New therapies offer relief for longtime sufferers
For many of the nearly 30 million Americans who suffer from migraines, the standard treatments, such as over-the-counter and prescription medication, do not always provide relief.
Latest development: A variety of new, highly effective therapies are now available for migraines.
DRUG COMBINATION EASES MIGRAINE
Migraines cause moderate-to-severe pain that usually occurs on one side of the head. The exact cause of these headaches is unknown, but many experts believe that the attack starts in the brain, where pain receptors become activated when arteries widen (dilate) and become inflamed.
Sumatriptan (Imitrex) and similar drugs, known as triptans, affect pain receptors and constrict dilated arteries in the brain. These drugs are among the most effective treatments for migraine pain. However, triptans have little effect on inflammation of arteries in the brain, another component of migraines.
New approach: Combining sumatriptan with naproxen sodium (Aleve), an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The combination works better than either drug alone because it reduces arterial dilation and inflammation.
Scientific evidence: When Philadelphia researchers recently looked at 1,111 patients who experienced two to six migraines per month in the period preceding the study, about half of those given sumatriptan plus naproxen were pain-free within two hours, compared with about 16% of those given a placebo. This approach can be tried by combining any triptan with any NSAID, including ibuprofen (Motrin) or aspirin.
Caution: If you have a history of ulcers or stomach upset when taking NSAIDs, talk to your doctor before trying this approach.
HEART REPAIR REDUCES MIGRAINE RISK
Between the left and right chambers (atria) of the heart, there is an opening known as the foramen ovale that is present in all newborns. The foramen ovale, which aids in fetal circulation, normally seals shut in the first years of life.
In up to 18% of Americans, the opening doesn’t completely seal. This defect may increase risk for migraines — perhaps because small blood clots that normally would be dissolved in the lungs instead bypass the lungs and are pumped out of the heart, then into small blood vessels in the brain.
New approach: Surgical repair of the heart defect.
Scientific evidence: For several years, doctors have noticed that some patients who undergo surgery or catheterization (threading a small tube from the groin to the heart) to repair the heart defect reported fewer migraines. A study is currently under way to determine if this approach is an effective treatment for migraine in people who have the heart defect.
BETTER SLEEP PREVENTS HEADACHES
People who sleep poorly tend to get more headaches than those who sleep well. That’s because poor sleep alters the body’s natural biorhythms. Disturbed sleep is especially problematic for people with “transformed migraine” — a condition in which periodic migraines begin to occur on a daily or near-daily basis.
New approach: Counseling (from a primary care doctor or sleep specialist) to learn better sleep habits.
Scientific evidence: When researchers at the University of North Carolina studied 147 patients with transformed migraine, most had poor sleep habits, including watching TV in bed. Patients who received counseling on good sleep habits, such as adhering to a specific schedule for going to bed and rising, had a 29% decrease in headache frequency and a 40% decrease in headache intensity. Patients who did not receive such counseling did not improve.
MAGNETIC DEVICES QUELL PAIN
About 20% of migraine patients experience an aura, which may include visual symptoms (such as seeing zigzagging lines) along with other sensory changes, including tingling sensations in an arm or leg. In those patients, auras typically precede migraine pain by 20 to 30 minutes.
New approach: Transcranial magnetic stimulation (TMS), a technique involving the use of a handheld device that is placed against a person’s head and sends a magnetic pulse to interrupt the brain’s erratic electrical signals. TMS, which has been available only in hospitals, now is being investigated for home use. If approved by the FDA, the TMS device will be sold at pharmacies with a doctor’s prescription.
Scientific evidence: A recent study of 201 migraine patients found that 39% of those who used TMS were pain-free after two hours, compared with 22% in a control group that used a sham device.
NEW TRIPTANS ON THE WAY
Triptan drugs are available in tablets, injections and a liquid nasal spray. An injection of sumatriptan can stop a migraine in five to 10 minutes… oral and nasal forms work within 30 to 60 minutes.
The drugs aren’t perfect, however. Injections are inconvenient and uncomfortable, and the oral forms require relatively high doses, which can cause adverse effects, including high blood pressure. Nasal sumatriptan sprays work quickly, but are not widely used because they have an unpleasant taste and can cause gagging when spray residue drips into the back of the throat.
New approach: A spray powder that is administered to the nasal membranes. The powder is more easily absorbed than liquid spray and reduces drips into the throat.
Scientific evidence: A recent study found that patients using the powder form achieved maximum blood concentrations of sumatriptan in 20 minutes — a rate that is comparable to that of injections. The powder is being studied by pharmaceutical companies and could be available within a few years.
MIGRAINE MEDS FOR LESS
Generic versions of sumatriptan liquid nasal spray and injection, which are significantly less costly than the brand-name medication (Imitrex), are expected to be introduced this year. Generic sumatriptan tablets are slated to become available in 2009.