Newsnight Maryland; 493; Migraines

Helpful migraine sufferers I'll look at new treatments tonight. Plus horse racing and western Maryland. And queuing for loved ones with Alzheimer's. This. Is. NEWSNIGHT. Good evening everyone. There are headaches and then there are headaches. One American in ten suffers from the neurological disorder known as migraine. For many the pain is so intense and last so long that during an attack they can do little more than lie in a darkened room and wait for the pain to pass. On tonight's Maryland discoveries a look at new research on the mechanisms behind migraines and new treatments for the pain. But. For nearly all his life Michael John Coleman has coped with migraine attacks. Some so severe they leave him unable to function. The early fond memories of migraines were in the first grade and being told to put your head

down. A photographic artist his work often expresses the profound effect changes in weather have on his disorder and the vivid memory. We're always the days I was most ill where the dramatic thunderheads and clouting dramatic skies. It's debilitating when I have. A very intense migraine. I'm mostly bed ridden for at least a day. For many people weather is a prominent trigger of migraine attacks over 20 years. Roberta Bryant Gray has found things like caffeine nicotine and strong odors can set her up for severe migraine. 26 million Americans suffer from the neurological disorder of migraines. You get no medical test exists for it. The diagnosis is based on symptoms but back when Dr. Mark puppet Galo was in his neurology residency he noticed a striking similarity between people with migraines and those who had meningitis. These are patients complaining of severe throbbing headache nausea light

sensitivity noise sensitivity to lie down in a wide room essentially with patients with similar features as patients with migraine headache. I'm talking about to explore further the similarity with migraine Dr. Apapa Galo and his associates at Johns Hopkins recently conducted computerized tomography brain scans of patients who were at that moment experiencing migraine attacks. The images clearly outlined where in the brain covering or meninges the inflammation was occurring. Those images also coincided strikingly with written descriptions of the attacks each patient recorded. This small pilot study suggests migraine attacks may occur when a major nerve is stimulated it releases molecules known as neural peptides which set up a cascade of events that lead to the migraine attack and was never picked sides. Activate the muscle the cells mass cells release histamine. The other

factors these factors cause the dilatation of the blood vessels. There is a leakage at that point of plasma or codings from the blood from the bloodstream outside the blood vessels and then you have what we call a sterile because there is really not an infection or not any sterile inflammation. The walls are called neurogenic inflammation. Instead of responding to a stimulus such as an infection or injury the nerve itself is causing the inflammation. If further studies confirm these results new methods for diagnosing and treating migraine may be developed which is thrilling to Michael John Coleman. Several years ago. He and Terry Miller Birchfield another migraineurs formed a national organization to promote better understanding of migraine. The organization Magnan is also campaigning to have severe intractable migraine recognized as a disability. The general public is understand that this is a very debilitating health problem and it's

not just a bad headache and that it has an incredible life impact. And that requires good medical care and it requires specialists. And more importantly. All these things that there's so much that can be done to improve quality of life the development of new medications such as Imitrex have made an enormous difference for many people with severe migraine. Roberta Gray calls it a godsend. She is even more encouraged that the scientific community is paying more attention to the disorder that at times dominates her life. I always thought my brain was a forgotten illness and I am just so excited to see this research going on and I'm so tight with the new medication so it encourages me and it makes me feel hopeful that something can be done to create this condition and I won't have to suffer for the rest of my life. Joining us now are Dr. Skip strain of Mercy Medical Center and Dr. Michael Papago of New York University Medical Center. And you can join our discussion.

Just call the number at the bottom of the screen. Dr. Popper Gallo using the specked scans that you did this first pilot study with could that lead to a way to ultimately diagnose and lead to treatments for migraines. I believe so. I believe so it would be fantastic to have a tool to actually at least arrive at the right diagnosis in patients with headaches. There are so many types of headaches or at least two different symptoms and the to say that this particular headache it's really related to an inflammation of the images that would be very very important. But the timing is critical. You have to get them at the beginning. Well that's that's that's true. We have to get the patient doing the in doing the attack and perform the test. So the study per se that we actually conducted at up Dobkin it was very difficult to carry the carry out for that reason.

