This Newsletter Brought to You by the Physicians and Staff of the Center for Primary Care


Migraine: Not Just a Really Bad Headache

Amandas migraine headaches begin with a collection of subtle signs a twinge on one side of her head, slight weakness, diminished alertness a vague impression that something is not quite right. It isnt pain just yet, but having suffered frequent migraine attacks from an early age, she knows better than to ignore it. Left alone, it would almost certainly evolve into intense throbbing pain behind one eye, nausea, and an inability to tolerate movement, light, sounds, and smells. Once the pain sets in, she could be incapacitated for anywhere from a few hours to a few days and, for the duration, unable to work or care for her family.

Amanda is fortunate because she recognizes the early signs of her migraines and has a medication that, if taken soon after her first symptom, will stop a developing attack. Others who are less familiar with the causes of and treatments for their headaches must routinely deal with the excruciating pain, lost time at work and home, and the inconvenience and frustration of never knowing when they might be stopped in their tracks by an attack.

Between 25 and 30 million Americans three fourths of whom are women suffer migraine attacks. A migraine is more than just a really bad headache. Despite migraine being a very old problem, the exact mechanism that causes it is still uncertain. However, it seems to begin in a migraine center in the brain and develop into head pain.

The Facts on Attacks affect 25 to 30 million people in the United States.

often interfere with a persons ability to function normally.

usually result in throbbing pain on one side of the head.

cause nausea and/or vomiting and sensitivity to light, sound, and smells.

affect three times more women than men.

can be preceded by an aura (colored, twinkling, and/or zigzag light patterns moving across the field of vision) just before the onset of pain.

occur as often as once or twice a week and last from several hours to several days.

can be triggered by many environmental, social, and psychological factors.

Research has suggested heredity may play a role in some but not all migraine sufferers susceptibility to attacks, but regardless of genetic involvement, everyone who is predisposed to these debilitating headaches is subject to numerous physical, psychological, and environmental factors that can trigger migraines.

Triggers vary from person to person, but some of the most common are foods, such as caffeinated beverages, red wine and other types of alcohol, aged cheeses, and sourdough bread; food additives, such as MSG, and nitrites; environmental factors, such as bright/flashing lights, glare, loud noises, strong odors, and changes in barometric pressure and humidity; emotional factors, such as stress, anger, depression, fatigue, and anxiety; motion from riding in cars, planes, and boats; excessive or inadequate activity and sleep; strenuous exercise; hormones; and some medications.

Medications available to treat migraines include fast-acting, migraine-specific triptans, which can actually stop a developing attack from progressing by targeting the involved blood vessels as well as ease the nausea often associated with migraine. Triptans are expensive but are usually covered by insurance. Other medications, although not specific for a migraine, can be used to relieve the pain associated with attacks. Beta blockers, calcium-channel blockers, antidepressants, and some seizure medicines can also be used for prophylaxis to decrease the frequency and severity of migraine attacks.

Among over-the-counter pain relief medications, Excedrin Migraine has been identified as one of the most effective treatments for the full spectrum of migraine symptoms. Based on a clinical trial involving 1,250 migraine sufferers, the Food and Drug Administration recently approved Excedrin Migraine, which contains aspirin, acetaminophen, and caffeine, to migraine relieve pain and the accompanying symptoms, such as light and sound sensitivity, and to improve the headache sufferers ability to perform usual activities during an attack.

One of the most important things you can do to reduce your frequency of migraine headaches is to avoid triggers whenever possible. If youre not aware of what factors contribute to your headaches, it is important to keep a headache diary. When you get a headache, record information such as what you have eaten recently, changes in the weather, stressful events, and how much sleep and/or physical activity you had in the day or two prior to the attack.

Because there are many types of headaches that respond to different treatments, it is important for headache sufferers to be evaluated by a physician not only to identify the type and most appropriate treatment, but also to ensure that the headaches are not being caused by a different and potentially more serious medical condition. This is especially important for headaches that are different in character, come on suddenly, or are unusually intense and frequent.

