Migraine headaches affect 28 million Americans, 75 percent of whom — roughly 21 million people — are women. Migraine symptoms occur in various combinations and include pain, extreme sensitivity to light and sound, nausea and vomiting. The pain of migraine is often described as an intense pulsing or throbbing pain in one area of the head. Some individuals can predict the onset of a migraine with tell-tale signs that include visual disturbances. This is called a migraine "aura."

Despite the fact that 1 in 4 households in the United States have someone affected by migraine headaches, migraine is still not considered by many employers and insurers to be a legitimate medical problem. Migraine, however, can cause significant disability and costs the American taxpayers $13 billion in missed work or reduced productivity annually.

On June 8-9, 2000, leading migraine experts from around the world gathered together in Bethesda, Maryland for 21^st Century Prevention and Management of Migraine Headaches, a scientific meeting designed to develop practice guidelines for migraine management. The National Institute of Neurological Disorders and Stroke presented the meeting in cooperation with the American Academy of Neurology, the American Headache Society, and the National Headache Foundation. Thomas Jefferson University, Philadelphia, and Gardiner-Caldwell SynerMed jointly sponsored the program.

For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine is caused by inherited abnormalities in certain cell populations in the brain. Using new imaging technologies, scientists can see changes in the brain during migraine attacks. Scientists believe that there is a migraine pain center located in the brainstem, a region at the base of the brain. As neurons fire, surrounding blood vessels dilate and become inflamed, causing the characteristic pain of a migraine. In order to keep this process in check, prompt treatment is of the essence.

What causes migraine? Though the causes are not precisely known, it is clear that migraine is a genetic disorder. For some forms of migraine, specific abnormal genes have been identified. People with migraine have an enduring predisposition to attacks triggered by a range of factors.

What triggers migraine? Lack of food or sleep, exposure to light, or hormonal irregularities in women, can set off a migraine attack in individuals with the disorder. Anxiety, stress or relaxation after stress, and fatigue are also triggers.

Medications for migraine may be taken on a daily basis to prevent attacks. Some medications developed for epilepsy and depression may prove to be effective treatment options. Medicines can also be used to relieve pain and restore function during attacks. The most promising of these are drugs called triptans. For some women suffering from migraines, hormone therapy may help. Stress management strategies, such as exercise, relaxation, biofeedback and other therapies designed to help limit discomfort, may also have a place in the migraine treatment arsenal.

For additional information about headache and pain, contact the National Institute of Neurological Disorders and Stroke Brain Resources and Information Network (BRAIN) at

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov/