Slowly conquering migraine

People's Pharmacy

March 10, 1998|By Joe Graedon and Teresa Graedon, Ph.D. | Joe Graedon and Teresa Graedon, Ph.D.,SPECIAL TO THE SUN King Features Syndicate

Imagine a headache so severe that you can barely stand it. Migraines produce nausea, sensitivity to light and misery so intense that many victims have been driven to seek refuge in a dark room until the attack passed. That often took hours to days.

Classical migraines, with bizarre visual symptoms and one-sided pain, have been familiar to medicine for centuries, but until recently treatments were limited. Many migrain sufferers abused over-the-counter medications to ease the pain. Others turned up in emergency rooms begging for narcotics to relieve their anguish.

Physicians frequently prescribed ergotamine in an attempt to abort an attack, but side effects and dosage limitations made this therapy less than ideal for many.

New medications that have only recently become available are revolutionizing the management of these horrible headaches. Now migraine sufferers have such a range of options it may be confusing to sort out all the possibilities.

Imitrex (sumatriptan) was the first of this new generation of "triptan" migraine medicines that work by affecting receptors for the neurochemical serotonin. Scientists believe that when they cause blood vessels in the brain to contract, migraine pain is alleviated.

When Imitrex first became available early in 1993, patients had to inject it themselves. At least half reported excellent relief within 30 minutes, and 80 percent had responded within two hours. But Imitrex was used more widely after it became available as a pill.

Now there are additional prescription medications similar to Imitrex. The Food and Drug Administration has recently approved Zomig (zolmitriptan) and Amerge (naratriptan). Both pills appear very effective against migraines and provide relief within two to four hours for approximately two-thirds of the patients tested. Headache recurrence may be less common with naratriptan.

All of these drugs have the potential to cause some side effects. Imitrex should never be given to anyone with underlying heart disease or high blood pressure. Spasms of the coronary arteries have occurred in some patients and can be very serious.

Side effects such as chest pressure or tightness and sensations of warmth, cold or tingling seem more common with Imitrex. Dizziness, drowsiness or fatigue may occur with triptan-type compounds, but overall these medications are generally well tolerated.

Imitrex is now also available in a nasal spray formulation. This has advantages for people whose migraines make them feel extremely nauseated.

Another new prescription nasal spray for migraine is Migranal (DHE or dihydroergotamine). This drug is rapidly absorbed and begins acting within 15 minutes. Irritation of the nasal passages and an unpleasant taste may discourage some patients, however.

Other compounds may also prove useful. Rizatriptan and eletriptan are both awaiting FDA approval. And researchers are investigating the use of high doses of riboflavin (vitamin B-2) as a preventive strategy.

Write to the Graedons in care of The Baltimore Sun, 501 N. Calvert St., Baltimore, Md. 21278, or e-mail to pharmacindspring.com.

Pub Date: 3/10/98

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