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Migraines attack approximately 28 million people. Doctors believe that they occur when various internal and external triggers—from hormones to weather changes to foods—set off nerves surrounding certain blood vessels in the brain, causing inflammation in those areas. The result can be incapacitating head pain, nausea, vomiting and sensitivity to light and sound. According to the National Headache Foundation, 70 to 80 percent of sufferers have a family history of migraine. Here are some of the latest developments:

Medications
More than 50 drugs are used to treat migraines. Many of them are approved for other disorders, such as hypertension, epilepsy and depression. According to Fred Sheftell, M.D.—cofounder of the New England Center for Headache and coauthor of Conquering Headache——triptans are the most effective medications once an attack occurs. They include Imitrex, Zomig, Amerge, Frova, Maxalt and Relpax. To help reduce the frequency and intensity of attacks before they start, preventive drugs—such as Topamax, Depakote, Inderal and Elavil—can be taken daily.

Complementary Therapies
Alexander Mauskop, M.D., director of the New York Headache Center and coauthor of What Your Doctor May Not Tell You About Migraines, recommends biofeedback, acupuncture and vitamin supplements—daily dosages of 400 milligrams of magnesium and 400 milligrams of riboflavin (B2), or 150 milligrams of Coenzyme Q10 (CoQ10). Herbs that may help migraines include feverfew and ginger. Preliminary studies suggest that some herbs or supplements might lower the efficacy of migraine medications or cause them to reach toxic levels, so consult your doctor before taking any.

Nerve Connection
According to Joel Saper, M.D., founder and director of the Michigan Head-Pain & Neurological Institute, a migraineur's brain is more sensitive to triggers than the average person's. So the goal is to stop pain messages from reaching the brain and causing headaches. When standard treatments alone don't work, the following techniques might be considered for chronic sufferers.

Botox: This toxin, derived from the bacteria that cause botulism, is known for its ability to erase wrinkles. Studies are under way to assess its ability to prevent migraines. It was initially thought that Botox relieved headaches by relaxing tense muscles in and around the head and neck. New studies, however, suggest that it might inhibit nerves from sending pain signals to the brain.
Trigger-point injections: Numbing medications are injected into muscle and nerve sites for short-term relief.
Facet joint and occipital nerve blocks: Areas around the head and neck are injected with Novocain-like drugs or steroids to reduce inflammation. If this relieves pain, nerves may be frozen or burned for a more long-term solution.
Neurostimulation: This experimental technique involves surgically implanting an electrode beneath the skin, which sends impulses to the nervous system and peripheral nerves to block pain signals.

For more information, go to achenet.org and www.headaches.org.

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