Dr. Jon Hallberg: New ideas on migraine research

About 10 percent of people suffer from migraine headaches at some time in their life, according to the Migraine Research Foundation. But women are more than three-times more likely to suffer from migraines than men.

MPR's medical analyst Dr. Jon Hallberg discussed the mysterious world of migraines with Tom Crann of All Things Considered on Wednesday. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic.

An edited transcript of that discussion is below.

Tom Crann: Migraines. First, let's determine how they're different from normal everyday headaches.

Dr. Jon Hallberg: Migraines are just very different. They last longer, they hurt more, people feel nauseous. They may be on one side of the head, not both. They can have light sensitivity, sound sensitivity. It's just a miserable experience. Any of us who have ever seen or known someone with a migraine, you can appreciate what they're going through.

Crann: Physiologically, what's happening in the head when there's a migraine headache?

Hallberg: It used to be thought that migraines, because they often throb, that it was a vascular headache. It was because you'd go from a state of maybe being kind of stressed to now you're not-so stressed, the blood vessels have dilated and that's what's kind of causing it.

But they've really changed their thinking on this. They think it's this neurochemical, neuroelectrical storm, in a way. It's not a seizure, but it's this cascade of activity that's happening in the brain that's really causing it.

Crann: For people who are prone to have them, are there things that can trigger them.

Hallberg: There sure are. Stress is right at the top of the list. Something like 80 percent of people of migraines recognize that coming out of or going into a stressful event can trigger it. We know that hormones are a big factor for women...The list goes on, there're all kinds of triggers.

Crann: Let's get to this issue of why they'd be more common in women rather than men.

Hallberg: I think it was thought years ago that maybe women were more predisposed based on the way they handle stress, and I think we've pretty much debunked that now. There are probably two main factors, one is hormones. And not just hormones, estrogen. It really seems to boil down to that. Before puberty, boys actually have more migraines than girls. But once puberty hits, girls have it, so we know it's much more hormonally related. Another thing is genetics seem to play a big role...It seems to run in families.

Crann: How often do you find it in the clinic? How common is this?

Hallberg: I would bet not a day goes by that I don't see somebody who has had migraines. They may not be presenting with that to me that day, but it's on their problems list. It's an incredibly common thing.

Crann: And then what are the common treatments?

Hallberg: Some people are lucky, they can just take acetaminophen or Tylenol or ibuprofen or Advil or something like that. Some people will go maybe one step up and take an Excedrin, which is sort of a combination pill... Other people need to take a nap. Just sleeping seems to break the cycle. Then there are people who need heavy-duty medications. It might be something like narcotic pain medication.

Crann: What do those do?

Hallberg: When those drugs came out we thought that the main way they worked was by causing vasoconstriction. They caused the blood vessels to constrict to sort of stop that throbbing. But the way they work, we're having to sort of rethink that a little bit more now.

Crann: They're the kinds of medications that people who are aware that they're going to have a migraine take?

Hallberg: Some people are lucky. They get an aura, they get a premonition that it's about to happen and they can do something to just stop it. If people get a lot of these though, we actually have to start looking to prevention and what are some things that we can do to stop them in the first place

Crann: Is there a long-term prevention strategy here?

Hallberg: There can be. Sometimes it's just a matter of avoiding certain things. If a certain food seems to be a trigger, they can avoid that. We'll use things often like cardiac medications like beta blockers. We think that they work by keeping the blood vessels from constricting and vasodialating or expanding as much. Calcium channel blockers are another family. It's a very highly individualized, highly tailored treatment program.

Crann: It sounds like as much as we may know about them, there's still some mystery about migraines?

Hallberg: There sure is. This is so interesting with neuroscience in general. We're learning so much. I look at what was state of the art ten years ago, and I thought I was really up to date on all this, and I realized the thinking has completely changed. The state of the science has evolved so much.

Interview transcribed and edited by Jon Collins, MPR reporter.

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