Migraine: The Future of Migraine Therapy (cont.)
That's when everything starts hurting, Solomon tells WebMD. The pain-nerve cells are stuck in the "on" position. The slightest touch or movement hurts. Even the pulse of blood in your brain causes pain. Your intestinal system gets thrown out of whack, too, by the onset of nerve chemicals. You feel nauseous, you throw up, you get diarrhea. Your hands and feet grow cold. The color drains from your face.
There's nothing pretty about having a migraine.
Not everyone has this threshold or central sensitization effect, researchers say. Luckily, these patients can take existing painkillers such as Motrin, Advil, Excedrin, or certain prescription pain drugs. These are nearly 100% effective in kicking their headaches, says Solomon.
But most people with migraines need more effective drugs. They must take them before the headache lasts an hour. After that, some relief will come, but usually not enough.
Too many people ignore those very early symptoms, Solomon tells WebMD. "These people get lots of headaches, which are often tension headaches, and they hope against hope that this one isn't a migraine. So by the time the window is past, it's too late to stop it."
In the early days of migraine research, a class of drugs called ergots (short for ergotamines, such as dihydroergotamine or DHE) was aimed at stopping migraine pain in progress. Then came the triptan drugs, which were even more effective at halting pain. They include:
Both ergot and triptan drugs are still prescribed today, Solomon says. However, because both drugs work to constrict swollen blood vessels, not all patients can take them. "If a patient has heart disease or high blood pressure, they just can't take those drugs," he tells WebMD.
Preventing Migraines in the First Place
More recently, to try to stop migraine headaches from developing at all, doctors have prescribed drugs used to treat other disorders. These drugs are taken daily to suppress the brain chemical or blood vessel activity that leads to migraines. The hope is to prevent a migraine from getting started. These drugs include:
"All these are able to keep migraines from happening," says Silberstein. The problem with most, however, is side effects. Topamax can cause numbness, tingling, heat sensations, slowed thinking, and weight loss. Some calcium channel blockers, tricyclic antidepressants, and Depakote can cause weight gain.
"The bottom line is, you pick side effects," says Silberstein. "I tell the patient, 'This drug may have cognitive side effects in some people, may make you lose weight, or here's one that may make you gain weight. Which one do you choose?' With Topamax, you know right away if you'll have side effects. With the others, the side effects [such as weight gain] sneak up on you."
Despite all these advances, some patients still suffer. "One in 10 migraine patients cannot tolerate certain migraine medications. So we're better than we were, but we're still not perfect," Silberstein notes.
For some desperate people, the muscle-paralyzing drug Botox, usually given via injection to facial muscles to reduce the appearance of wrinkles, is a saving grace, he says. "Botox seems to work for patients who get frequent migraines, more than those with infrequent ones. If it works, the treatment is every three or four months." However, Botox treatments can be expensive. "Sometimes insurance covers it, but often it doesn't," he notes.
Finding the Window of Vulnerability
In another approach to the goal of preventing migraine headaches, Silberstein and other researchers have looked at "drug timing." This involves finding the window of vulnerability, a critical time period for migraine headache sufferers. If patients can take their drugs just at this point instead of ongoing, some side effects can be offset. They'll also take less medication, cutting out-of-pocket costs.
Two recent studies of menstrual-related migraines produced the first scientific evidence for a pattern of vulnerability in migraine headaches. Researchers say their findings could apply to other types of migraines, not just menstrual headaches.
It's an exciting finding. If altitude changes are your nemesis, then taking a long-acting triptan drug twice a day on the day before you go skiing in Utah and continuing it for a week may nip your migraine from starting at all.
New migraine drugs are also on the horizon. "A lot of drugs are coming down the pipeline, drugs that work by different mechanisms," says Silberstein. One is a class of enzyme-blocker drugs, such as Aricept, currently prescribed to treat mild to moderate confusion related to Alzheimer's. This drug is a contender for migraine prevention, he tells WebMD.
Alternative Choices for Migraine Pain
While medications are the mainstay of migraine treatment, they're not a cure-all. For women who are pregnant or hoping to be, supplements are a safe alternative. For people who can't get enough relief from prescriptions or who dislike the side effects, supplements can also help.
"Almost anyone, including children, can take magnesium," DeRossett tells WebMD. "The only side effect is diarrhea. Some people get it, some don't. For some, it's dependent on how high the dosage is."