdul-Jabbar, Whoopi Goldberg, Elvis Presley, Lewis Carroll, Serena Williams, Ben Affleck, Sigmund Freud, Ulysses S. Grant, Julius Caesar, Terrell Davis and Virginia Woolf.

Woolf wrote that English “has no words for the shiver and the headache… Let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.”

Author Joan Didion also wrote about migraine in her 1968 essay “In Bed”:

“The physiological error called migraine is, in brief, central to the given of my life… When I am in a migraine aura, I will drive through red lights, lose the house keys, spill whatever I am holding, lose the ability to focus my eyes or frame coherent sentences, and generally give the appearance of being on drugs, or drunk… That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.”