Relief At Last: For years, untreated migraines threatened actress Bellamy Young's career and well-being. She hopes that by sharing her story she can spare others a similar fate.

Bolster, Mary; Roberts-Grey, Gina

doi: 10.1097/01.NNN.0000511237.20069.c2
Features: Bellamy Young

For many years, untreated migraines threatened actress Bellamy Young's career and well-being. She hopes that by sharing her story she can spare others a similar fate.

PHOTOGRAPH BY BEN MILLER

WEB EXTRA: For more information about migraines, check out Neurology Now's Basics at http://bit.ly/NN-MigraineBasics. For advice about supplements and vitamins that may reduce the pain and frequency of migraines, go to http://bit.ly/NN-VitaminsforMigraine.

Article Outline

Bellamy Young has two things in common with former First Lady and presidential candidate Melody “Mellie” Grant, the scheming, ambitious, and frequently intoxicated character she plays on the ABC drama Scandal: She's smart and has harbored a secret for years.

Figure. No caption a...

A graduate of Yale University with degrees in English and theater, the 46-year-old North Carolina native won Celebrity Jeopardy! in 2015 and donated her $50,000 winnings to a charity that supplies blankets to animal shelters. The lifelong animal lover has participated in public service ad campaigns for the United Humane Society, and this year she was featured in “Being Vegan Keeps Me Young,” a campaign sponsored by the People for the Ethical Treatment of Animals.

As for her secret: she endured debilitating migraines for years. “I can't remember life without them,” says Young, who recalls days of being bedridden, backing out of social events, and hiding from light. And because she didn't recognize the signs of a migraine—blinding pain on the left side of her head, sensitivity to light and odors, and nausea, among others—she hid her pain and delayed seeking help or even relief. “For several years, I didn't have a word or diagnosis for what was happening. I just knew that when the pain started, I had a limited amount of time to get to a place where I could lie in complete darkness and silence until it subsided. I became a professional at lying in bed waiting for the pain to pass.”

Before long, these excruciating episodes were ruling her life. She was either having a migraine or anticipating one. Over time, Young began turning down social invitations because she didn't want to ruin plans for family and friends. “Something like spending a day at the beach or going to a dinner party might bring on a migraine, and rather than be the wet blanket I made excuses for why I couldn't go.”

Instead of seeking treatment—“I fell into the thinking that it's just a headache,” she admits—Young silently endured the disruptive events.

Back to Top | Article Outline

A COMMON DISORDER

Thinking a migraine is “just a headache” is typical, says Patricia D. Scripko, MD, a neurologist at Salinas Valley Memorial Hospital in California, who founded and manages the hospital's headache program. “Studies have been done that ask people with migraine what type of headache they thought they had, and they say sinus or stress headaches, by which they mean tension-type headaches,” says Dr. Scripko. “Because migraine is so common, it's easy to downplay or minimize it.”

More than 36 million Americans and about 10 percent of school-aged children experience migraines, according to the Migraine Research Foundation. And unlike a tension-type headache—which is marked by a dull, nagging background pain evenly distributed around the head and is by far the most common type of headache—migraine is characterized by severe throbbing or pulsing pain, typically on one side of the head, most often in the temples or behind one eye or ear, although any part of the head can be affected, says Anjan Chatterjee, MD, MPH, FAAN, a board-certified neurologist in New York. “People may also experience nausea, vomiting, dizziness, extreme sensitivity to light, sound, smell, and touch, and numbness and/or tingling in the face, arms, or legs.”

Some people with migraine experience visual aura, a partial loss of vision or the appearance of zigzag or squiggly lines in the field of vision, which usually happens at the start of the migraine and typically lasts less than an hour, says Dr. Scripko, who herself has migraines. “Visual disturbances such as wavy lines, dots or flashing lights, and blind spots prior to the onset of pain are common,” agrees Dr. Chatterjee, who also has migraines.

As a rule of thumb, Dr. Scripko says, if a headache interrupts your daily life—stops you from going to work, forces you to miss a social function, prevents you from cooking or cleaning—it's most likely a migraine.

Back to Top | Article Outline

GOING IT ALONE

Although Young didn't experience visual aura during her episodes, she did feel “a horrible searing pain in my left eye that eventually spread like a vice.” That was the signal to stop what she was doing and try to get to sleep before the pain was so great she couldn't sleep. “I needed to be asleep before other symptoms started, and I became practically debilitated.”

Despite these classic signs of migraine, Young tried to treat symptoms on her own. She experimented with acupuncture and aromatherapy and modified her diet. In college, she became a vegan when she noticed that red meat and dairy triggered headaches. To this day, she avoids red wine, orange juice, and foods with acid and nightshades (white potatoes, eggplant, tomatoes, chili, and bell peppers, as well as spices made from peppers such as paprika, cayenne pepper, and red pepper flakes), and limits chocolate.

Back to Top | Article Outline

A DELAYED DIAGNOSIS

It wasn't until 15 years ago that someone suggested her pain might be a migraine. When she talked to her primary care physician about her symptoms, he suggested that her disruptive headaches were a “ladies' problem”—even though her symptoms were not tied to her menstrual cycle. (Hormonal fluctuations are thought to partly explain why women are three times as likely to have migraines as men and why about half of women have more than one headache a month, says Dr. Chatterjee.)

