Aura-ble: Migraines cost millions yearly

What is the deal with all the TV reality shows? Weren't The Brady Bunch and The Cosby Show good enough? Now, when I'm on the elliptical rider at the gym, I see people on Fear Factor eat everything but nuclear waste.

At home, I prefer "quality" reality TV (if I ever get a chance to watch) such as Dancing With The Stars and American Idol. I saw a "wardrobe malfunction" occur with some soap opera diva who was dancing the Samba (which almost became the Booba), and I thought, "My, my, this is live. Suppose the contestants get something like diarrhea, a bloody nose, or a migraine? What then?"

Forty million Americans suffer from migraine headaches, mostly women. The affliction peaks by age 40. Men at 40 have a mid-life crisis and go bald; women have a migraine and a new hair-do to go with it.

Thomas Jefferson suffered them, and I'm sure you have a co-worker who has missed work for a day or two because of a migraine headache. Migraines cost our country hundreds of millions of dollars due to lost productivity, ER visits, and medications.

What is migraine disorder? You need at least five headaches lasting 4-72 hours associated with nausea/vomiting or photophobia (lights hurt your eyes– kind of like staring at the sun) or phonophobia (sounds hurt your ears– kind of like listening to Mariah Carey) to qualify as a migraine.

Migraines tend to be on the right or left side of the head and to boom like drums in a heavy metal band. The pain is severe enough to make doing daily activities as much fun as climbing Mt. Everest without boots and oxygen.

The American Migraine Study II discovered that only 48 percent of people with migraines have been diagnosed by a doctor. The majority of migraine sufferers use over-the-counter medications, such as Excedrin, to treat their headaches. For most, inadequate treatment leads to loss of work, family stress, and unrelieved pain. Sounds like a reality TV show to me: "My Kids, My Job, MyGraines."

For those who have migraines at least twice a month, prophylactic medicines are available. This means you take a pill every day to help prevent the onset of an attack. Yes, it's a pill a day, which can be no fun, but for most it's preferable to lying in a dark room, vomiting into the trash can, and moaning songs about death, "Nobody knows the trouble I've seen...."

Other popular medicines are triptans like Relpax, Imitrex, and Maxalt. Triptans are not the chemicals in turkey that make you tired. Triptans constrict blood vessels in the brain to prevent the throbbing headaches as well as prevent neurochemicals from causing inflammation and dilation of the brain's blood vessels. For some people, the migraine starts with constriction of the blood vessels in the brain, which can result in an "aura"– seeing flashing lights and smelling trash (like the show Cops) followed by dilatation of the vessels 30 minutes later.

The ER is flooded with people with migraine attacks who demand, "I can't take morphine, Dilaudid, Percocet, Vicodin, Tylenol #3, or Fentanyl." Hmmm, that leaves only Demerol.

Overall, the triptans are safe, but if you have heart disease, they can give you a heart attack. So I decided to do an evidence-based review on the triptans. Relpax sounds like a fax machine, but actually it appears to be the best triptan available as far as efficacy, safety, and tolerability are concerned. I prefer that my patients take prophylactic medications if needed, and Relpax for the attacks that sneak in so I don't get a call from the ER saying, "Ms. So-and-so is here for the 29th time this month with a migraine. She wants..." Let me guess: "Demerol?"