Why Migraine Treatment Sometimes Fails
Triptan Therapy Effective Only If Given Early During the Migraine Attack
Nov. 7, 2003 -- The success or failure of migraine treatment
with the most commonly prescribed migraine medications may depend on
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
"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
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
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.