Heading off migraines

When Carin awakened, her vision was blurred. Halos surrounded the light streaming in her bedroom window. She struggled out of bed, her head throbbing. Turning on her light, she gasped at the sudden unexpected pain in her eyes. For most people, it was a school day, but Carin returned to bed immediately, hoping against hope that she wouldn't vomit. Forget her Spanish skit that was due first period and all else on her schedule for the morning, and maybe for the whole day. Carin was in the throes of a migraine. Any sort of normal life she had planned for the day was now an impossibility.

Sadly, for Carin, this scene has been repeated at least weekly since her freshman year of high school. Now a junior, she struggles to maintain her grades with significant absenteeism. A healthcare professional might think Carin has a problem with headaches. But to Carin and millions like her, the problem is much worse. It is chronic but unpredictable disability, or migraine. And Carin-a real person-would do just about anything to be rid of her problem permanently. For Carin, excellent medical care has measurably reduced the impact of her migraines, but they're still extremely disruptive.

Migraines are worse than just headaches. According to the World Health Organization (WHO), a severe migraine causes disability equivalent to quadriplegia, psychosis, or dementia. And migraines are costly. Healthcare statistics estimate the direct medical cost of migraines at more than $2 billion annually; indirect costs to employers are estimated at $13 billion. But, in all likelihood, the sum of these two costs far understate the accumulated personal cost of disability-just ask anyone who experiences severe migraines.

The advent of triptans during the 1990s revolutionized migraine therapy by offering a means to abort migraines. They rounded out existing options, including dihydroergotamine and over-the-counter therapies such as aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs. Two medications, valproic acid extended-release (Depakote, Abbott) and topiramate (Topamax, Ortho-McNeil Neurologics), that are specifically approved for migraine prophylaxis, were recently added to a host of other commonly prescribed prophylactic drugs-antidepressants, beta-blockers, calcium-channel blockers, and supplements (e.g., riboflavin, feverfew)-as part of the therapeutic armamentarium. But, despite the many options available, the battle to mitigate migraines is far from over.

Current treatments