CRACKING THE MIGRAINE ENIGMA : NEW THERAPIES FOR BIG DADDY OF HEADACHES.

Byline: Rick Ansorge Colorado Springs Gazette Telegraph

Denver Broncos' star running back Terrell Davis isn't a poster child for migraine headaches.

But when he's sitting on the sideline, hands on head, face contorted in agony, he might as well be.

To millions of football fans, Davis is the symbol of how migraines can threaten a brilliant career.

Davis isn't alone in his misery. More than 23 million Americans suffer from migraines, which are to an ordinary headache what World War II was to the invasion of Grenada.

``It's a terrible thing,'' says Dr. Lawrence Adams, a Colorado Springs neurologist who knows how bad his migraine patients feel because he's been there.

Starting in high school, Adams began experiencing migraine aura, the hallucinatory signal that a killer headache is about to strike. Seen by about 20 percent of migraine patients, such auras can include sparkling lights, blind spots and vibrating patterns called scintillating scotomas.

Such patterns often resemble castle battlements. Instead of being gray, however, they're made up of bright, primary colors.

``It's like looking down at a fort from above,'' Adams says. ``A lot of the visual phenomena people describe is absolutely fabulous.''

A first aura, however, can be absolutely terrifying. Unaware of what's causing these sensations, people often assume they're either losing their eyesight or their minds. Some worry they've developed a brain tumor or are about to have a stroke.

But the aura, which usually lasts no longer than a half-hour, is a rock 'n' roll light show compared to the migraine itself. As the brain's blood vessels constrict and then dilate, it produces an intensely painful headache usually, but not always, on one side of the head. A migraine can last up to three days.

According to a recent study cited by the National Headache Foundation, sponsors of this month's National Migraine Awareness Month, 87 percent of migraine patients also suffer nausea and 56 percent of them vomit. Other symptoms include blurred vision, malaise, diarrhea and increased sensitivity to light, sound and smell.

Taking medications ranging from aspirin to opiates, some migraine sufferers are able to stay on the job or in the classroom. But many find it impossible to do anything other than go home, crawl in bed and wait for the worst to pass.

``There's no way in the world you can play (football),'' Davis told the Gazette in September.

Migraines take a huge toll on the nation's economy - up to $18 billion a year in lost productivity alone. According to a recent Gallup survey, the average working patient experiences one attack per month and calls in sick five times a year because of migraines.

Its personal toll is just as staggering. About 30 percent of respondents say the disorder has hindered their ability to compete in the workplace. More than 70 percent of respondents say migraines have hurt relationships with family and friends. And nearly 50 percent lament that family and friends don't understand the seriousness of their condition.

Although migraines affect both sexes, all races and every socioeconomic group - most often striking between ages 25 and 44 - three out of four diagnosed cases are in women.

Some researchers believe this is partly due to women's greater willingness to seek medical treatment. But most agree that women's hormonal changes make them more susceptible to the disorder. Women often experience migraines around the time of their periods.

Until recently, researchers believed the brain's blood vessels constricted and dilated on their own. Today, increasing numbers of researchers believe the cause of this vascular mayhem is an electrical storm that affects the brain's serotonin system.

Serotonin is a neurotransmitter, a chemical that enables nerve cells to ``talk'' to one another. With too much of it, people become bundles of nerves. With too little of it, they get depressed.

Prozac and other antidepressants that affect serotonin levels are effective treatments for depression. These drugs also can be effective treatments for migraine.

``There is a tie between depression and headaches,'' Adams says.

A recent Opinion Research Corp. study shows most people with migraines suffer in silence. Even people who bring the condition to their doctor's attention typically wait 3-1/2 years after the onset of symptoms. The reason: ignorance and shame.

``Intolerance of migraine is very common,'' says Dr. Bruce Peters, a Colorado Springs neurologist. ``A doctor called the other day to say, `I've got this guy who says he has migraines.' His belief was that men don't get migraines. Well, they do.''

``If some doctors don't understand that, imagine the lack of understanding among the general public,'' says Peters' wife and co-worker Nancy Peters, a nurse who counsels migraine patients.

Since migraine can cause swollen sinuses, many people with migraine mistakenly believe they have sinusitis. They go from doctor to doctor, receiving prescriptions that at best only partly relieve their pain.

During counseling sessions, patients learn about migraine triggers. A multitude of substances have been identified, ranging from caffeine, chocolate and MSG to cosmetics, hair sprays and household chemicals. Other triggers include fluorescent lights, noise, cigarette smoke and sex.

``It's like a dragon inside your head,'' Nancy says. ``Feed it the right amount and boom.''

Doctors once believed that migraine sufferers tend to be ambitious, hard-driving, inwardly sensitive and stressed-out. While they no longer believe in the existence of a ``migraine personality,'' they often see such traits in those who come for treatment.

``Classic migraine people are quite perfectionistic and good workers,'' Bruce says.

Unfortunately, they often expect to receive the perfect medicine and are shocked to find there isn't one. What works for one patient can make another patient worse.

``That's why we tailor everything to the individual and what they perceive as their triggers,'' Nancy says.

Finding triggers can be tricky. Sometimes, people with migraine can safely eat chocolate chip cookies. Other times, one cookie is enough to send them into the ozone. Often, a trigger won't set off a migraine until a day or two later, making it difficult to make a connection.

``That's why we strongly encourage people to keep a diary,'' Bruce says.

But it's not easy getting people to write down what they eat, drink and do.

When triggers are found, patients often are reluctant to avoid them.

``They say, `What's life without chocolate?' '' Nancy says. ``I say, `Isn't life without a headache better?' ''

Patients who are unwilling to make the necessary lifestyle changes often find themselves in deep trouble. They begin by taking nonprescription painkillers for acute attacks. When that doesn't work, they graduate to prescription painkillers they take around the clock.That sets them up for what doctors call ``analgesic rebound headaches.'' As the painkiller wears off, the headache returns more forcefully than ever and can become chronic.

``It makes the migraine worse and makes people dependent,'' Bruce says.

The remedy is harsh, but necessary: going cold turkey.

``People don't like to do that,'' Bruce says. ``It may lead to two or three weeks of misery.''

But it takes that long to flush the system, he says, before prevention therapy can begin. Many medications, among them anti-depressants and beta-blockers, are prescribed to prevent migraines. Some patients also benefit from neurofeedback, stress-management classes and relaxation therapy.

When migraines strike, such patients often are able to handle them by taking a couple of aspirin and placing an ice bag on the back of their heads.

For more serious headaches, there's serious medicine. One of the newest and best-known is Imitrex, which can be self-administered by injection or pill. While it can stop a migraine cold, it's expensive: about $20 a shot, $8 a pill.

Other medications include Depakote, an anti-seizure drug approved this fall for migraine treatment by the U.S. Food and Drug Administration, and lidocaine, an old anesthetic that has found new life as a migraine remedy.

A recent study found that lidocaine nose drops brought relief within five minutes to more than half of the migraine sufferers who tried it.

Meanwhile, as scientists worldwide scramble to crack the genetic code, there's hope they'll find the faulty genes responsible for migraines. If they do, it's possible they'll develop drugs to correct those genes' evil influence.

``We're probably looking 10 to 20 years out,'' Adams says.

For Adams, it'll probably come too late. Migraines fade with age. At 41, he's experiencing a migraine every other year instead of every month.

But for the millions of Americans for whom migraines are a monthly or even daily agony, an effective drug can't come soon enough.

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Photo: Terrell Davis of the Denver Broncos is one of more than 23 million Americans who suffer from migraine headaches. During an attack, ``There's no way in the world you can play (football),'' he says.

Associated Press