New Drug Kicks 2nd Migraine Attack
Frova Offers Longer Relief Than Similar Drugs
June 25, 2002 -- Still seeking relief from those blasted migraine headaches? Your doctor now has another option, called Frova. It's been FDA approved for treatment of adult migraine attacks, and it can help prevent headaches from coming back -- at least in the short term, according to a study presented at the American Headache Society meeting in Seattle this week.
Frova is in a class of drugs called triptans, which includes Imitrex, Axert, Amerge, Maxalt, and Zomig. These drugs activate serotonin receptors. Serotonin is a brain chemical associated with pain and pleasure pathways. How these drugs work to relieve migraines isn't clear, but they do narrow the blood vessels in the brain and scalp, which may help reduce pressure on pain-sensitive structures, and they may alter the way the brain perceives pain.
Trouble is, up to one-half of people taking these drugs have a migraine recurrence within 24 hours.
"You're dealing with an attack that wants to lurk around for 24 hours, so when the drug wears off, the attack's back," says study author Jan Brandes, MD, a clinical instructor of neurology at Vanderbilt University School of Medicine in Nashville.
The difference with Frova is how long it stays in your bloodstream, says Brandes. Frova stays in the body for 26 hours, which is usually long enough to abort another headache. In fact, "if the first attack doesn't go away immediately, patients can take another dose at two hours and can use up to three tablets in a 24-hour period," she tells WebMD.
In five randomized studies involving more than 4,000 patients, Frova significantly reduced migraine pain when compared with those taking a placebo. Patients also reported less nausea and sensitivity to light and sound. Headache recurrence rates were "consistently low -- 17%," Brandes says.
"Two-thirds of migraine patients were able to get to 'no pain' or 'mild pain' in four hours," she says. "That's pretty impressive, especially when you consider these patients had moderate to severe headaches. They were not treating mild pain. Imagine what the results would be if they were treating mild pain."
Other drugs can do that, but they have higher recurrence rates, Brandes says.
The drug is slow-acting at first, so it will likely work best for people who have a "slower rise time" -- their migraines take several hours to peak, Brandes tells WebMD.
"If you awaken with your migraine, you may have slept through the rise in pain," she says. "But those patients who wake in the morning with twinges or mild discomfort, they -- particularly if they have long attacks -- really benefit from it, since [the drug] doesn't kick in immediately. Those people are likely to be good candidates."
Women suffering from hormonally driven menstrual migraines -- which last for a longer period of time, making recurrence more likely -- may also benefit from Frova, she says. "There's no data yet, but there may be an advantage."
One percent of patients withdrew from the studies because of side effects, most of which were mild or moderate or transient, she says. Dizziness, fatigue, burning or prickling sensations, flushing, headache, dry mouth, hot or cold sensation, and chest pain were reported side effects.
"We just got the samples [of Frova] today, so we haven't had a chance to try it in clinic," says Paula Mendes, MD, a neurologist at the Diamond Headache Clinic in Chicago.
"We're excited to use it," she tells WebMD. "Every patient is different, and patients can respond to one triptan and not the other -- it's a matter of trial and error. ... A lot of doctors don't realize that they have to try different ones."