Eventually, Young realized she needed help getting a handle on her headaches. She sought a second opinion and was prescribed sumatriptan/naproxen sodium (Treximet), a combination triptan and anti-inflammatory prescription medicine, to treat her debilitating symptoms.

Back to Top | Article Outline

FIGHTING STIGMA

Getting proper treatment was a revelation for Young. Before then, she says, her feelings of embarrassment and shame about her headaches kept her from getting help sooner. That stigma is one of the reasons she shared her story during National Migraine Awareness Month in 2015; she wants anyone who experiences migraines to get a proper diagnosis and the right treatment.

That's an important message, says Dr. Scripko, who believes migraine is misunderstood. “It's often dismissed as a ‘woman thing.’ Migraine is not a woman thing. It's common and treatable, and we have to understand it so we don't belittle it in any way.” Proper treatment also helps prevent migraines from getting worse. “If you don't treat migraine adequately,” Dr. Scripko says, “it becomes chronic.”

Back to Top | Article Outline

HEALTHY HABITS TO HEAD OFF HEADACHES

Much of what Young did to treat her own symptoms is what neurologists recommend today. For example, Dr. Scripko advises her patients to keep a diary to identify potential triggers. “Track what you eat, how much you sleep, how much water you drink,” she says.

Dehydration may cause blood vessels to narrow, resulting in a reduced supply of blood and oxygen to the brain. In order to compensate, blood vessels dilate, which can activate pain receptors in the lining surrounding the brain. “I encourage my patients to drink fluids that hydrate the body and avoid those that don't,” says Dr. Chatterjee.

Dr. Scripko does the same. “Everybody should drink eight to 10 cups of water a day, more if you're in the heat,” she says, adding that the color of your urine is a good gauge of whether you're hydrated. “Urine gets clearer the more hydrated you are.”

Since sunlight and bright lights can also trigger a migraine, Dr. Chatterjee suggests that patients who experience this trigger wear sunglasses and/or a wide-brimmed hat whenever they're outside to reduce glare and exposure. He also reminds patients to take their medication as early into the migraine as possible to help lessen its severity.

Young knows she will never be free of migraines—“I still get nervous when I spend a long day outside in the summer because heat and dehydration are triggers,” she says—but they don't rule her life the way they once did. “It's wonderful knowing there's something that can help me manage my symptoms if they do strike,” she says. “I enjoy life a lot more now that I have a plan.”

Back to Top | Article Outline

Evolving Treatment Options

Experts continue to discover new ways to treat migraine.

Reducing and managing triggers with behavioral and lifestyle changes can lessen the frequency and severity of migraines, but often these remedies are not enough to block the debilitating pain and other symptoms, says Stewart Tepper, MD, professor of neurology at the Geisel School of Medicine at Dartmouth College and director of the Dartmouth Headache Clinic in Hanover, NH.

In the past decade or so, Dr. Tepper and other experts have prescribed medicines that were originally approved for other purposes. “For example, some antidepressants such as amitriptyline (Elavil) and nortriptyline (Pamelor) and anticonvulsant medicines such as topiramate (Topamax) and divalproex sodium (Depakote) can reduce the frequency of migraines by 50 percent in 50 percent of people who take them,” he says.

Back to Top | Article Outline

PEPTIDE BLOCKERS

More than two decades ago, researchers discovered that the neuropeptide calcitonin gene-related peptide (CGRP) was being released at the trigeminal nerve—which is responsible for sensations in the face and motor functions such as biting and chewing—during a migraine attack, causing inflammation and dilation of blood vessels, two factors believed to contribute to migraine pain. Subsequent research showed a class of drugs called triptans could ease pain by inhibiting the release of CGRP.

Recently, pharmaceutical companies have developed antibodies designed to block or neutralize the effects of CGRP, says Patricia D. Scripko, MD, a neurologist at Salinas Valley Memorial Hospital in California, who founded and manages the hospital's headache program. For example, in a phase 2b trial of TEV-48125, an injectable antibody that binds to CGRP manufactured by Teva Pharmaceutical, patients reported significant decreases in the frequency of headaches just three days after receiving an injection.

Teva and three other pharmaceutical companies with their own antibodies—Eli Lilly and Company, Amgen, and Alder Biopharmaceuticals—are currently conducting phase 3 trials and hope to have results by early next year. “We're waiting to see if these therapies become options,” says Dr. Scripko. “It's a feeling of excitement mixed with skepticism and caution.”

Back to Top | Article Outline

DEVICES MAY HELP

Neuromodulation devices that target specific nerves implicated in migraines show promise in preventing or aborting migraines, says Dr. Tepper. Two have been approved by the US Food and Drug Administration and are available by prescription. One is the Cefaly headband, an external trigeminal nerve stimulator that sends targeted electric pulses to the trigeminal nerve through an adhesive electrode attached to the forehead of the patient. Patients wear it for 20 minutes a day to reduce the frequency of migraines.

Another device, SpringTMS (transcranial magnetic stimulation), creates a mild electrical current that can interrupt the abnormal electrical activity in the brain associated with migraine. Patients hold the device at the back of their head and press a button.

“It's a hopeful time in migraine treatment,” Dr. Tepper says. “We're on the verge of having all sorts of devices and drugs to help people with migraines take back their lives.”

© 2016 American Academy of Neurology