DALLAS – If you’ve never had a migraine headache, says Mel Pokorny, you just can’t imagine what it’s like. “It’s indescribable to most people,” says Pokorny, who’s suffered from migraines for more than 30 years. “You can hear the blood rushing through your head. You start seeing spots in your vision and within a few minutes you’re throwing up.” Still, the malady isn’t always apparent. “You can’t see a headache, and that makes it harder for people to understand how debilitating a migraine can be,” says Suzanne Simons, executive director of the National Headache Foundation. “For many years, physicians as well as many people thought people with migraines were just complainers, or didn’t handle stress well, or just wanted to get out of doing something.” These days, people know better – but not enough of them. Dr. Stephen Herzog, a neurologist at Baylor University Medical Center at Dallas, says that out of about 28 million Americans who suffer migraines, “only 10 million are properly diagnosed and only 4-5 million are properly treated.” Despite major advances in recent years, Herzog says, “There’s probably no disorder that’s as misunderstood and misdiagnosed and mistreated as migraine.” To try and clear that up, here are a few basics: Migraine, says Herzog, is a “chemical disorder of the brain, like diabetes is a chemical disorder of the pancreas. Ninety percent of the time it’s hereditary.” The pain is caused when blood vessels become dilated and inflamed, which can last a few hours or a few days. Depending on the severity, the pain can be accompanied by nausea and vision problems, plus extreme sensitivity to light and sound. That can happen once a week or once a year. Though migraine is a chronic condition, headaches are often caused by triggers that vary from person to person. They can range from certain foods to stress, menstrual cycles to changes in the weather. Treatments include preventive medications and lifestyle changes to ward off migraines, as well as medications – and actions – that minimize attacks when they occur. The bad news, Herzog says, is that the condition has no cure. The better news is that there has been an “explosion of science to understand migraines and new medications to target them.” Proper treatment for migraines usually starts at a neurologist. That’s what Nancy Christy finally did about 15 years ago after suffering headaches for most of her life. “I just thought it was normal all those years, and I just learned to function with it,” says Christy, 60, who lives in Dallas. “But they were getting worse.” So with her doctor’s help, she says, “I began to get educated, and I began to take control of this.” Taking control, Herzog says, begins with a comprehensive history: tracking when headaches occur, charting the patient’s eating and lifestyle habits. Then comes a process of trial and error: ruling out possible triggers, testing which medications may help, making changes ranging from losing weight to getting more sleep. “It can take months to sort out, and it can involve some work for the patient, but we can do more than ever before both in acute treatment and preventive therapy,” Herzog says. Christy, a potter who does ministry work in her church, has made a lot of changes during the years. She lost a lot of weight, worked on relaxation techniques and learned to watch out for too much sugar, red wine and MSG, among other things. “I’m much better and much smarter than before,” she says. “I couldn’t make it without the preventive medicine, but I function real well. I don’t let it become an all-consuming deal.” Pokorny, a 51-year-old empty-nester who’s a student at the University of North Texas, took a similar approach – without medication. After years of taking painkillers, she says she didn’t want them in her system anymore. So she worked at relieving stress and learned what to do when she feels a migraine coming on: ice packs, a dark room and relaxation. “If I don’t catch mine right at the beginning, I can be down for a couple of days,” she says. “But you learn what works for you and what you need to do. I have it down to about six a year.” Herzog and Simons are optimistic about the prospects for making progress against migraines. The battle rages on many fronts, from research into brain chemistry to drugs developed for other uses that may be effective in controlling migraines. Baylor is one of 60 sites around the country studying the phenomenon that when some people have a small hole in their heart called the patent foramen ovale repaired, their migraines go away. In the meantime, Simons says, the message should be clear: “People who have migraines don’t just have to suffer. We want them to know there is something they can do.”