Why Migraine Treatment Sometimes Fails

Nov. 7, 2003 -- The success or failure of migraine treatment with the most commonly prescribed migraine medications may depend on timing.

New research shows that in order for triptan-based drug therapy to work effectively in relieving migraine pain, the drugs must be taken early during the migraine attack before the development of exaggerated skin sensitivity, a symptom often seen in migraine sufferers. If the drugs are taken after this sensitivity develops, the triptans may be rendered powerless against the migraine pain.

Researchers say the findings may help explain why some migraine sufferers simply can't seem to find relief from treatment with the drugs in this class, such as Imitrex and Zomig. By educating doctors to look for signs of skin sensitivity in migraine patients, they can instruct patients to take the drugs early and may be able to improve the effectiveness of these drugs.

"Doctors can then instruct those patients to take triptans early in the attack, rather than delay treatment until the headache has reached a moderate-to-severe level," says researcher Rami Burstein, PhD, of Beth Israel Medical Center and Harvard Medical School, in a news release.

Timing Critical in Successful Migraine Treatment

Researchers say triptans have become extremely popular in migraine treatment since they were introduced a decade ago. But many doctors do not understand why the drugs work well in some patients and not at all in others and why their effectiveness varies in individual patients from one migraine attack to the next.

Two studies published in the Nov. 7 advance online edition of the Annals of Neurology suggest that the success of migraine treatment with triptans is related to the skin sensitivity symptom commonly found in migraine sufferers. This symptom, known as cutaneous allodynia, occurs in about three-fourths of migraine suffers and frequently affects the skin of the face and neck, making even mundane activities like brushing one's hair or shaving extremely painful.

In one study, researchers compared the outcome of triptan therapy in resolving 34 migraine attacks associated with this symptom at the time of treatment with the outcome in 37 attacks that were free of this symptom at the time of treatment.

The study showed that when the drugs were given before the skin sensitivity symptom developed, the migraine pain stopped. But the drugs had little effect on easing migraine pain when given after the symptom developed.

Researchers say that in the early stages of migraine, nerve cells in the brain become sensitized and eventually lead to skin sensitivity. Once those nerve cells are stimulated, it's hard to keep them in check.

But in the second study, an animal test showed that if triptans are given at the first sign of a migraine the drugs could stop the activity of these nerve cells before they become sensitive.

Researchers say if more studies confirm these results, new migraine treatments may be developed to inhibit the activity of these nerve cells even after they are stimulated.