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UCLA neurologist says docs doing a 'miserable job' treating migraines among low-income patients

Aspirin, pictured above, isn't much use to folks who are in the midst of a migraine, which can include symptoms of fatigue, nausea, neck pain and blurred vision, to name just a few. The most well-known symptom, of course, is the throbbing, violent headache.
Aspirin, pictured above, isn't much use to folks who are in the midst of a migraine, which can include symptoms of fatigue, nausea, neck pain and blurred vision, to name just a few. The most well-known symptom, of course, is the throbbing, violent headache.
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In the heart of South Los Angeles, surrounded by the clamor of a strip mall, is Mirta Orellana's hair salon.

She's been a stylist for 16 years, but in all her years of cutting, curling and coloring what's on top of other people's heads, she hasn't found a way to deal with what's happening inside hers: migraines.

"Even when I walk, I feel the pounding on my head," she says. "By walking, moving my head when I turn to the side, it feels like the whole head is going to break."

Orellana is one of the estimated 28 million Americans who suffers from migraine headaches, and has been for about a decade. Sometimes they last for days. As a 37-year-old working single mother of two, she can't just take a day off. As she washes the hair of a friend in her salon, she says she just has to power through it.

"Sometimes what I do is, if I don't have any clients, I go to the back and lay down for a while," she said. "That's the only time I can take for myself to relax. And sometimes I just take a towel with ice and put it on my head, or take some pills, have some tea, to relax. That's about all I can do over here."

The "perception problem"

A recent poll from Research!America shows that only 18 percent of the more than 1,000 respondents named chronic pain as a major health problem in the United States. That same poll showed that 60 percent of respondents believed chronic pain "tends to be dismissed by doctors and the public."

Dr. Andrew Charles, a professor of neurology at UCLA's Geffen School of Medicine and the director of the school's Headache Research and Treatment Program, said that's part of the problem with migraines.

"There's still a public perception problem of it as just a headache," he said.

Which is only part of what happens when someone gets a migraine: There can be fatigue, mood swings, neck pain, nausea, blurred vision, trouble with speech, tingling or numbness on one side of the body or sensitivity to any sort of sensory stimuli. And then, of course, the "throbbing, one-sided headache," said Charles.

"This is what's confusing about migraine, is that it can be moderate in severity and have fairly subtle symptoms for some people, and yet for others, it's absolutely devastating, incapacitating pain," said Charles. "And then things like nausea and vomiting just completely take them out of their ability to function."

For some people, it may last several hours; for others, it can drag on for days. It's not uncommon for them to strike twice a month, and while that may not sound very frequent, said Charles, it certainly doesn't feel that way to the person with the migraines.

"It's true that it's intermittent," he said. "But two days a month over a lifespan is a pretty significant percentage of your time spent incapacitated."

Migraines in South L.A.

Migraine headaches are still largely a mystery to doctors. A recent study appearing in the journal Radiology is just one of the latest attempts to explain why some people are prone to this debilitating condition. It concluded that in the brains of people who get migraines, the areas that process pain tended to be thinner and have less surface area.

In other words, researchers found a potential physiological indicator in the brains of people prone to migraines.

But like other migraine research, this study only adds another clue fragment to a heap that still hasn't pinpointed what's behind the condition: Is it driven by diet? Genetics? Stress? Changes in sleep patterns? Whatever the cause, the cost of medications that can offer many people at least some relief – like Imitrex or Amerge – adds up pretty quickly. That's true even for people with health insurance, meaning those who are uninsured and pinching pennies to make ends meet are in an even tougher spot.

"We're really doing a miserable job in terms of treating patients with migraines in underserved areas," said Charles. "This is, again, part of the public perception that migraine is not a significant problem: It's just a headache. There isn't the recognition that it's a major cause of disability."

Mirta Orellana is uninsured. When she had health insurance, she was prescribed Topamax, a daily medication that can prevent migraines. It's generally effective and comes with few side effects. But it upset Orellana's stomach, so she stopped taking it.

Doctors would advise against what she did next.

"I would just take anything that people would tell me to take," she said. "Or if any friend would have any leftover pills for pain, they would pass them to me and I would take them."

That was a bad idea. The pain would ease, but the next day, it would come back even stronger. Orellana said she even went to Tijuana to buy pills. Now she's under a doctor's supervision at St. John's Well Child and Family Center in South L.A., but she still gets headaches. She's still not cured.

"It gets me mad," she said. "Not to feel normal, just one day."

There’s some good news: Several top migraine medications – the “triptan” drugs – are now available as generics. That includes Maxalt, a generic version of which came onto the market just this year. But even the generics can cost as much as $10 per pill; a prescription pack is often $100 or more.

For now, Orellana is resigned to working around the crippling headaches. As she continued washing hair in her salon, Orellana said she realizes the work she does "looks simple."

"But it's just frustrating when you're in pain," she said. "I try to avoid music. I'll just concentrate on what I'm doing and try to do my best to satisfy the client and not think about the pain, because it's worse when you're thinking about it."

That resilience will come in handy until someone figures out how to cure her migraines – or at least soothe her pain.