Migraines are equal opportunity headaches: they hit men, women, rich and poor


September 01, 1992|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

One of the benefits of modern public health research is that we are able to correct mistaken assumptions about illnesses. As a result, people are more likely to seek help.

Migraine headaches are an example. For years it has been assumed by the public and some researchers and physicians that migraine headaches are most common in affluent women. But Dr. Walter Stewart, a colleague at the Johns Hopkins School of Hygiene and Public Health, has new evidence that migraine is one of the most common illnesses in this country, and it crosses social, economic and gender lines.

Q: What, exactly, is a migraine?

A: Migraine is caused by a chemical imbalance in the brain that leads to constriction and inflammation of blood vessels. The result is severe headache -- usually on one side of the head -- accompanied by nausea, vomiting, unusual sensitivity to light, noise or smells and, sometimes, visual distortions, called aura. There may be other sensations that occur before the onset of headache pain. A migraine generally lasts 4 to 72 hours.

Q: What causes them?

A: Researchers think migraine is a neurological disorder, while .. others think it is a blood vessel problem. Heredity may play a role. Whatever the reason, we know it can begin with specific triggers that are as diverse as:

* Stress

* Foods such as red wine, cheese and chocolate

* Sleep or eating pattern changes

* Barometric changes

* Bright light, loud noises and intense smells

* Physical exertion

Q: How great a problem is it?

A: There is a personal side and an economic side to migraine. Dr. Stewart estimates that 23 million Americans have migraines, but as many as 14 million of them don't know it, either because they haven't seen a doctor or because they haven't received an accurate diagnosis. At least 11 million people have headaches so severe that they require bed rest, or are unproductive at work. As a result, millions of workdays are lost each year, estimated to cost between $6.5 billion and $17 billion.

Q: Who is most likely to have a migraine?

A: Dr. Stewart's research, in conjunction with Dr. Richard Lipton at Montefiore Medical Center in New York, shows that men and women 35 to 45 years old are most likely to have migraine. Women are three times more likely to have them than men. More than 3 million women and 1 million men experience one or more disabling attacks per month.

Q: At what age do they usually begin?

A: Dr. Stewart has found that migraines often first occur at a young age. Below age 10, they are more common in boys than VTC girls. After that, the pattern reverses. It appears boys experience their first migraines as young as 5 years and often with visual aura. More than half of male migraine sufferers will have their first ones before age 12. More than half of females with migraines will have their first one before age 17.

Q: What about income levels?

A: Dr. Stewart says that contrary to a long-standing belief, people from low-income households are 60 percent more likely to have migraines than from higher income households. This difference may be caused by greater stress and less adequate health care among lower-income families. And poor women tend to seek help at emergency rooms rather than getting appropriate long-term treatment.

Q: Is there effective treatment?

A: Yes, there is good news. Despite the fact that migraines can't be cured, their symptoms can be controlled. So if you think you have migraines, see your doctor. He or she can help you identify the "trigger factors" and avoid them. There are two types of medication. One alleviates pain and nausea after the headache begins and the other medication, which must be taken daily, reduces the number of episodes in patients who experience frequent attacks.

Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.

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