Nadine Jones, a 33-year-old registered nurse at Bon Secours St. Mary's Hospital, constantly watches for drastic weather changes — one of the main triggers of what has become a frequent companion: a migraine.
"A migraine headache is intense. It feels almost like a pain you cannot get away from," she says.
Jones is among the 16 percent of women nationally who battle migraines, which commonly develop between the ages of 20 and 30, according to Dr. Philip Davenport of James River Neurology. Jones' first experience with migraines at age 17 included the frightening but temporary loss of sight in her right eye. After an emergency-room visit and CT scan, she discovered that her vision loss was a common migraine precursor, part of what doctors call an aura.
During the next decade, Jones' migraines increased in intensity, and soon her pain was what she rates a 10 out of 10. Once, "the pain was so bad that I was gritting my teeth. My neck was so stiff I could not move my head for a week. That was the worst ever," she says.
Jones' mounting pain prompted a call to Dr. Alan Towne, director of the headache center at VCU Medical Center, about three years ago. Jones still has twice-monthly headaches but now controls the pain with prescription medication.
A migraine is a medical phenomenon, says Dr. John Wittman, a neurologist with Neurological Associates, because the activity cannot always be traced to a specific portion of the brain. Biologically, Towne adds, migraines begin with some kind of trigger that activates a cascade of events deep in the brain.
"There is a chain in brain chemistry during headaches. Some of the changes are that your brain has an increase in certain kinds of neurotransmitters that cause us pain," Towne says, "and it causes inflammation." The trigeminal nerve in particular, the main sensory nerve of the face, is activated.
While researchers continue to study the causes of migraines, the symptoms are clearly defined: severe, throbbing pain that's commonly concentrated on one side of the head and associated with nausea, vomiting, and sensitivity to sound and light. Migraines normally last one to six hours, but can last longer (in some cases weeks or months) if not treated, Towne says.
Towne, also a professor of neurology at VCU, says the most vital aspect of treating what he calls the "disease of migraines," is discerning a patient's triggers. Foods and drinks are a frequent trigger, with red wine being the most common culprit, partly because of its tannin content, Wittman says. Davenport adds that chocolate, caffeine and foods with high MSG or nitrate content are equally common. Strong scents such as perfumes can also contribute, as may stress, exercise and skipping meals.
While migraines affect women at a higher rate, about 6 percent of men nationally also struggle with migraines; the overall rate for adults is 12 percent, Daven-port says.
Migraine treatment begins with the elimination of all possible triggers, Towne says, and a consistent schedule is a vital part of healing. Those changes must be teamed with the early intervention of medication, including over-the-counter drugs (Wittman recommends acetaminophen, Excedrin Migraine and ibuprofen), but patients who need to take medicine two or three times per week should see a doctor.
If a patient suffers a few migraines per month, Towne prescribes medication (Emitrex is the most common) that treats the pain after a headache begins. For patients who have about one per week, however, he suggests a daily preventive medication.
Wittman says many patients initially fear the worst, often self-diagnosing their migraines as a brain tumor. But tumor patients rarely show the same symptoms as migraine sufferers, he says. Still, severe headaches should be treated with caution. "Anyone who has the worst headache of their life should go to the emergency room," Wittman says, "to make sure they do indeed have benign headaches and not something more serious."