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Migraine headaches are not 'all in your head'

by Roger Martin

It's bad enough to suffer. To have your suffering doubted is worse.

That's how it's been for those with migraine headaches. Three-quarters of the 28 million Americans who get migraines are women. And yet until recently a great many doctors have not believed migraine was a real disease.

A migraine is the Moby Dick of headaches. The suffering can go on for three days. In 35 percent of the cases, visual illusions are the kickoff -- zig-zag lines or even holes in the visual field.

Michael Welch remembers watching boxer Cassius Clay, later Muhammad Ali, duke it out with a pug named Henry Cooper. "Suddenly," Welch said, "I couldn't see Henry Cooper's head. Once the head went, the punch disappeared as it hit the head. The hole in my vision got bigger and bigger, and I went to bed with it."

And then Welch, vice chancellor for research at the University of Kansas Medical Center, knew that migraines weren't 'all in the heads' of neurotic women. For 25 years he has studied the brain when tormented by a migraine, and he knows it is not like other brains.

An ordinary brain is like a city at night, with lights going on and off here, there and everywhere. The twinkling is the firing of nerve cells as they communicate in a language that is part electrical, part chemical.

In a migraine, this disorderliness becomes eerily regular. Nerve endings are usually splayed out, like tree branches spreading outward from a tree trunk.

But the nerve endings bundle up and groups of nerves fire together. The excitement starts in a patch of cells, often at the back of the head, the center of visual processing. Then those cells fall silent.

If you're watching a boxing match when that happens, Henry Cooper's head may disappear.

This pattern -- way too much firing and then nothing -- creeps across the brain. Welch calls it a spreading depression. One by one, bodily functions are lost as clumps of nerve cells stop working. There may be numbness in an arm, like a stroke, or loss of words if a language-controlling area of the brain is affected.

"It's like the forward march of an army that lays waste to everything behind it," Welch said.

Welch's research group was the first in the world to use a brain-imaging technique to document this spreading depression. More recently Welch made a discovery about the mystery of menstrual migraines, which affect more than 6 million women a month in the United States. Those migraines had been tied to a drop in estrogen, but nobody knew why that caused headaches.

Then, at last month's American Academy of Neurology meeting, Welch and colleague Nancy Berman reported that in mice, falling estrogen levels quiet down a gene that ordinarily makes a chemical called neuropeptide Y. With too little neuropeptide Y around, a second brain chemical, CGRP, is released. And it causes pain and inflammation.

So does this mean menstrual migraines differ from other kinds? Welch's answer is a little coy.

"That question's heavily debated," he said. "I'll enter into the debate at the end of June."

I asked, "Did doctors really think until recently that migraines were an illusion of neurotic women?"

"There was such a body of opinion," he said. There was a silence, and he added: "What I'd like carved on my gravestone is the fact that I used noninvasive imaging methods to show that a migraine is a real event."

Good thought, Dr. Welch. To suffer migraines only to have a physician doubt them is an entirely avoidable pain.