If your headaches are severe or frequent or interfere with your ability to perform daily activities, call your CPC physician for an evaluation, and remember to bring along your headache diary. Learning how to avoid migraine triggers and having an effective medication on hand if case you do get a migraine can make a big improvement in the quality of your life.

Source: JAMA Migraine Information Center, Education & Support Center, American Medical Association, 2002); American Council for Headache Education,, December 2002; Headache Information, American Council for Headache Education, January 2001 (all webpages).

The Internet is a convenient, easily accessible resource for all sorts of information, but it is important that you dont believe everything you see online, especially when it concerns your health.

Over 6 million people seek health advice online each day, but fewer than one fourth of those verify the accuracy of the information they find by checking the source and when the information was posted or updated. In spite of research studies on the quality of web-based health information that found significant problems with 70% of the content evaluated, many people are inclined to believe whatever they find online.

On an encouraging note, up to three fourths of people who use the Internet to research health topics at some point reject online information that appears out of date, unprofessional, or too commercial, and only about one fifth act on the advice they find online without first consulting their physician. How can you discriminate between reliable and inaccurate health information on the web? Here are some tips:

Make sure the information you find is current. Most web sites indicate when the information was posted or most recently updated.

Check your sources. Find out who sponsors the information you find online. Keep in mind that sites with a commercial sponsor might be less objective than what you find on health or medical sites, such as the Mayo Clinic or the American Heart Association.

Verify what you find. Make sure the information you find online is backed up by a primary source, such as medical research studies, abstracts, or links to other reputable health sites.

Check for a seal of approval. The American Accreditation HealthCare Commission recently established an accreditation program for health websites. While the commission has awarded only 16 seals of approval at the time of this writing, the program is expanding. Presence of this seal shows that the site is reliable, but because the program in new, information found on sites without the seal should not be automatically dismissed as inaccurate.

CPCs website includes links to other reliable health sites: Click Here

Potential for Bioterrorism Renews Concerns About the Smallpox Virus

In 1980, when the World Health Organization declared that smallpox was no longer a threat as a naturally occurring disease, the virus was considered officially eradicated and routine vaccination was discontinued. However, now that biological warfare using the smallpox virus is considered a potential threat, there is renewed public interest in the virus, how it spreads, and its prevention and treatment. Here are some important facts about smallpox:

Smallpox is less contagious than chickenpox, measles, or the flu. It takes several hours of close contact with an infected person to get the virus.

Smallpox is spread from person to person by infected aerosolized droplets (e.g., coughing or sneezing). Infected persons are most likely to spread the disease within the first week of the illness.

If you were vaccinated against smallpox in 1972 or earlier, when vaccination was a routine practice, you are probably no longer immune.At the present time, smallpox vaccinations, which contain a small amount of the live virus, will be given only to medical and military personnel who would be the first to respond in the event of bioterrorism.

The incubation period is about 2 weeks after exposure to an infected person. Fortunately, vaccination within 3 days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may modify the severity of disease.

Beginning in 2004, smallpox vaccines will be available to the general public, but it is expected that the potential side effects will discourage many people from being vaccinated. Although there is no definitive way of preventing vaccine side effects altogether, vaccinia immune globulin, an antidote currently being produced in large quantities, is effective against some vaccine side effects, and the antiviral medication cidofovir is effective against severe smallpox vaccine reactions and as a smallpox treatment.

Source: Prescribers Letter, Therapeutic Research Center, Stockton, CA, December 2002; Vaccine Basics, Smallpox Fact Sheet, CDC Public Health Emergency Preparedness & Response, Centers for Disease Control and Prevention, Washington D.C., December 2002 (website); DOD Details Military Smallpox Vaccination Program (press release), U.S. Department of Defense, December 13, 2002.