National Headache Awareness Week 2006: Reflections

The media have paid little attention to headaches during this year’s National Headache Awareness Week, which ends tomorrow. Everything I’ve seen is a variation on the National Headache Foundation’s 12 tips press release. Scrounging around for coverage, I found a couple interesting things.

First, there are a gazillion health-related awareness days/weeks/months. With all of them competing for attention, it’s not surprising that only the most well-recognized illnesses are covered. Doesn’t do much for awareness, does it?

Second, in 2000 Bristol-Myers Squibb released “a timeline of the false starts, red herrings and ahead-of-their-time discoveries that have led to today’s highly effective and accessible migraine therapies,” according to a press release from the company. Highly effective and accessible? Yeah, right!

But that’s beside the point; some of the historical information is interesting. Just remember that it was issued by a major player in the pharmaceutical industry. Specifically, the company that makes Excedrin Migraine. You’ll see what I mean.

‘Milestones in Migraine Management’ Introduced During National Headache¬† Awareness Week

In ancient civilizations, headaches were believed to be caused by evil spirits who inhabited the head. The spirits were chased away with prayer or the application of some unpleasant substance, such as goat dung. Severe headache was sometimes treated by trepanning — boring a hole into the skull to release the evil inhabitant.

Incredibly, this unscientific notion of pain being “all in your head” persisted all the way into the late 20th century. Migraine was largely thought to be psychosomatic; sufferers were told to relax and sent to therapists and hypnotists. Thankfully, contemporary research has revealed precise physical events that bring about migraine pain, legitimizing the condition and providing long overdue relief.

500 B.C. Hippocratic “Humors”
Hippocrates asserted that headaches could be traced to “humors” (fluids or vapors circulating in the body). To release the humors, he recommended bleeding and the application of herbs to the head.

100 A.D. Migraine Gets its Name
The Roman physician Galen described and named the one-sided headaches characteristic of migraine. His term “hemicrania” eventually evolved into our familiar word “migraine.” Treatment with “liver pills” becomes popular and remains so all the way into the 20th century.

1600’s: Swelled Heads
English physician Thomas Willis suggested that the pain of “megrim,” or migraine, was caused by swelling of blood vessels in the head … an astonishingly accurate theory that was not scientifically confirmed until the 1940’s by Dr. Harold Wolff.

1920’s: Gotta Get Ergotamines
Ergot extracts — a product of moldy bread — had been used to treat headaches since the late 19th century. In 1918, they were synthesized into ergotamine tartrate, a vasoconstrictive treatment initially used to control bleeding after childbirth. In the 20’s, however, ergotamines became the first pharmacological treatment for migraines.

1950’s: Suddenly Seratonin
Scientists first began to uncover the true nature of migraines in the 1950’s, when it was proposed that migraine attacks might be associated with abnormalities of the neurotransmitter seratonin. Methysergide was developed to act on what was incorrectly thought to be one, simple seratonin system in the brain. The success of this drug in alleviating migraine provided the first proof that the condition might be more physical than psychosomatic.

1960’s: Polypharmacy
As research into the seratonin system progressed, it was thought that there may be as many as six different neurotransmitters involved in the production of a migraine, prompting some physicians to prescribe three or four drugs simultaneously.

1970’s: The Holistic Approach
Perhaps as a backlash to the overmedicated 1960’s, the 1970’s brought on a wave of holistic approaches to migraine management: stress reduction, relaxation, meditation, yoga, herbal remedies, acupuncture and various self-help methods using the will or the mind, aided by the newly developed techniques of bio-feedback.

1980’s: Progress in Isolating the Cause of Migraine
Scientists finally fully charted the complicated system of neurotransmitters and seratonin receptors, identifying one of them — 5-HT1 — as the primary receptor responsible for migraine pain. This important discovery led to the development of an agent called sumatriptan, which had its first highly successful trials in 1988, and paved the way for effective migraine treatments in the 1990s.

1990’s: From Doctor’s Office to Drugstore Shelf
January 1998
OTC Pain Relief … and a Superbowl Stunner
For the first time, the FDA approves a non-prescription medication for relief of migraine pain: Excedrin Migraine. Finally, a quick trip to the corner drugstore can provide migraine pain relief. That same month, Denver Broncos star running back Terrell Davis is forced to leave Superbowl XXXII due to a migraine, opening many people’s eyes to the seriousness of the condition.

October 1999: OTC Rivals Rx
Another “first” as the FDA grants an OTC treatment the same indication as prescription drugs. Excedrin Migraine received an expanded indication to include the full migraine syndrome: pain plus associated symptoms of nausea, sensitivity to light and sound, and difficulty performing everyday activities.

May 2000: New Migraine Guidelines
The U.S. Headache Consortium issues new Migraine Treatment Guidelines, intended to help doctors diagnose and treat tension and migraine headaches. For the first time, an OTC treatment, Excedrin Migraine, is recognized as a first-line therapy for migraine headache.

Hmm… Why do most people think a migraine is “just a headache” that an OTC painkiller will wipe out? And just how many of these so-called awareness weeks were developed for advertising purposes?

It’s good that National Headache Awareness Week is now orchestrated by the National Headache Foundation, an organization that seeks to “gain recognition of headache pain as a real and legitimate neurobiological condition.” And they are doing a good job. The program seems to build more steam each year. Although there hasn’t been much media coverage, headache education sessions were hosted around the US this week.