Promising anti-migraine drug only as good as the diagnosis


November 15, 1994|By Joe Graedon and Dr. Teresa Graedon | Joe Graedon and Dr. Teresa Graedon,King Features Syndicate

Migraine headache pain can be excruciating. People who have never suffered the agony of such an attack have no inkling what it's like to be incapacitated for hours or days.

Judy is a high-powered executive who has climbed the corporate ladder through hard work and her personable style. The only thing that has prevented her from rising to the very pinnacle of her company was the attack that would strike out of the blue, overpowering her with nausea, incredible pain on one side of her head, and an inability to tolerate bright light. She attempted to work through the pain, but sometimes had to retreat to a darkened room to try to ride out the migraine.

Many of the medicines Judy's doctor prescribed caused unacceptable side effects for her. When a new self-injectable drug called Imitrex (sumatriptan) became available, it really changed her life. At the first sign of a migraine, she could treat herself and get back to business.

Imitrex has helped revolutionize migraine therapy, but it is still not completely clear how it works. This drug affects a specific receptor for the neurotransmitter serotonin and causes constriction of blood vessels in parts of the brain. This action may be one way the drug relieves migraine pain within minutes.

Imitrex has achieved extraordinary success. It has been used by 1 1/2 million people for 30 million migraine headaches. Despite this record, Imitrex is not for everyone.

There have been a number of serious adverse reactions and some deaths associated with Imitrex. Part of the problem is that a migraine can sometimes be difficult to diagnose. If the medication were used to treat a headache caused by a stroke or some other brain condition, the results could be disastrous.

Anyone with a history of heart disease or who has had symptoms such as chest pain must not use Imitrex. Cases of people experiencing potentially life-threatening heart rhythm changes have been reported.

The biggest challenge for physicians and patients is determining who can take the drug safely and who is at risk. People with no symptoms of coronary artery disease may still have substantial blockage, which could pose a serious hazard. A family history of heart problems or any unusual symptoms (palpitations, dizziness, shortness of breath) should raise a red flag of caution.

Imitrex can interact in a dangerous way with certain anti-depressants, including Marplan (isocarboxazid), Nardil (phenelzine) and Parnate (tranylcypromine). If you are taking one of these medications, be sure to alert your doctor.

Even a revolutionary new medicine like Imitrex can cause major trouble for some people. Although millions may benefit, doctors must be well informed about migraine diagnosis, proper use and risks.

Q: My girlfriend takes a lot of Tylenol for tension headaches. She also likes to unwind after a stressful day at work with a couple of beers or a cocktail. I have read about a case of liver damage when someone mixed alcohol and Tylenol. Is this a problem?

A: Combining alcohol and acetaminophen (Anacin-3, Tylenol, Panadol, etc.) is not a good idea. An occasional drink is probably not a problem, but regular alcohol consumption can make big doses of acetaminophen toxic to the liver.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.

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