THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Wednesday, July 24, 1996 TAG: 9607240394
SECTION: FRONT PAGE: A6 EDITION: FINAL
SOURCE: NEW YORK TIMES
LENGTH: 80 lines
For years, people with migraine headaches faced a difficult choice: they could resign themselves to being incapacitated for at least a day, or they could take a drug called sumatriptan that has serious side effects.
But the choice should get easier soon because several safer drugs are showing promise of rapid relief for migraines.
The biggest surprise was the discovery announced Wednesday that the fastest, safest relief yet documented for migraines comes not from one of the many new drugs that are under development but from a veteran painkiller called lidocaine, perhaps best known as the drug dentists inject before performing root canals and as the painkiller in some over-the-counter sprays and lotions.
In a study being published today in The Journal of the American Medical Association, 55 percent of the migraine sufferers who used lidocaine nose drops felt better within just 5 to 15 minutes, compared with 21 percent of patients given a placebo made of saltwater.
``This is very impressive information,'' said Dr. Alan M. Rapaport, director of the New England Center for Headache in Stamford, Conn., who was not involved in the research. ``Relief in five minutes is dramatic, almost unbelievable. Clearly, this is a very important study.''
Migraines are severe headaches that regularly affect 17 percent of women and 6 percent of men. Most sufferers get, on average, three migraines each month, and each migraine lasts an average of two days, Rapaport said.
Though people with minor migraines can often control the pain and other symptoms, including nausea and extreme sensitivity to light, with over-the-counter painkillers, Rapaport said, many people suffer for a decade, seeing numerous doctors before finding one who can help them.
The latest study was conducted by Dr. Morris Maizels, a family doctor and longtime migraine sufferer who practices at the Southern California Permanente Medical Group, a health maintenance organization in Woodland Hills, Calif.
Maizels found that lidocaine nose drops, used to treat cluster headaches for more than 10 years, were effective for his migraines, so he put them to the test in a double-blind controlled study.
His research included 81 migraine sufferers at the medical group's urgent-care department. Those with headaches lasting more than three days and occurring more than once a week were excluded because of the likelihood that they actually had many types of headaches, not just migraines. Of the 53 patients given lidocaine nose drops, 29 said that their symptoms had diminished by at least 50 percent within 15 minutes.
Twenty-four of those patients were followed for 24 hours, and the pain did not return for 13 of them, or 55 percent. The pain did return for the others, usually within just one hour.
Maizels said it was too early to recommend lidocaine nose drops for treating migraines because larger studies were needed. The drug is not approved for this purpose by the Food and Drug Administration. But if lidocaine proved effective, Maizels said, it would have several advantages over sumatriptan, the leading migraine medicine.
First of all, it causes only minor side effects, like irritated nasal passages. The FDA says sumatriptan has been linked to serious heart problems and one death. Because of its side effects, the FDA says, sumatriptan cannot be taken by people with heart disease or high blood pressure.
Maizels estimated that lidocaine nose drops would cost just a half-cent per dose, compared with $10 for a sumatriptan pill. ``Even if there's just a small percent of the migraine population that gets complete relief from the drug, it would be a significant addition,'' he said.
Further relief is anticipated from seven new drugs that either are being considered or are about to be considered for approval by the FDA. Unlike lidocaine, which is thought to work by deadening a cluster of facial nerves near the eyes, these new drugs are designed to cure headaches by increasing serotonin levels, a neurotransmitter believed to promote migraine pain when its level dips too low.
Though the cause of migraines is not completely understood, the latest thinking is that they are caused in part by an abnormality in the body's handling of serotonin. In the early stages of a migraine, serotonin floods the brain, causing the blood vessels deep inside to constrict and producing one of the classic symptoms, the aura that many people see before the pain begins.
Then serotonin levels plummet; that makes the blood vessels dilate quickly, which causes the intense, throbbing pain of a migraine. MEMO: MIGRAINE PAIN
Seventeen percent of women and 6 percent of men are believed to
suffer from migraines, which involve severe, throbbing pain, often in
the front of the head. by CNB