Katie Biggs' students often know before she does that a migraine is about to strike.
A high school English teacher and theater coach in Naperville, Ill., Biggs, 42, has had migraine headaches since she was 8 years old, and they've increased in intensity since then.
New research on headache and pain management will be the focus of a symposium, workshop and posters presented by scientists at the annual meeting of the American Neurological Association, held in conjunction with the Association of British Neurologists, starting Friday in Boston.
For Biggs and other chronic migraine sufferers, the need for new and better therapies is urgent. For them, headache or the threat of one is not an occasional inconvenience. It's something to be managed every day.
"My students who know me well sometimes can tell I'm getting one because I start to stutter," Biggs says. "They'll look at me and say, 'You need to take your medicine.'"
Speech disruptions sometimes afflict patients who also experience an "aura," spots, flashing lights or other visual or physical symptoms.
Migraine is one of about 300 types of headache described in medical manuals, says neurologist Richard Lipton, director of Montefiore Headache Center and professor of neurology at Einstein Medical Center in New York. To diagnose patients and determine which treatments might help, he says, doctors first must rule out underlying causes. These can be serious (brain tumor, stroke, aneurysm) or less so (hangover or flu).
Once those are ruled out, that leaves what doctors call "primary headache disorders," meaning the headache isn't a symptom of some other health issue. The major ones:
Migraine
Nearly 30 million Americans are afflicted with this most common form of disabling headache. It tends to run in families, and some patients have them 16 times a month or more, says neurologist Seymour Diamond, executive chairman of the National Headache Foundation. More often, patients have two to four a month. Migraine is linked to hormonal changes; 70% of sufferers are women.
Once a migraine is triggered, a series of brain activities begins that Diamond describes as a "spreading wave over the cortex," the nerve tissue covering the outer part of the brain. The wave, he says, is a depression of electrical activity that excites the trigeminal nerve, the largest cranial nerve, which monitors pain. That signals blood vessels on the affected side of the brain, causing them to dilate and contract, and to press painfully on nerve receptors. That's why "migraines are commonly on one side," Diamond says.
Tension headache
These occur when the muscles of the scalp or neck tense in response to stress, anxiety, depression or a head injury. Lipton says tension headaches have pressure on both sides and are not made worse by physical activity, light or sound, unlike migraines.
Cluster headache
These most painful of headaches occur on one side of the head, often near the eye, and sufferers often have two to 10 attacks a day. "It's described as a hot poker in the eye, a searing, stabbing, debilitating pain," Lipton says. About 80%-90% of sufferers are male, for reasons unknown, Diamond says. "People get markedly depressed," he adds. Treatments include triptan medications and high-volume oxygen, steroids and lithium.
Biggs, who gets about 15 migraines a month, says her life is full and busy, but she makes time to volunteer with the National Headache Foundation to try to increase headache awareness .
"People don't believe us," she says. Headache patients are often suspected of exaggerating or making up excuses to get out of work. "It's, 'Oh, right, you have a headache,'" she says. "Many people don't understand it."
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