Are there a variety of underlying physiological reasons that set up migraine attacks. Certainly the list of triggers that. They come about are cause migraines are almost endless. And that's part of the trouble with treating patients is a lot of times they may have a certain trigger and they don't realize it and they continuously have that trigger exposed and causes a migraine. When you treat a patient do you try to go down certain lists of maybe dietary things or something like try to get some kind of correlation short not only go down a list of sort of the better known triggers but also ask them to try and keep a diary of maybe 24 hours preceding the onset of their migraine and see if they can identify certain patterns or certain triggers that maybe they can avoid in the future and diminish the likelihood of a migraine. Ordinarily How long does a migraine attack last. Well it depends. They're very variable. They should last at least several hours anywhere from four to several days three or four days worth. And a lot of times the duration depends upon how quickly the patient realizes they're having

and how quickly they seek treatment or give themselves medications. Now Dr. Perper to go for a long time people have known that this is somehow related to blood flow whether it's blood vessel constriction or dilation. Is it one or the other or both. Well that's that's really intriguing question because we have blood vessels to our body leading constricting. It's not like we have pain because of this constriction of dilatation of blood vessels in our body. So there is something definitely more than just a construction of dilatation of blood vessels. And in this case in this particular situation I believe well we believe that it's really the sensitization of the pain nerves around the blood vessels that bring will detect the pain. So in a way is that normally the pulsation of the blood vessels is not painful in a case of migraine attack or doing any maggoty an attack just the

pulsation of the blood vessels become painful. And this is we're talking about blood vessels and nerves that are actually serving the recovering of the brain not not the deep brain. Right. Correct. Now why are women more susceptible apparently to migraine than men. Good question. A lot of times the susceptibility is associated with the menstrual period. And it's thought that the. Fluctuating levels of estrogen and specifically the dropping off of estrogen causes certain changes in the central nervous system more sensitivity to certain neurotransmitters. And for that reason a lot of them as soon as they're approaching menstruation get migraines. Let's go to the phones Sally is on the line from Ann Curry County high salary. Hi Doctor. Just recently I have something called complicated migraines versus making migraines regular migraines. Want a bad headache. I like my left arm would go numb. And it's only happened once

just recently that my whole left side went numb and looked like I had a mini stroke. The doctors told me I wouldn't have my knees were OK I wouldn't have a stroke. I respect complicated migraines can bring on a stroke etc.. Is there a relation between migraine and stroke. Well that's what we think that potentially people get migraine headaches may be at more risk for having stroke that hasn't been proven. So it's sort of conjecture at this point. There can be neurologic symptoms that happen usually prior to the onset of the headache and that's called an aura. And it sounds like that's what this patient had. Sometimes they can be very frightening and people think they're having a stroke because it can cause numbness or visual symptoms dizziness some very profound symptoms. Is there any way is there any specific way you treat those. Maybe numbness in the extremities or is you just consider that part of the what's going on with the migraine. Well that those particular types of migraine

attacks whether they are or not as we call complicated migraine they probably require particular attention prophylactic treatment. So in a way patients require prophylactic medications to prevent the attacks. And number one and number two the typical drugs that we are now or have for migraine probably should not be used. There is a contradiction in the list because some of the very effective drugs like the triptans may actually induce vasoconstriction as a side effect. So there is a deal. There is so this relative contraindications to using those drugs. So you might have to somebody for somebody with a heart condition or something like that. Let's go back to the phones again. Vincent is on the line from D.C. Vincent. Hi how are you. Well thank you. I wanted to propose to either of both gentlemen I suffered for years with migraine headaches from the time I was 13 years old

when it was treated with a variety of drugs everything from volume to Thailand to Percocet for the intense pain. Until about four years ago I was treated for clinical depression. What surprised me was is when I started the series of drugs or the program of Prozac up to that 30 milligram point I have not had a migraine headache since I started on Prozac. And I was wondering if there's any correlation between what could be cardiovascular versus what is neurological. Because it seemed that when the Prozac kicked in really took effect I have not had a migraine sense and I cannot tell you of the years of excruciating pain that migraine can bring on. Let's see if we can get an answer. Well one of the difficult things is migraines cause depression. And so it's hard to distinguish between the two although usually when the migraine is not present

then depression like symptoms should be gone as well. And if they persist in between attacks then that's maybe more likely indicative of depression. Sometimes we actually use Prozac or other anti-depressants as prophylactic medications. And so that actually may be the case here that Prozac is working prophylactically just to avert the migraine. I want to get an idea from each of you what what are the really effective new drugs that are out to treat migraine and what's on the horizon that you're aware of. To. Us. Well I think they did then say as I mentioned before exceptional drugs that really make the difference for a lot of patients suffering from migraine attacks. There are probably new molecules that are in the same line they will have fewer side effects especially bad pasuk basic constricting effect. Should there be safer to use. But I think that more

importantly is the research progresses and we find out how and why this Dittrich Jeremy no nerve of my penis activated. At what point we can actually have grags they will turn off that mechanism what would be the real thing. That's the major nerve that serves the energies are demeaning Jacinda blood vessels and that that's where the pain signal pain travels. And Brian is on the line from Oxford Pennsylvania hello. We just lost him. Getting back for some of these other drugs we saw one of the patients in the set setup piece using Imitrex and I think a lot of people have found that to be a tremendous help for them. That's a trip down right. That's right. That was the initial trip tan introduced. And there are several second generation triptans that have been recently introduced that are maybe more tolerable as far as side effects go. One of the problems with Imitrex or sumatriptan was that it has a relatively short half life. And so the recurrence of

