ILLUSTRATION FOR TIME BY BRIAN STAUFFER

The New Science of Headaches
	As doctors learn more about our throbbing heads, they are uncovering amazingly effective ways to kill the pain before it starts
	By Christine Gorman and Alice Park

Posted Sunday, September 29, 2002; 10:31 a.m. EST

For Henry Schipper, 49, of Venice, Calif., the first warning signs are mild and almost pleasant—a giddy light-headedness that evolves into what he describes as a "happy series of energetic moments." Then for about 15 minutes his eyes play tricks on him, and a wall of shimmering light obscures his field of vision. "There's no pain at that point," says Schipper, who produces documentaries for the History Channel. "But once the shimmer starts, the countdown begins."

If Schipper can't get to his medication quickly or if it doesn't kick in, he will experience a neurological event that 28 million Americans know all too well—the tidal wave of headaches known as a migraine. For Schipper the pain is sudden and sharp. "The front quarter of my head begins to pound and throb," he says. In extreme cases, he vomits violently every 20 minutes. His senses of smell and hearing become agonizingly acute. "All I want to hear is gentle white noise at most and no movement, please. If there's a car alarm that goes off nearby, it's unbearable."

It was not that long ago that migraine sufferers like Schipper had no choice but to retreat to their darkened bedroom and wait, often for days, until the agony passed. Doctors could prescribe heavy-duty painkillers, but regular use often triggered even more painful episodes. Making matters worse, friends and co-workers tended to treat headache sufferers as the punch line of a bad joke, as if they were having headaches on purpose to avoid work or sex or some deeply repressed memory.

	Allowing migraines to go untreated is not only extremely painful but may make future attacks harder to control

That bleak state of affairs is changing rapidly. Now physicians have at their disposal a growing arsenal of headache drugs—medications that can stop an accelerating migraine in its tracks, reduce the risk of recurrence or, in some cases, keep one from happening in the first place—but scientists are starting to uncover subtle defects in brain chemistry and electrophysiology that lead not just to migraines but to all kinds of headaches. Indeed, many neurologists now believe that most severely disabling headaches are actually migraines in disguise and so are more likely to respond to migraine medications than to standard analgesics such as aspirin, ibuprofen or acetaminophen.

What it all adds up to is a revolutionary view of extreme headaches that treats them as serious, biologically based disorders on a par with epilepsy or Alzheimer's disease. "Before, patients got shipped around from doctor to doctor until eventually they wound up at a psychologist," says Dr. Joel Saper, director of the Michigan Head-Pain and Neurological Institute in Ann Arbor. Now their headaches are seen as the result of wayward circuits and molecules, not personality disorders.

The revolution in migraines was very much in evidence last week in London as more than 600 scientists from 32 countries gathered for the biennial symposium of the Migraine Trust (whose patron, the late Princess Margaret, suffered from migraines). A ripple of excitement followed reports of progress in blocking a key neuropeptide called cgrp (more on that later). But the biggest headlines came from a seemingly unlikely source, the anti-epilepsy drug topiramate. Dr. Stephen Silberstein of Thomas Jefferson University in Philadelphia presented a study of nearly 500 patients showing that topiramate significantly reduced both the occurrence and duration of migraines—offering hope that a whole class of existing antiseizure drugs could someday help migraine sufferers put an end to attacks before they occur.

Much remains to be determined. Researchers aren't sure whether they have identified all the pieces of the puzzle or if they know the order in which those pieces fall. "Does it all fit together in a cogent picture?" asks Dr. K. Michael Welch, a migraine researcher at the University of Kansas Medical Center in Kansas City. "I don't know. But we know a hell of a lot more than when I started in this field 25 years ago."

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