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Migraine Treatment Getting Easier to Take


WebMD Health News

June 27, 2000 (Montreal) -- Some migraine sufferers are at the end of their ropes. It's not so much that the medicine doesn't work, it's just that they can't bear the taste of the tablets or can't swallow them, or just can't keep them down. And then there are those who don't experience the relief they'd hoped for from the drug.

So what's new in migraine therapies? Not much, at least in the way of new medications. But newer, easier-to-take forms of existing treatments may offer significant relief to migraine sufferers, reported several researchers at the 42nd annual scientific meeting of the American Headache Society.

Teen migraine sufferers in particular may benefit from the nasal formulation of Imitrex, says A. David Rothner, MD, from the Cleveland Clinic. In a long-term follow-up study, 70-80% of patients taking either a 10 milligram or 20 milligram dose of Imitrex nasal spray experienced significant relief from migraine.

Additionally, teenagers don't seem to avoid taking the medication, because "kids like to put things in their nose," says Rothner in an interview with WebMD. "They like it better than pills and they like it better than shots." He points out that one of the best things about the drug is that it did not seem to lose its effectiveness over time, as is seen with some migraine treatments.

Although the main side effect is the bad taste of the medication -- it can be tasted at the back of the throat even when sprayed up the nose -- "kids are pretty good at learning to mask it, probably better than the drug companies. Lemon drops seem to work very nicely," Rothner says.

He emphasizes, however, that treatment for migraine is highly personalized, and that it's important to match the drug, the dose, and the way it is taken to the needs of the child and the family. Therapy with the stronger migraine treatments may be appropriate for more severe and persistent migraines, but mild migraines are often effectively managed with Advil or Tylenol and rest, he notes.

For those who don't mind oral medications, two companies are rolling out oral forms of the triptan group of migraine drugs. These drugs promise to do for migraine therapy what M&Ms did for chocolate -- melt in the mouth. Merck's fast-dissolving version of Maxalt MLT, now on the market, is peppermint-flavored, and AstraZeneca's Zomig, awaiting FDA approval, will be orange-flavored, representatives of the two companies tell WebMD.

Both pills are designed to dissolve on top of the tongue rather than under it. The primary advantage of the new oral formulations, say researchers, is that they can be taken without water, which may be helpful for patients who have trouble swallowing pills without it, or for those whose migraines are accompanied by nausea and can't keep anything down.

But when it comes to how well these drugs work, the melt formulations are comparable to, but no better than, tablets.

"The benefit of the drug is in reducing pain. That does not mean pain-free -- it's ... very similar to Zomig tablets," says Allan Purdy, MD, professor of medicine at Dalhousie University and chief of neurology at Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia.

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