migraines was fairly high. So they'd have to reduce themselves. And so it wasn't a smooth state after they tried to treat themselves. The newer triptans last a bit longer and like I said are a bit more tolerated. Can I ask you all about this rebound effect that so-called wear. I guess it's someone if someone takes an analgesic maybe too late or something that it can actually magnify the problem is that is that the way it works. Well I think that's a really still poorly understood the phenomenon the rebound headache phenomenon. In a way it could be that patients taking some of these agents and it could be often over-the-counter preparations. There are most of them are short acting preparations. So one possibility it's really the withdrawal from the drug itself. So the drug the whatever it is the agent picks and then that they know course of goes down in the bloodstream and just the withdrawal date it's a trigger for the migraine Percey or vice versa. That could

be just as a side effect of the agent the side effect that we know that if you if you take a look at the PDR you see that lots of drugs common side effects headache and so that would be the other possibility that just the agent for that particular individual trigger the migraine is on the line from Bethany. Delaware hello hello. Hello. My question is I recently had open heart surgery for valve repair and I had a history of migraines in the past. Since the surgery for the last eight days I have had a migraine every day. On the day of discharge from the hospital they prescribe Imitrex which I've been taking and almost every day at a similar time. I've experienced a migraine. My question is this could this be a result of just the stress of the surgery. Is this a result of being on coumadin low pressure or some of my other medications quite distressing. I have the classic aura I have the Jack vision I have some numbness in my arm.

I get sort of one sided pressure if I don't get the attraction time. See if we can find out. Well it certainly sounds like she's having them. That's for sure. I don't think that they're precipitated by the Coumadin or some of the other medications that she mentioned the fact that they're not responding to the Imitrex is certainly concerning. I'm not sure what dose of Imitrex she took that dose can be incrementally increased or she could try another longer acting trip down which essentially I would do at this point to try and combat the headache. A lot of times with the Imitrex it doesn't last long enough. And so it won't effectively treat it. Do people generally age out of migraines. That appears to be the case. Most of the time individuals who develop migraine headaches or early life then and especially this may be more the case for women with the hormonal factors in a way then over time the migraine

attacks the decreasing frequency and disappear. But it's also true that a small portion of over individual patients you have headaches migraine persisting for many many years. The other thing I want to say here that really the challenging cases or the individuals who really suffer are not those who have a migraine attack or once in a while would probably the deep sleep side effect even in the can make it through throughout the attack for a few hours in the regions that we see in the clinic. Are the individuals who suffer from often chronic daily headaches and those are the challenging cases. In my practice basically see I mean I would say 50 percent of my patients are patients who have a migraine attacks or an underlying chronic daily. Do want to try to squeeze one more call in Kate from Harford County is on the line. OK.

Hello. I wanted to follow up on something that Dr. strain had mentioned and that was the women who have some monthly induced migraine headaches. I talked to different doctors about this because I believe that something I have and they all seem to stop after saying yes it's it's probably brought on by the level of estrogen dropping. And then there's this this you know they say well we don't know what to do about it because estrogen is so difficult to deal with. Could you could you address those in a very few seconds. Well sometimes it will actually do is supplement estrogen in patients even though it causes headaches. It's the dropping off of the estrogen levels and so if you make it a steady state either with oral contraceptives or estrogen supplement even though they both can cause headaches it may actually make the headaches better. Doctors thank you very much for joining us this evening.

Thank you. Next Tuesday on Maryland discoveries medical advice for weekend warriors who play hard but end up with some hard knocks. Will they stop the presses in Baltimore. And what about horse racing in western Maryland. Jeff Salkin has the latest in the Maryland biz. Well right now the 600 Baltimore Sun employees represented by the Newspaper Guild are meeting to consider the latest offer from the company that offer coming after all day in negotiations there hasn't been a strike since 1987 at the sun. However the union has been vocal in its criticism of the company's offers this time especially vocal at a demonstration last week about a company proposal to outsource certain non editorial jobs. The company however says it has modified those positions and is offering lucrative pay increase and bonus package. No word tonight on when that vote will actually take place. The Maryland racing commission today

began work on a new track for western Maryland. The legislature authorized a new track during the last session. It was accepted by ownership of the current thoroughbred tracks as part of a deal for additional state aid. The owner of Delaware Park is among those expected to compete for the license once the racing commission finalize its rules. And Maryland steel workers were among those protesting on Capitol Hill today. They were calling for quotas on cheap foreign steel. Such legislation passed the house easily earlier this year but it was rejected in the Senate today 42 to 57. The Clinton administration lobbied against quotas fearing a trade war. And in fact the industry was split on this with some companies that rely on foreign steel as raw material opposing any new quotas. Bob and Cabello that is today's Maryland biz. OK thanks a lot Jeff. Caring for a family member with Alzheimer's can be a 24 hour job. Coming up later on NEWSNIGHT Maryland. Find out about support services for individuals and their

