Monica Seles aims to ace migraine pain.

By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Tennis champion Monica Seles has won nine Grand Slams and 53 singles titles during her career. But the sweetest victory has been beating migraine pain.

"I started getting migraines when I was about 15 or 16," says Seles, 30. "As a teenager I didn't know what was wrong really so I went undiagnosed for about seven years. There's nothing worse. If you haven't had a migraine, I don't think you understand how bad they are."

But approximately 28 million Americans do know - they too suffer from migraine headaches.

Of these, an estimated 70-80% of sufferers have a family history of migraine.  Three times as many women suffer migraines. Onset occurs most frequently during reproductive years - from the age of menarche to menopause. About 50% of female migraine sufferers get a migraine immediately before, during or right after menstruation.

Migraine attacks typically last from four to 72 hours.

And migraines are also painful to the US economy. According to a 1997 study, migraines cost American business approximately $13 billion a year in direct and indirect costs, including decreased productivity and absenteeism. 

Because it is estimated that about 52% of migraine sufferers are still undiagnosed, getting effective treatment is essential.

"I want to help people understand that they don't have to suffer like I did," says Seles, who is now a paid spokesperson for GlaxoSmithKline, manufacturer of the migraine drug Imitrex. "Getting diagnosed is one of the biggest hurdles."

Migraine is defined as a moderate to severe headache that occurs episodically at a frequency of one to three times per month. It is a pounding or throbbing pain that gets worse with activity and can involve nausea and vomiting.

"Sixty percent of the time the headache is on one side of the head," says David Kudrow, a neurologist and director of the California Medical Clinic for Headache. "Forty percent of the time it is on both sides."

Approximately 10-15% of the time a migraine is preceded by a visual aura - a colorful crescent-shaped shimmering display -- that usually moves from the center of the field of vision to the periphery. After the aura ends, the migraine typically erupts. Other precursor symptoms, known as a prodrome, can include ringing in one or both ears.

Scouting report

The symptoms Seles describes having are classic migraine headache.

"I get a pounding headache, especially on the left side," Seles explains. "I get very sensitive to light and noise - noise is a big one for me so I'd keep the room dark and completely quiet."

Experts believe that migraine occurs more in women because of fluctuations in estrogen. These changes in estrogen seem to trigger migraine activity.

Other triggers include:

• Changes in circadian rhythm - sleeping too much or to little
• Fasting, dieting or hunger
• Alcohol
• High altitude
• Loud noises
• Odors
• Excessive stress

"It was not one circumstance for me," Seles says. "The headaches would come when I was playing a tournament or meeting friends for dinner. They can be around my cycle. I never knew why one would start.  If I got one, I just couldn't do anything. I couldn't go out with my friends. Nothing."

But migraines don't just interfere with a person's social life. They can have a profoundly negative affect on careers and livelihoods.

"It really interferes with your life," Seles says. "Not knowing when a migraine will strike is really a problem for me on the tour.  I can't afford to spend the whole day in a dark room feeling terrible."

Especially when she had a match to play.

"I had to withdraw two times in 1996 because of the migraines," Seles says. "I am a pretty private person so I never said why. I've played with a migraine a few times and it was terrible - it feels like your head is going to explode."

Ironically, while her father was in the hospital in 1997, Seles was finally properly diagnosed with migraine. For Seles her diagnosis enabled her to begin taking new class of migraine-specific drugs called triptans.

Advantage Seles

"I started taking Imitrex in late 1997," says Seles. "I wouldn't do this awareness campaign if I didn't use it and know how well it has worked for me. This medicine has really saved my sanity."

Triptans work by binding to the receptors at the ends of the nerve terminal and preventing the release of inflammatory neurochemicals which cause dilation in blood vessels. This inflammation and dilation process is believed to cause migraine headache pain.

There are several triptan drugs available which can be administered orally, by nasal spray or by subcutaneous injection. While Seles takes oral medication which can take two hours to work optimally, Kudrow says the most efficient way to treat a severe migraine is by injection.

"This delivery system works within 20-30 minutes and is especially advantageous for someone who is nauseous and vomiting and can't swallow a pill or keep it down," explains Kudrow, who is an independent headache expert not affiliated with the Seles campaign.

Kudrow also notes that while triptans work better if the migraine sufferer treats their headache early, they still work if taken after the onset of the migraine.

"It works better if taken when the person feels the headache coming on," Kudrow says. "This is ostensibly because they are treating the migraine at a stage when the nerve cells that are active are more receptive to the medication."

Some triptan side effects are:

• Feeling tired following an injection.
• Chest pressure or pain
• Tightness in the throat

Most people who have heart disease, history of stroke or uncontrolled blood pressure should not use triptan medications.

For Seles a new 'headache' may come sooner than expected. She will be facing off against Martina Navratilova on March 22.

"I'm looking forward to playing again," says Seles, who missed much of the women's tour last year due to a foot injury. "We'll see how it goes."

She's also hopeful she can help fellow migraine sufferers find some relief.

"Everyone is different but if you're experiencing symptoms you have to see a doctor and find out," Seles says. "There is help and you can go on about your life. The solution is simple. You don't have to suffer. I can't believe how many days of my life I wasted where I was in a dark room and made everyone leave me alone."

For more information on migraine, click here

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 3/14/2004  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 3/14/2004  -  Donnica Moore, M.D.