Help for an Aching Head

Ordinarily, headaches don’t make headlines. They should because headaches don’t just hurt your head. They also hurt your pocketbook as well as your social and working lives.

Headaches come in two flavors, primary (independent of any other medical problem) and secondary (linked to something else such as the flu). The four common primary headaches are tension type headaches (TTP), cluster headaches (which usually circle one eye), MOHs (medicine overuse headaches) and the Queen of them all, the migraine.

Every year around the world, one billion people experience at least one migraine. According to the American Migraine Foundation, 35,000,000 of these people are right here in the USA where age and gender matter. Women are more likely than men to be migrainers, and, while the pain may strike first during adolescence and is most common from age 18 to 44, once you’ve got it its yours for life.

Which can be expensive. The multi-medico-member website Medscape blames migraines for a yearly $13 billion loss of American productive work time. Across the Pond, the Brits say migraines cost Englanders up to 25 million working or school days a year.

Given the price and the number of people in pain, you’d think there be a proportionate number of doctors to treat them. You’d be wrong. Both here and abroad, the average medical student gets a bare minimum 4 hours of instruction on headache disorders. Perhaps as a result, the Migraine Research Foundation lists only 700 certified American headache specialists. Happily for New Yorkers, at least a dozen of them are right here at NYU Langone Health and Mount Sinai where they have much to offer.

Physiological Cascade

In March 2010, an international trio of researchers from Harvard, Sweden’s Lund University and Denmark’s Rigshospitalet in Copenhagen confirmed a protein called CGRP (short for calcitonin gene-related peptide) and the brain particles it hooks onto as key players in the physiological cascade leading to migraines. Since then, a number of monoclonal antibody injections and pills that help to neuter CGRP have made their way into the medical pipeline. The first, Erenumab, was approved in 2018, followed by Ubrelvy in 2019 and Nurtec pills that dissolve on your tongue in 2020. While nothing’s perfect, these drugs led the Coalition for Headache and Migraine Patients (CHAMP) to name May 2021’s National Migraine & Headache Awareness Month “A New Era of Care.”

May 2022 may be even better because there’s more on the way including nasal sprays, pills, skin patches and, for the mechniacal minded among us, the 8-year-old Cerena Transcranial Magnetic Stimulator which you hold against your head to deliver a brief magnetic pulse that interrupts signals hitting your occipital cortex (the part of the brain that enables vision) that would otherwise make your head ache.

All that being said, the last two words on migraines are Mom & Dad. Like looks and smarts, the tendency to this headache seems to pass from parent to child. Statistics compiled by Minnesota’s Williams Integracare Clinic suggest that kids with one migrainer parent have a 50% chance of joining them. If both parents are migraineurs, that’s 75%.

Ouch.