THE WAR ON MIGRAINES FROM CHANGING HABITS TO NEW MEDICATIONS, DOCTORS HAVE WAYS OF DEFEATING THE PAIN.

Byline: Mariko Thompson Staff Writer

Before she learned how to manage her headaches, Ana Maria Chavez popped ibuprofen by the handful. She'd take eight tablets at a time. She'd finish an economy-size bottle in three months. Still, the migraines came.

Shrieking, paralyzing pain. Nausea. Aversion to light. The symptoms sometimes lasted up to seven days and struck three times a month.

``I can handle a lot of pain,'' said Chavez, a 40-year-old Simi Valley resident. ``But I worried that I was going to do damage by taking so much medication. I worried that I had a brain tumor or something like that.''

That's when Chavez turned to Dr. Ernestina Saxton, director of UCLA's Comprehensive Headache and Migraine Pain Program. After a battery of tests ruled out a life-threatening condition, Saxton confirmed that Chavez is one of more than 25 million Americans who suffers from migraine.

``Migraine is not just a personal thing,'' said Saxton, a neurologist. ``It affects everyone. When you can't participate in family events or go to work, it takes a toll on the family.''

Fear of a catastrophic illness spurs many migraine sufferers to see their doctors. But many more - as many as half - go undiagnosed, according to the National Headache Foundation. That statistic concerns headache specialists. While migraines can't be cured, they can be reduced in length, intensity and frequency through a combination of medicine and basic lifestyle strategies.

``A lot of people who have migraines think they're nuts,'' said Dr. David Kudrow, a neurologist and director of the California Medical Clinic for Headache in Encino. ``Other people think they're nuts - you're thinking about too many things, you're stressed, that sort of thing. People need to understand migraine is a legitimate condition.''

Is it a migraine?

Migraine isn't just a headache. And the pain, while sometimes excruciating, can also be mild or moderate. To make matters worse, migraines are frequently misdiagnosed as sinus headaches. Dr. Morris Maizels, a family physician and headache specialist at Kaiser Permanente in Woodland Hills, has a quick test for people who wonder if they suffer from migraine.

--Any two of the following four descriptions apply to the pain: severe, unilateral, throbbing that worsens with activity.

--You also suffer from at least one of the following: nausea and sensitivity to light or sound.

If both of those statements are true, then it's probably a migraine, Maizels said.

Headache specialists describe migraine as a neurovascular condition that can be genetic. However, inheriting the gene only makes a person susceptible to migraine. Migraine can be triggered by any number of factors, including a change in hormones (three out of four migraine sufferers are women), low blood sugar, alcohol, caffeine, fatigue, jet lag and emotional stress.

Once the migraine is triggered, the mid-brain sends an impulse to the nerves and the blood vessels that line the brain. This signal releases inflammatory proteins that cause the pain and the blood vessels to dilate, said Maizels, who also serves on the American Headache Society board of directors. One in five migraine sufferers also experiences an aura, often a pattern crossing through the field of vision.

Ancient civilizations saw headaches as evil spirits that could only be released by boring holes into the skull, and there's no doubt the migraine can feel like a malevolent force taking over the body. When Chavez has a nasty seven-day migraine, her body shuts down.

``You can't think,'' she said. ``You're in a foggy state. My family knows: When I have a migraine, leave me alone.''

Kudrow likens the withdrawal to crawling into a cave to weather a storm. He theorizes that migraine plays a restorative role.

``Is there any evolutionary advantage to having these storms of physiological events which pass by themselves?'' he asked. ``Even if you don't treat migraine, it goes away. It probably allows the brain to regenerate, replenish, refuel. That philosophy underpins a lot of my thinking about migraine and how I treat it.''

The critical role of daily health habits bolsters Kudrow's theory. Eating regular meals, exercising and sticking to the same sleep patterns can make a huge difference in the severity and frequency of migraines, headache specialists say.

``Sometimes that alone is enough to control the headaches,'' said UCLA's Saxton.

