Throughout her early 20s, Shirley Kessel ran through a gamut of medications, but none brought relief from her daily migraines.
Special occasions weren't spared: On her wedding day, Kessel suffered the worst headache of her life.
"I couldn't wait for the day to end," said Kessel, who now is 56 and executive director of Miles for Migraine, which raises money for research and education for the disease.
Finally, during her first pregnancy, the chronic headaches abated. After the birth of her first daughter, Kessel's headaches subsided to one or two menstrual migraines per month. For years, she got relief from triptans, a fast-acting class of drug developed in the 1990s for migraine attacks. During perimenopause, however, her chronic headaches returned, along with fatigue, nausea, light and noise sensitivity and ringing in her ears.
Migraines affect an estimated 39 million Americans, and about three out of four people who suffer from them are women. The World Health Organization estimates 127 million to 300 million people worldwide experience chronic migraine, defined as 15 or more headaches per month over at least three months.
Migraines also often have a genetic component. Along with her mother, two of Kessel's three daughters – Julia, 26 and Sydney, 21 — suffer from migraines. Sydney, who is in college, lost a year of high school to migraines, which transformed her from an active "social butterfly" to a withdrawn and nauseated young woman who spent most of her time in bed.
While a number of interventions exist, many work only for a limited time.
There are many medications for migraines – including topiramate, antidepressants, blood pressure medications, and Botox injections. But there hasn't been a new drug specifically designed for migraines since triptans.
That's likely to change. A new study recently in the New England Journal of Medicine reports that fremanezumab, an immunotherapy drug, has been found to reduce the number of days that chronic migraine sufferers experienced headaches. The drug blocks the activity of a molecule called calcitonin gene-related peptide or CGRP, which spikes during migraine attacks. By blocking this peptide, doctors hope to break the cycle of increasing inflammation and heightened pain sensitivity that contributes to migraine headaches.
"It's the first specific migraine drug," said Stephen D. Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University Hospitals and lead author of the study. "This therapeutic approach offers new hope for people whose migraines cannot be treated with existing medicine."
Based on the promising phase III clinical trials, the drug could be available later next year.
Women get more migraines than men because of hormonal changes, said Roderick Spears, a physician and clinical associate of neurology at Penn Medicine.
"If you look at the statistics, boys outpace girls with migraines until girls start to menstruate, and you begin to have hormonal fluctuations," said Spears. "About two-thirds of women [with migraines] will get some type of migraine around ovulation or menstruation."
"It's the cycle of rising and falling estrogen levels," said Silberstein. "During perimenopause, when periods and estrogen levels are irregular, headaches increase. Stable estrogen is better for migraines." He notes that sometimes, as was true in Kessel's case, the second or third trimester of pregnancy brings a drop in migraines.
Because of the hormonal connection, some physicians prescribe low-dose estrogen patches, or try IUDs that are progesterone-based to stem headaches, said Spears. Other women use anti-inflammatories like naproxen sodium or a long-acting migraine medication.
Meanwhile, Silberstein suggests preventive measures for those with migraines.
"First and foremost, regular exercise, meditation or biofeedback," he said. "Then there are medications. Prevention can also include doses of Co-Q 10 and riboflavin, which have been shown to help."
Another useful supplement is magnesium, which has been clinically shown to prevent menstrual migraines, said Spears.
Lifestyle changes can also prove useful: Spears recommends regulating sleep, eating regular meals, avoiding artificial sweeteners, limiting caffeine intake, and holding rescue medications to two days per week.
As if the pain weren't enough, migraineurs, as sufferers are known, may also cope with stigma.
"Migraine in the 20th century had been considered a disease of neurotic women," said Silberstein. "But this is a neurological disease."
"Also, some people have one attack every three months, others have it every day. And if you have infrequent migraines, it may not seem a big deal," Silberstein said.
And attitudes from the medical community may not help.
"I think this may be changing in health care," said Spears, "but because migraine affects women more than men, there is a stigma around the stereotype of a patient who comes in with multiple complaints, calls frequently and wants to see the doctor frequently." Men, on the other hand, have been stereotyped as going to the doctor "only when something he has is real."
Another problem is that you can't see a migraine.
"If you're walking around with crutches or your arm in a sling, you can see that, but if you tell people your head hurts, light bothers you or sounds bother you, people don't really believe it," Spears said. "It's hard for people to understand what migraineurs are really going through."
These days, Kessel, who lives in Lafayette Hill, struggles to weather her headaches and looks toward the future for a cure.
"My lifestyle is not the same as other women my age," she said. "I may look completely normal. But that's not how I feel."