Migraine sufferers may get new relief Lidocaine nose drops show promise of help with fewer side effects

July 24, 1996|By NEW YORK TIMES NEWS SERVICE

For years, people with migraine headaches faced a difficult choice: They could resign themselves to being incapacitated, or they could take a drug called sumatriptan that has serious side effects. But the choice should get easier soon because safer drugs are showing promise of relief for migraines.

The biggest surprise was the discovery that the fastest, safest relief yet documented for migraines comes not from one of the many new drugs that are under development but from a veteran painkiller called lidocaine, perhaps best known as the drug dentists inject before root canals and as the painkiller in some over-the-counter sprays and lotions.

In a study being published today in the Journal of the American Medical Association, 55 percent of the migraine sufferers who used lidocaine nose drops felt better within five to 15 minutes, compared with 21 percent of patients given a placebo.

"This is very impressive information," said Dr. Alan M. Rapaport, director of the New England Center for Headache in Stamford, Conn., who was not involved in the research. "Relief in five minutes is dramatic, almost unbelievable."

Migraines are severe headaches that regularly affect 17 percent of women and 6 percent of men. Most sufferers get, on average, three migraines each month, with symptoms including nausea and extreme sensitivity to light.

The latest study was conducted by Dr. Morris Maizels, a family doctor and longtime migraine sufferer who practices at the Southern California Permanente Medical Group, a health maintenance organization in Woodland Hills, Calif.

Maizels found that lidocaine nose drops, used to treat cluster headaches for more than 10 years, were effective for his migraines, so he put them to the test in a double-blind controlled study.

His research included 81 migraine sufferers at the medical group's urgent-care department. Of the 53 patients given lidocaine nose drops, 29 said their symptoms had diminished by at least 50 percent within 15 minutes.

Twenty-four of those patients were followed for a day, and the pain did not return for 13, or 55 percent. The pain did return for others, usually within one hour.

Although the speed with which the relapse occurred is a serious drawback, the frequency of the relapses -- about 40 percent -- was comparable to that seen with sumatriptan, Maizels said.

He said it was too early to recommend lidocaine drops for treating migraines because larger studies were needed. The drug is not approved for this purpose by the Food and Drug Administration.

Further relief is anticipated from seven new drugs that are being considered or are about to be considered for FDA approval.

Unlike lidocaine, which is thought to work by deadening a cluster of facial nerves, these new drugs are designed to cure headaches by increasing serotonin levels, a neurotransmitter believed to promote migraine pain when its level dips too low.

Each of the new drugs, said Rapaport, who has studied some of them, is expected to be better than sumatriptan for one or more of the following reasons: causing fewer side effects, acting faster or lasting longer.

The first are expected to be on the market in six to 18 months.

Pub Date: 7/24/96

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