When the silverfish start to dance...

By VIRGINIA WINDER

A SMUDGE on the car windscreen won’t go away.

A squirt of water and quick flick of windscreen wipers makes no difference, neither does a firm, fast rub with a cloth on the inside glass.

Damn. The smudge has become a silverfish that slips out of sight.

Within minutes it’s joined by a line of quicksilver critters doing a zigzag dance in the peripheral vision of the driver’s eyes.

Slow-moving commuter traffic becomes a terrifying distortion of movement and flashing metal. So, with exaggerated care, the young woman noses her car to the side of the motorway and waits until a policeman finds her slumped over the steering wheel, hands covering light-sensitive eyes.

I got a police escort that day more than 20 years ago, because the man in blue knew what was going on in my head.

He was a migraine sufferer too. We are among 400,000 New Zealanders affected by this neurological disorder.

Of those sufferers, called migraineurs, 300,000 are women. The 3:1 ratio can possibly be blamed on hormone irregularities, which are listed among the triggers for this invisible illness.

Lack of sleep, stress, relaxation after stress, fatigue, overuse of over-the-counter pain relievers, irregular exercise, bright lights and smoke are named as other possible migraine starters. So is diet, including cheese, red wine and yes, coffee. Double damn.

While there are hundreds of research programmes going on around the world, scientists have yet to locate the definitive cause of this often debilitating disease.

“It is thought a migraine attack is triggered within the brain itself,” says the National Headache Foundation, in the United States.

The foundation says that once an attack begins, it is believed the pain and other symptoms of migraine stem from an inflammatory process.

This may be caused by an interaction between the trigeminal nerve (the fifth cranial nerve responsible for sensation in the face) and blood vessels in the coverings of the brain.

The brain chemical, serotonin, is linked to this inflammation, but its role is not yet clear.

Scientists in Japan are studying this connection.

While researchers have yet to pin down the underlying culprit, or culprits, there is no doubt it’s painfully real for the afflicted.

“Migraine is a legitimate, biological disease characterised by throbbing head pain, usually located on one side of the head, often accompanied by nausea and sensitivity to light and/or sound,” the American foundation says.

“Migraine is more common than asthma, diabetes or congestive heart failure,” its website says.

Similar information is echoed throughout the internet, including on the Neurological Foundation of New Zealand’s site.

“Though the causes are not precisely known, it is clear that migraine is a genetic disorder,” it says.

Global research isn’t good news for children of migraineurs. If one parent is a sufferer, there’s a 50% chance their children will also be afflicted. But if both parents get migraines, there’s a 75% probability their kids will inherit the illness.

The highest incidence of migraine occurs in both men and women aged between 20 and 45, but even toddlers can get migraines.

In fact children can get stomach migraines, which present as severe tummy aches.

Among all sufferers, only about 20% of people experience visual disturbances that herald the onset of a pounding head. This telltale sign is called a migraine aura.

People may see light flashes, blind spots, shimmering lights, or zigzag lines.

Or a smudge on a windscreen that turns into silverfish…

Unlocking the migraine puzzle

By VIRGINIA WINDER
AN Auckland University scientist is trying to unlock the key to migraine treatment.
Senior lecturer Dr Debbie Hay is leading a study into a group of molecules believed to play a role in the painful illness.
Dr Hay, from the university’s School of Biological Sciences, uses a lock-and-key metaphor to explain the basis of her study and how it is opening the door to migraine knowledge.
The key is a hormone called calcitonin gene-related peptide (CGRP), which is found in people’s nerves.
“People who have migraines have more of this in their blood,” she says.
This hormone fits into a lock, called a receptor.
When this happens, it causes blood vessels to open up. In medical terms, the hormone is a naturally occurring vasodilator. Migraine pain is thought to be caused by blood vessels in the brain opening up, allowing more blood to flow through them.
“That’s one of the reasons we think CGRP might be involved in migraines,” Dr Hay says.
But she is frank about scientists’ knowledge of the hormone’s role in migraines. “We don’t know if it’s causative or part of the process.”
In fact, the hormone is proving a bit of a mystery. “We don’t know exactly why we have it…we don’t know its true function yet. We know it has this relationship with migraines.”
Clinical trials overseas have shown that a new drug, which prevents the key fitting into the lock, or the hormone activating the receptor, is effective in treating migraines.
“The problem is that it has to be given by injection, which is not ideal,” Dr Hay says.
“We need to be able to design a better drug.”
This is where her research programme comes in. “I’m working very much at the molecular level to see how this drug interacts with the receptor so we might be able to design more useful drugs.”
a $492,000 biomedical grant from the Health Research Council of New Zealand is funding the three-year Auckland study.
“It’s an ongoing thing – it contributes to the global drug discovery process.”
Dr Hay says her work does not involve human samples or clinical trials, but she does consider the reality of her research. “I know people in the building who have migraines and I’m always very interested in them; it’s always important to talk to the end user.”

FREAKY FACTS... A pain in the head

1) The World Health Organisation ranks migraines in the top 20 of disabling medical conditions.
2) Botox treatment for frown lines may also help prevent migraines, according to a case report in Auckland.
3) Migraines cost the American taxpayers $US13 billion ($NZ18.4b) in missed work or reduced productivity annually.
4) Spanish researchers have found that treating inflammation in the eye’s trochlea tendon can relieve migraine pain.
5) Famous migraineurs include Elvis Presley (right), Albert Einstein, Julius Caesar, Joan of Arc, Cervantes, Pascal, Nietzsche, Robert E. Lee and Karl Marx.