Headache specialists spend a lot of time talking to their patients. How long have they been getting headaches? Have the headaches become more frequent and, if so, when do they occur? They also encourage their patients to keep headache diaries, noting the date, time and severity of the migraine. The diaries can help patients pinpoint triggers and establish patterns. For women, migraine may coincide with their menstrual period or ovulation. Skipping meals may aggravate it. Or an unexpected project at work. Or a glass of red wine. Typically there's no single factor.

``If you're rested, you're exercising, and you're not letting your boss get you angry, your threshold will be high,'' Saxton said. ``You could eat a pound of chocolate and it wouldn't bother you. But if you haven't slept, you have a big project, and you're skipping meals, chocolate could put you over.''

Behavior to medication

Health habits and triggers form the education component. Then headache specialists reach into their arsenal of medications. People who seek the help of headache specialists tend to be like Chavez. They've taken high doses or daily doses of over-the-counter pain relievers to no avail. Instead of getting rid of the pain, these remedies can actually exacerbate the condition and create rebound headaches.

``Most of the public and most physicians are not aware of it,'' Maizels said. ``It's a challenging problem.''

Chavez no longer pops ibuprofen by the handful. Now, at the first sign of a migraine, Chavez takes Amerge, a form of triptan. Triptans, a powerful class of drugs that are packaged as injections, tablets and nasal sprays, mimic serotonin in the brain and narrow the blood vessels.

``They're extremely effective in aborting migraine attacks,'' Kudrow said. ``That's the revolution in migraine recently.''

In addition to drugs taken at the onset of a migraine, some patients take preventive medications, which include anti-convulsants, anti-depressants and anti-hypertension drugs. For Simi Valley resident Todd Paxman, adhering to a regular exercise and sleep schedule cut his headaches in half. The other half he manages with four drugs taken daily. He most recently added Topamax, an anti-convulsant, to his regimen. Topamax - hailed as the next big migraine drug not because it's necessarily more effective but because people also tend to lose weight while taking it - put an end to his low-grade, everyday headaches.

``Since mid-March, I haven't got a headache every day,'' said Paxman, a 31-year-old environmental engineer. ``It's down to a couple times a week. You don't appreciate that until you go five years with a headache all the time.''

Not everyone turns to pills. Some use a dental nightguard to keep from clenching their teeth during sleep. Others swear by the herb feverfew or acupuncture. Lately, the buzz surrounds Botox, the cosmetic injection that smooths out wrinkles.

Kudrow, whose clinic was a study site for a clinical trial for Botox as a preventive migraine medicine, said he was disappointed by the results. The placebo group performed about the same as the high-dose Botox group. The low-dose Botox group had marginally better results, he said.

``I don't use it at all,'' he said. ``I'm not a big believer.''

Though various studies have shown mixed results, Maizels has patients who have experienced marked improvements. Questions still remain about which patients will find Botox most useful and at what dose, he said.

``I came as a strong skeptic,'' he said. ``I have no doubt that it's effective. It's not a cure-all, but I think it's here to stay.''

Botox, like other remedies at doctors' disposal, will be another tool in the toolbox, Maizels said. There's no one-size-fits-all approach to migraine. From triggers to treatments, physicians and patients have to work together to find the right approach.

``You never get rid of them, you just manage them,'' Chavez said. ``I can better manage my pain rather than the pain managing me.''

FOR MORE INFORMATION:

American Council for Headache Education: www.achenet.org

National Headache Foundation: www.headaches.org

California Medical Clinic for Headache in Santa Monica and Encino: www.headachedoc.com/main.html or call [phone] for information on enrolling in clinical trials.

UCLA Comprehensive Headache and Migraine Pain Program: [phone].

CAPTION(S):

5 photos, 2 boxes

Photo:

(1 -- cover -- color) More than a headache

Migraines afflict 25 millions Americans - but new approaches are helping to redue the suffering

(2 -- 5) no caption (Woman with migraine)

Photo by Michael Owen Baker/Staff Photographer, photo illustration by Roger W. Vargo/Staff Photographer

Box:

(1) IS YOUR HEADACHE A MIGRAINE?

Daily News

American Council for Headache Education; National Headache Foundation

(2) FOR MORE INFORMATION: (see text)