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Longtime migraine sufferers search for new treatments

Cheryl Beech endured a headache that persisted for the better part of the past eight years.

Not a head splitter. It was more of a constant level of nagging pain and discomfort that would ebb and flow but never really go away.

"It just feels like there's constant pressure," she says. "It can almost feel like a shroud coming over my head."

A shroud of pain and pressure that medicine calls a migraine.

The onset of Beech's migraines came when she was about 20 years old. Slowly they became more frequent and more unrelenting.

Over the years, she's tried all sorts of medications and therapies: physical therapy, chiropractics, pain clinics, massage therapy, acupuncture.

All provided some benefit, but no lasting relief.

Then, at her neurologist's suggestion, a year ago she turned to a relatively novel treatment involving injections of a neurotoxin best known for removing facial wrinkles: Botox.

The therapy is expensive and only used for a small group of chronic migraine sufferers.

"This is a suppressive drug," says Dr. Cynthia Knutson, a neurologist at Sanford Health and Beech's doctor. "There is no cure. Botox is not a cure and it's not for everybody."

It takes about two weeks after a treatment to begin feeling the difference. But for Beech, the difference was dramatic, as if a fog lifted.

"When you come out of it everything looks bright and clear and in focus," she says.

Source of pain

The cause of migraine headaches - which can cause intense, throbbing pain, sometimes associated with nausea or extreme sensitivity to light or sound - remains a mystery.

They often originate in childhood. They are three times more common among women than in men. For some, they are telegraphed by sensory warning symptoms called an aura - a flash of light, blind spots, or a tingling sensation in an arm or leg.

And they seem to thrive on instability.

Women's hormonal fluctuations, in fact, are widely thought to help explain why migraines are so much more prevalent in women than in men.

To help keep migraines at bay, neurologists advise their patients to carefully manage their lifestyle.

"The higher the frequency of your headaches," Knutson says, "the more you have to scrutinize your lifestyle."

Exercise, which makes the body produce endorphins - natural "brain soothers" - helps prevent migraines.

"I have patients who, when they start getting a headache, will get on a treadmill," Knutson says.

Yoga, with its combination of meditation and breathing control, helps some migraine patients.

"Yoga seems to produce a lot of brain relaxation," Knutson says.

Maintaining regular sleep and meal schedules is especially important to avoid migraines.

Migraines can be triggered by noise, light, even smells, such as perfumes, scented laundry detergents or petrochemicals.

"Migraine brains have high sensitivity to stimuli," Knutson says.

Frank Johll can attest that stress is a major trigger for migraines.

Johll, who recently moved from Fergus Falls, Minn., to the St. Louis, Mo., area, has suffered from debilitating migraines since childhood.

Last year during the holidays, he began having severe migraine attacks, with "crippling" headaches that twice sent him to the emergency room.

"I couldn't do anything," he says. "I could hardly even sleep."

Johll had recently gotten married, moved to the area because of family connections, and struggled to find work - a raft of changes and stressful situations that contributed to his headaches.

"Six weeks it was a continuous headache. Nothing was working. It was bad."

Dr. Shaun Christensen, a neurologist with Essentia Health in Fargo, worked with Johll to find the right medication and dosage to suppress his migraines.

After finding the right drug, Christensen kept increasing the dosage until the headaches went away, Johll says.

Now, as he is getting settled in a new city with a new job managing a driver's license bureau, Johll considers his migraines well managed.

"I just keep taking my medication," he says. "Every day is a new day."

It's common for severe migraines of the kind Johll can experience to be debilitating, Christensen says.

"It's a huge health and societal problem," he adds. "It's a very frequent cause of emergency room visits, missed days from work."

Migraines actually are more common than many people realize, Christensen and Knutson say. Many headaches involving the sinus region actually are migraines.

Finding relief

Cheryl Beech had her first Botox treatment a little more than a year ago.

Knutson gave her 31 injections on her forehead, temples, head, neck and shoulders. The needle is very fine, and Beech says the pricks are much less painful than the headaches they suppress.

The treatments take a couple of weeks to take effect, and last for three months.

The 52-year-old Moorhead woman recently had her fourth treatment and says they have changed her life.

"You can have days with almost no pain," she says.

Beech has had what she considers moderate migraine headaches. Moderate, but also very stubborn.

"I would say I've had a moderate headache for years and years and years."

Over time, she learned to manage her life in ways to minimize her headaches: sitting with the right posture, getting regular sleep and meals.

"You plan your life around the pain, is what you do," she says.

"I've never missed work because of a headache," she says, "but there are times when I get home from work that I just crash."

Botox is a muscle relaxant that helps to alleviate the muscle stiffness in the neck is common among migraine sufferers. Researchers believe there is a vascular component to migraines, something muscle tension exacerbates.

"People with chronic migraines almost always have chronic neck stiffness," Knutson says. "It's almost like they go together."

That's certainly the case with Beech, whose muscle tension is constant, and whose migraines are worse when she's tense.

"What's really made the difference for me has been getting the Botox," she says. Beech, who works as a nurse diabetes educator, marvels at how much more energy she has now that her headaches are subdued.

Botox treatments for migraines are only recommended for chronic sufferers. The treatments are expensive - between $1,300 and $1,600 per treatment, according to figures from Sanford Health.

Insurers only cover them for patients who have migraines more than 15 days per month sustained over at least three months, Knutson says.

Patients who have failed to find relief from at least three standard migraine prevention medicines would be candidates.

Beech is a Botox believer.

"It's amazing what a difference it makes," she says. At times, her headaches are gone; when migraines strike, they are less intense.

"It's at a lower level that's much more tolerable and makes life much more enjoyable."