families. But first a possible link between lead and tooth decay. We'll be back with that story. Officials in Houston want a three month moratorium on major retail development. Some residents are concerned that overdevelopment could ruin instance small town atmosphere. Computer mechanisms 15000 new parking meters in the District of Columbia are being sent back to the manufacturer. Motorists have been complaining the meters don't always give proper credit after coins are deposited. Fiji officials have completed Y2K testing and say all applications functioned as expected. B.G. has more than a million customers in Maryland and District of Columbia suburbs. Last week we told you about a new LED awareness exposure effort going on in Baltimore tonight. New research indicates as many as three million excess cavities in the teeth of children and adolescents may be related to exposure to lead.

Although there has been a dramatic decline in tooth decay since fluoride was introduced into water supplies and toothpaste. Eight out of 10 youngsters have at least a few cavities by the time they're 17. Children growing up in poor households are especially vulnerable. New evidence suggests at least part of the reason for that may be lead in the United States. Children exposed to moderate voices heard about 10 percent of their tooth decay are attributable to boys. And about in children exposed to higher world. About 14 percent of the current could be attributable to environmental work. Dr. Marc Moss reached that conclusion after he and his colleagues studied the records of nearly 25000 people two years of age and older. They linked to decade to lead exposure levels much lower than those responsible for severe

health effects such as brain nerve and kidney damage. The study shows that tooth decay is goes beyond Florida. You go on you're going to go beyond oral hygiene. That word could be a factor that also plays a role and would have implications for prevention. Now we already know that. So this is just another thing to beware of all the bad things that might cause as well about 83000 Marylanders now suffer from Alzheimer's disease and thousands of baby boomers are at risk. Tonight's newsmaker Chris Campbell is from the central Maryland chapter of the Alzheimer's Association. Chris what's the difference between dementia and Alzheimer's. It's a good question and one I hear quite often dementia really describes the symptoms of memory loss changes in judgment. It's often used as a diagnosis even though it is

not a diagnosis. Alzheimer's disease is the most common form of dementia. There are many other forms in addition to Alzheimer's what do we stand in terms of treatment. Right now there are treatments available to help with the symptoms. They do not stop the disease from progressing and they don't cure the disease. They may temporarily enhance memory and there are medications available that can also help with the behaviors that become difficult for it to regress for example aggression agitation. Someone who may be hallucinating or experiencing some delusions or suspiciousness paranoia. I was told that there there are some drug trials underway in the Baltimore metro area. That's something that our office some mixed family is aware of quite often there are many drug trials available right now researching things like estrogen the effects of non-steroidal anti-inflammatory agents like ibuprofen to see what benefit those make if individuals with Alzheimer's. This is a disease that's not only debilitating to the person who suffers from it but also to the family as well because I can't the caregiver the caregiver

must be under tremendous amount of stress. Absolutely. It's a 24 hour job as the disease progresses people lose their skills. They need help with dressing bathing toileting decision making legal and financial planning it's a tremendous care burden. When do you start noticing or when would someone start noticing that this becomes just too much for them I'm talking about the person who's the caregiver. That's different for everyone. And as I talked to caregivers I find that for each person it's a different trigger point. Some folks are able to do the hands on care quite well they can manage the bathing issues and toileting other family members have limits with that particularly with incontinence issues. What about services available. Tremendous number of services out there. One of the best things that family members can do is join a support group where they can learn more about the disease they can talk about the issues important to them in a safe confidential environment. I really feel less isolated. Many caregivers feel alone in this disease. Another thing they can do is to take advantage of respite services either using daycare in-home care or a short

stay in a respite facility for people out there though who may not be able to afford that type of service. I mean are any kind of funding available. There is funding in many situations. There are a waiting list but we try to help educate folks about what services are out there and get them connected to those services. Speaking of services what other types of services does the association provide. One of the most popular services is their helpline for families can call and ask questions about everything from what is Alzheimer's Disease. Do I have the disease and what services are out there. And we stopped that by trained professionals and volunteers have been caregivers themselves. What I find very interesting here is that you say that's the most important service that you have and you would think that a lot of people would already be aware of Alzheimer's. There is greater awareness I think President Reagan's diagnosis has helped with that. But I also think many folks don't understand the disease. There are a lot of misconceptions that memory loss is normal aging to this degree and it's not. And folks really need to understand the disease to better cope with it.

OK Chris Campbell thank you very much for joining us. And a reminder that tonight at 9:00 here on NPT you can learn more about Alzheimer's in the Frontline special pop. Thanks for watching Newsnight Maryland tonight. Tomorrow on our planet Maryland edition protecting big grasses. The Chesapeake underwater grasses be restored. Good day. Good night