Dr. Cynthia Collawn, chief resident at Sinai Hospital, was ready to begin her 36 hours on call recently when she was struck by one of the disabling migraine headaches she has suffered since she was a teen-ager.
The pain had started, as usual, above her right eye and traveled to the back of her head. She curled up in a ball of pain in a dark corner of the hospital's emergency room, a bandanna pulled tightly around her forehead, hoping for a partial recovery from an injection of a strong prescription drug.
Instead, Sinai neurologist Howard Weiss arrived with something better: sumatriptan, the newest weapon against migraines. Ten minutes after the injection,Dr. Collawn's hideous migraine was gone.
"I couldn't believe it," the 30-year-old physician recalls. "I got up and did my 36-hour call without any problem."
Eagerly anticipated for several years, the drug sumatriptan, sold under the name Imitrex, has been helping migraine sufferers since its March release in the United States, local physicians say. It has been used in England and Holland for two years and in Canada for more than a year. Currently, it is only available in the United States by injection.
(It is also available for children under the age of 16, although its safety and effectiveness have not been formally tested.)
Even as they praise its general efficacy, physicians caution that it will not work for everyone."The hype is that this is the solution to migraines. It is a step in the right direction, but it's not the answer. It won't prevent headaches," Dr. Weiss says.
But it may prevent many people from having to miss work. A 1992 study funded by Glaxo Inc., the manufacturer of sumatriptan, estimated that migraine headaches cost U.S. employers more than $5 billion a year in lost labor costs.
Sumatriptan acts by stemming the dilation of blood vessels in the brain that cause the painful headaches. Non-narcotic, it may be used safely once or twice a week, according to the American Council for Headache Education (ACHE).
Formerly, migraine sufferers tended to use an ergotamine derivative -- effective for many patients, but often causing nausea -- or a narcotic analgesic such as Demerol.
A costly condition
Improved relief does not come cheaply. With sumatripta costing as much as $35 per injection, Dr. Weiss calls it "a designer drug."
"The cost still beats missing a day's work," he says. "But for those patients who get one or more migraines a week, sumatriptan is clearly not the answer."
Dr. Joel Saper, chairman of the American Council for Headache Education and director of the Michigan Headache and Neurological Institute, credits the publicity about sumatriptan for focusing attention on headaches.
He calls the headache a misunderstood condition affecting roughly 40 million Americans as well as "a massive public health care problem of women."
Migraine is a condition that includes not only headache but nausea. It can also produce such neurological symptoms as numbness or tingling in hands, blurred vision, slurred speech and difficulty maintaining balance. Headaches are usually severe, with throbbing pains on one side of the head and other symptoms such as nausea, vomiting and sensitivity to light and sound.
Typically lasting six to eight hours, these headaches can continue for a couple of days. Some people suffer from several migraines a month; others may have one a year. Some migraines require hospitalization, especially if the accompanying nausea has caused a patient to become dehydrated.
Although no one is sure what causes migraines, some people are born with a higher chance of developing them, perhaps because they have inherited a disturbance of some chemical or nerve activity in the brain, according to ACHE. Most people who suffer from migraines have a parent or close relative with the condition.
However, it can sometimes be brought on by a head trauma like a whiplash injury.
Women suffer most
Roughly three times as many women as men suffer from migraines -- a fact that has kept the illness undervalued and understudied, according to Dr. Saper.
Researchers have found that women's monthly fluctuations in estrogen are a factor in triggering the illness. Dr. Saper says that estrogen affects serotonin, a chemical messenger in the brain that controls the dilation of blood vessels. Serotonin is a key player in such brain-based disorders as depression and sleep disturbance as well, he says. And research suggests it may play a part in the eating disorder anorexia nervosa.
During the past decade, medical interest in headache has increased dramatically. There are 10 headache centers of national scope, 25 regional centers and "who knows how many" physicians devoting large portions of their practices to the subject, Dr. Saper says.
"This growth follows the recognition that we're dealing with a bona fide illness," he says. "It's an area that has been abysmally treated."
Women's complaints about headaches have been particularly disregarded, he says.