MIAMI For 17 years of her life, from middle school into young adulthood, Province Park lost at least three days a month to an excruciating migraine headache. She visited countless doctors over the years, but none could help her.
Her pain and frustration finally led her a year ago to the headache clinic at the University of Miami, and what followed was a full year without a migraine.
The experience of Park, now 29 and working in marketing for Northern Trust Bank, and an estimated 28 million people like her in the United States has inspired volumes of research on migraines.
Recent discoveries about the cause of these incurable headaches are pointing to new ways to halt the pain, nausea, visual disturbances and resulting depression. That could be life-changing news for the 18 percent of women and 6 percent of men who suffer migraines.
``Migraine is a very disabling condition in some patients,'' said Dr. K. Michael Welch of the University of Kansas Medical Center in Kansas City. ``It's totally disruptive to their life.''
Welch, the principal investigator at the first headache research center funded by the National Institutes of Health, recently presented his finding that migraine is a result of a disorder in the brain, not changes in the blood vessels as previously thought.
A migraine is a throbbing, knifelike pain, usually on one side of the head. In some sufferers it is preceded by an ``aura,'' a visual disturbance that can be like bright flashing lights or stars or a partial loss of vision in one or both eyes. Nausea, vomiting, tingling in the fingers and weakness on one side of the body are common symptoms. Many people become hypersensitive to light and sound.
Migraine sufferers have abnormally excitable nerve cells in their brains, Welch found. It doesn't take much to make these cells fire off, sending an electrical wave across the brain ``like ripples in a pond.''
As the wave goes through tissue, chemicals called peptides are released onto the blood vessels, causing them to suddenly dilate and start to pulsate. The peptides also cause the vessels to become painfully inflamed.
``The same neuroelectric event that sweeps across the brain also goes down into the depth of the brain and activates the structures in the brain that are responsible for pain,'' Welch said.
Researchers demonstrated the firing of the nerve cells by introducing a very low-intensity magnetic field into the brain, through the back of the head, causing the cells to fire off. Migraine patients saw bright flashing lights signaling the beginning of the migraine aura. ``This doesn't happen in normal people,'' Welch said.
What causes the excitability of the cells that leads to migraine? Two key factors are low levels of magnesium in the brain or low energy levels in the nerve cells, Welch said.
His headache center is pinpointing magnesium problems through magnetic resonance imaging. In the absence of a test, other physicians are prescribing magnesium in case that's the source of their patients' problem.
Welch also has had some luck addressing the energy deficiency with vitamins B1 (thiamine) and B2 (riboflavin), decreasing migraines for some patients.
Many things can trigger migraines in susceptible people: bright lights, too much or too little sleep, foods (commonly red wine, cheese, chocolate), weather changes, and changes in women's estrogen levels.
To illustrate the discomfort caused by bright light, Welch describes the scene in his office during a migraine clinic: Even between attacks, half the patients are wearing dark glasses.
Welch believes severe, frequent migraines cause long-term changes in the brain stem. That might be why sufferers who have episodic migraine gradually become afflicted with continuous migraine. And it makes early treatment all the more important.
``There is no cure for migraine,'' Welch said. ``It's an intrinsic part of you.''
But new drugs and techniques offer relief. A family of drugs called triptans can actually attach themselves to the central apparatus for pain and stop the process there, Welch said. They also constrict the painfully dilated vessels in the brain and reduce inflammation.
For people who can't take triptans because of heart disease, hypertension or kidney problems, non-steroidal anti-inflammatory drugs can be effective, said Dr. Priscilla Potter, who runs the headache clinic at the University of Miami and is assistant dean of curriculum for the medical school.
``The goal of treating headaches is to keep patients as active as possible for as many days a month as possible,'' Potter said. Migraine related to the menstrual cycle is the longest, most painful type, she said, triggered by a sudden drop in estrogen.
A big goal for Welch and Potter is getting more migraine sufferers the help they need. Potter estimates that only 11 million of the 28 million sufferers in the United States have seen a doctor about their headaches.
