Migraine? Relief Is Heading Your Way
June 11, 2001 -- You don't have to grin and bear it if you suffer the periodic, throbbing headaches known as migraines. New treatments -- and new ways to avoid the triggers that set an attack in motion -- mean relief for the vast majority of people.
Even as drug companies and headache specialists race to find new treatments, nearly half of migraine sufferers -- and their doctors -- aren't using the most effective treatments available today. Older agents treat the pain that comes from migraines, while the newer agents treat the brain itself.
"I think the important thing is that 40% of people who could be helped by migraine-reversal medications or by preventive treatments are still using pain medicines," Seymour Diamond, MD, tells WebMD. "Doctors and patients must realize that there are more effective therapies available aside from pain medication." Diamond is director of the Diamond Headache Clinic in Chicago.
The new drugs are called triptans, marketed as Imitrex, Zomig, Amerge, and Maxalt. They don't reduce the pain of migraine; instead, they target molecules in the brain to help reverse the migraine process itself.
"The triptans are fantastic, really, and have made a terrific difference," headache specialist David C. Haas, MD, tells WebMD. "Eighty percent of patients respond to one of the triptans, although they may have to inject it or use a dissolving tablet if nausea is one of the early symptoms of their migraine."
But even triptans have their problems, notes Haas, a neurologist at State University of New York Upstate Medical University in Syracuse. They, too, have side effects. And their cost ranges from $13 for a low-dose Zomig tablet to $47 for a single injection of Imitrex.
An Ounce of Prevention
What would be best would be to prevent migraines from happening in the first place. And this is where the drugs of today fall short.
"The problem is today's migraine-preventive drugs -- they tend to be weak and have lots of side effects," Haas says. "So when people have very frequent migraines and can't take triptans that often, their doctors have to struggle just to cut down attacks by 50% a month. I would like to see better preventive medicines, something that affects the brain positively and reduces the brain's tendency to get migraines."
Lisa K. Mannix, MD, is a migraine researcher and headache specialist in private practice in Cincinnati. Like Diamond and Haas, she sees many patients whose migraines have proven difficult to treat.
"I see the tip of the iceberg, because the people referred to a specialist usually aren't doing well on their first or third or fifth migraine drug," she tells WebMD. "Approximately 2% of migraine sufferers are on a preventive medicine. But based on epidemiological studies of people missing work and having restricted activity due to migraines, it is estimated that 20% of these people need to be on a preventive. From my clinical experience, the majority of my patients are on preventive medicine, and all need it because they have very tough and very frequent headaches."
Mannix hopes that new migraine-preventing drugs will come out of new understandings of how the brain works.
"From the preventive standpoint, we now think you may be able to take some drugs already in the pipeline for other central nervous system conditions and modify them for migraine," she says. "For example, something in the epilepsy pipeline may have migraine applications."