Magazine article Drug Topics

Latest Advances Deliver a Blow to Migraine Pain

Magazine article Drug Topics

Latest Advances Deliver a Blow to Migraine Pain

Article excerpt

Headache may be the No. 1 excuse for avoiding many of life's inconvenient chores. But for the 23 million migraine sufferers, the pain in the brain is a "syndrome" of episodic, violent, throbbing, and unilateral headaches, accompanied by nausea, vomiting,and sensitivity to light or sound.

So declared Peter J. Goadsby, M.D., Ph.D., DSc, FRAcP, consultant neurologist at the Institute of Neurology, The National Hospital for Neurology & Neurosurgery, London, during a recent teleconference sponsored by Zeneca Pharmaceuticals, Wilmington, Del. Goadsby spoke along with Stephen D. Silberstein, M.D., FACP, chief of the section of neurology and codirector of the Comprehensive Headache Center, Germantown Hospital & Medical Center, Philadelphia, to reveal the latest advances in migraine treatment.

Therapeutic agents used in acute attacks to "stop the headaches" are divided into specific and nonspecific categories, with analgesics falling into the latter slot. Agents such as aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs "work on any sort of pain and, not surprisingly, reduce some migraine problems," acknowledged Silberstein. Despite their widespread use, however, only a few "state-of-the-art clinical trials" are available documenting use of these therapeutic classes in migraines, according to the new edition of the Blue Books of Practical Neurology, Headache (co-edited by Goadsby and Silberstein). Ergot alkaloids, which are specific compounds used to prevent or abort migraine attacks, supposedly lack such trials altogether.

Imitrex (sumatriptan, Glaxo Wellcome), a selective serotonin (5-HT,) receptor agonist, was introduced in 1991 and has recently become "approvable" in a nasal spray formulation. The drug is claimed to be the only antimigraine compound with both scientific support for efficacy and recommendations on use. Falling into the specific category, the triptan "won't turn off tooth or sinus pain but will turn off migraine pain," noted Goadsby. Sumatriptan activates the 5-HT^sub 1^ receptors, producing cerebral vasoconstriction, an action correlating with relief of migraines.

But Silberstein believes that "blood vessels are just innocent bystanders pushing against raw tender nerves" that produce the sensation of pain in the first place. …

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