Magazine article Drug Topics

The Migraine Menace

Magazine article Drug Topics

The Migraine Menace

Article excerpt

Acute and preventive treatments team up in the attack against these debilitating headaches

As a society that is generally more health conscious than ever before, we have come a long way from the days when, if it hurt, you grinned and took the pain. These days, hospitalized patients have no qualms about beeping the nurse if their postoperative pain medication isn't providing adequate analgesia. Men are no longer too brave to complain to their doctors about an aching back. Women are surely not shy about asking their physicians for relief from menstrual cramps. Yet, when it comes to seeking help for migraine attacks, the most debilitating type of headache, many sufferers remain in the dark ages.

Surprisingly, a large segment of people with migraine disorder do not seek medical care. Of the estimated 14 million patients who should be receiving some form of prescription medication for migraines, only 3.5 million actually get them. It has been estimated that approximately five million migraine patients experience disabling pain at least three days per month Although these individuals would make perfect candidates for preventive therapy, only one million of them receive it. A portion of the problem lies with health-are professionals, who are not asking patients the right questions about their headache complaints and so are often missing the diagnosis.

The other part of the problem rests with the patients. Most consumers attribute migraines to sinus pain or stress and self-treat with over-thecounter meds-excluding themselves from effective prescription therapies. They simply are not aware of the strategies available to them, "because they are too reluctant to admit that they have a disorder and get medical help for it," noted Stephen D. Silberstein, M.D., FACP, professor of neurology at Thomas Jefferson University and director of the Jefferson Headache Center. He considers this attitude of denial among many sufferers to be the biggest barrier to treating the migraine population effectively.

It's time to spread the word to your patients that migraine is not just an occasional headache that can easily be cured with a few Tylenol pills. It's a multi-symptom disorder of the brain with a physiological, rather than psychological, basis. And it should be treated as such. Advances in molecular biology, coupled with noninvasive imaging studies, have allowed researchers to see actual changes in the brain that occur during a migraine attack. The findings that have risen from these observations have resulted in numerous breakthroughs in the management of migraines. So what are some of the major developments in the treatment and prevention of this disorder?

An immediate fix

In the acute management of migraine headaches, the triptan class continues its reign as a top-notch therapeutic option for stopping migraine attacks in their tracks. From the moment the first triptan, Imitrex (sumatriptan, Glaxo Wellcome), was born, this class has been welcomed by neurologists as the most significant advance in the acute treatment of migraine in more than 50 years.

The beauty of triptans doesn't necessarily lie in a nifty mechanism of action but rather in their selectivity. After all, old-time dihydroergotamine (DHE) is a serotonin agonist-ust like the triptansand it has been around since long before the discovery of sumatriptan. But like most of yesterday's drugs, DHE is nonselective and exhibits pharmacologic activity at several other receptors, which is responsible for the drug's long list of side effects. And so, the drive to achieve selectivity in a migraine drug pushed research efforts beyond DHE and even past sumatriptan-toward the rise of second-generation serotonin agonists, which include naratriptan, zolmitriptan, and rizatriptan.

According to Silberstein, the triptans are generally similar in efficacyproviding relief to two-thirds of migraine sufferers. But each of the second-generation products holds the promise of overcoming the various drawbacks of the original triptan. …

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