Biology 202
1999 First Web Reports
On Serendip

Six years later, still on the medication, I only suffer from an intense migraine about two or three times per month. However, searching for the correct medication was the most painful and helpless process of my life, an experience that I would never care to relive. Before I had settled on Norpramine, I was using medications that were only effective in relieving the symptoms after the onset of a headache, one of which was a painful injection that had a variety of uncomfortable side effects. Over the years, I have done some superficial research on migraines, finding it perplexing that a disorder that affects millions of individuals is so difficult for scientists to pinpoint. Thus, I decided to focus this paper on the probable causes of migraine headaches and examine some of the possible treatments that work well for many individuals, including me.

Migraine headaches affect an estimated 11 to 23 million Americans, women more commonly than men, and include symptoms like throbbing or pulsating pain and nausea (1). The first documented records of migraines originate from 3,000 B.C, when a popular treatment involved drilling holes in the skull to release evil spirits (1). Several scientifically based theories about the cause of migraines have recently developed, although the exact mechanism is still unknown. One of the current, highly supported theories suggests that migraines occur when there is a specific chemical imbalance in the brain, which in turn results in changes in the blood vessels (2). In this case, a trigger, which differs according to the individual, activates the release of neuropeptides from the trigeminal nerve, extending from the brain into the face and jaw (3). These neuropeptides evoke changes in the blood vessels of the brain, specifically causing them to dilate and become inflamed, irritating the surrounding nerve fibers that consequently send pain messages into the brain (2). This activity continues in the form of a positive feedback loop, with the pain messages causing the release of more neuropeptides, thus establishing a cycle of excruciating pain (3).

Another similar theory involving new evidence on serotonin indicates that this neurotransmitter may be a crucial instrument in causing migraines. It postulates that the trigger mechanism, which initiates the release of neuropeptides, is a decreased level of serotonin in the brain (4). This condition causes a chain of events similar to the above-mentioned theory in which the dilation of blood vessels aggravate the surrounding nerves causing them to send pain signals to the brain (4). With this research, scientists have been able to develop new medications that simulate the activity of serotonin and therefore, reduce the painful symptoms of a migraine attack (4).

Understanding the probable biological origins of migraine headaches is necessary when considering the wide spectrum of available treatments for migraine sufferers. The most common treatment is daily preventative medication that will reduce the frequency of attacks. There are three main classes of preventative drugs used in migraine therapy: beta-blockers, antidepressants, and calcium channel blockers (1). Beta-blockers, the most commonly prescribed prophylactic medication, actively prevent migraines by binding to the beta receptors of adrenaline, which is a neurotransmitter that increases heart rate and blood pressure and causes blood vessels to constrict (5). I found it interesting that Inderal, the medication that my grandmother takes daily, is a characteristic beta-blocker. Antidepressants function in migraine prevention by promoting an increase in certain neurotransmitters, especially serotonin (6). My nightly medication, Norpramine, is classified as a tricyclic antidepressant and essentially works by blocking the re-uptake of the neurotransmitter norepinephrine from the synapses of neurons (7). Finally, as a buildup of calcium can cause excess constriction of blood vessels, calcium channel blockers control the levels of calcium within the arteries, thereby restoring normal blood flow in the brain and decreasing the frequency of migraines (8). While many individuals afflicted with migraines consume daily preventative medication, most require general medications to relieve symptoms of migraines when they do occur, however infrequently. Depending on the severity of the migraine, general pain management includes a spectrum of medications from narcotics like Demerol and Codeine to over-the-counter drugs like aspirin, ibuprofen and Excedrin Migraine (9).

Recent advances in abortive treatments have frequently bombarded reports in current medical news. These medications, to be taken at the onset, provide relief of the symptoms and duration of a migraine (10), which can last anywhere from 4 to 72 hours (11). The well-known member of the attack-abortive medications is Imitrex, or sumatriptan. I am quite familiar with this medication as I received Imitrex injections to battle the nausea and throbbing pains associated with my migraines before I settled on a preventative treatment. Now available in tablet and nasal spray form, which are slower to alleviate pain than the injection (12), the relief Imitrex provides is consistent with the above-mentioned theory that decreased levels of serotonin triggers migraines. Imitrex targets specific serotonin receptors on both the trigeminal nerve and blood vessels in the brain and, binding to them, evokes the constriction of blood vessels (3). It is currently one of the most effective and widely used medications in combating migraines.

In addition to preventative and abortive medications, other treatments seem to be equally effective for certain individuals. For instance, many physicians will suggest special diet plans to their migraine patients. While specific triggers differ for each person, the most typical aggravators are chocolate, foods containing monosodium glutamate (MSG), alcohol, aged cheeses, caffeine and nuts (13). It is recommended that individuals who think food may be the cause of their migraines visit an allergist to be tested for specific food allergies. Finally, some alternative treatments, including acupuncture and biofeedback, have been successful in regulating some migraines (14).

Over the past six years I have taken for granted the fact that every day of my life could be miserable. Internet research has revealed millions of people who have suffered for years, which makes me appreciate the current subdued status of my migraines. Researching probable causes of migraine and effective treatments has been a personally enriching experience that has greatly contributed to my understanding of the disorder. With this acquired knowledge of the neurological basis of migraines, I will continue to combat the disorder, more enlightened about their extensive effects.

WWW Sources

2)Migraine Information

3)Taking Control of Your Pain

4)Treatment and Management: Historical Overview

5)Beta Blockers

6)5-HTP

7)Medication (Norpramine)

8)Calcium Channel Blockers

9)General Pain Management

10)Migraines: Current Treatment Methods

11)Migraine Diagnosis

12) Drug Profiles: Imitrex

13)What Causes Migraines?

14)General Symptoms

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