Magazine article Drug Topics

Head Pain

Magazine article Drug Topics

Head Pain

Article excerpt

A new oral remedy straight out of the triptan-packed pipeline and a couple of quick-acting nasal sprays offer an extended line of defense for patients pounded by painfully throbbing migraine attacks.

Manufactured by IPR Pharmaceuticals, a subsidiary of Zeneca Pharmaceuticals, Zomig (zolmitriptan tablets) is the second-and certainly not the last-triptan to hit the market for the treatment of acute migraine with or without aura. The selective oral 5-HT^sub 1B/1D^ receptor agonist was spotlighted recently at a Zeneca-sponsored teleconference on the latest developments in the treatment of the neurologic disorder.

Zolmitriptan's pharmacology was discussed by David Goodale, M.D., who noted that the agent produces cranial vasoconstriction and inhibits the release of neuropeptides-substances that produce inflammation of the surrounding cerebral blood vessels. The actions are thought to bring symptom relief. In addition, Goodale, a senior medical director at Zeneca, referred to preclinical animal studies that suggest a central inhibition of pain signals.

So how much help can the new triptan provide? Results of five placebocontrolled trials indicate that zolmitriptan provided relief from moderate or severe headache pain two hours after treatment significantly more often than placebo and maintained efficacy over a 24-hour period. Reductions in analgesic use and in migraine-associated symptoms, including photophobia, phonophobia, and nausea, were noted as well. In long-term studies, zolmitriptan demonstrated similar results in treating multiple migraine attacks for up to one year.

Apparently, the drug displays similar activity in the harder-to-treat, menstruation-associated migraines. This subtype is known for being particularly resistant to treatment. Elizabeth Loder, M.D., teaching professor, Harvard University and Medical Center of the Spauding Rehabilitation Hospital's pain management program, disclosed that "zolmitriptan response rates did not differ significantly in women experiencing menstrual migraines or oral contraceptive-related migraines, compared with those suffering from the Rarden variety migraines."

Patients categorized as poor responders to other treatments, including sumatriptan (p.o. and SQ), aspirin, nonsteroidal anti-inflammatory drugs, and ergotamine preparations, appeared to benefit from zolmitriptan as well. When given oral doses of 2.5 mg and 5 mg, these individuals experienced headache response rates ranging from 54% to 89% and 67% to 70%, respectively, compared with a 21% to 35% placebo response rate. "I think the bottom line is that people are different with individual responses, so don't make the mistake of assuming that it's not worth trying another triptan in a patient who has not responded to sumatriptan," said Loder. …

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