For more than 25 years, Susanne Van Cleave has battled migraines. The disabling headaches have caused her tremendous pain, disorientation and nausea. The same headaches have been responsible for her getting lost just blocks from home and being bedridden for days at a time.
Over the years, Van Cleave, an editor from New Rochelle, N.Y., has tried just about every drug and home remedy available. Most recently, she has begun using a combination of natural supplements that she says helps decrease the number and intensity of migraines. But basically, Van Cleave, like millions of other sufferers, has decided migraines are just something she has to live with.
However, headache specialists around the country are trying to get the message out that migraines “are no longer a cross you have to bear,” said Stewart Tepper, M.D., director of the New England Center for Headaches in Stamford, Conn., and an assistant professor of neurology at Yale University.
“It’s a fantastically optimistic time. There are so many things we can do that we couldn’t do a few years ago. I see patients every day who have dramatic, almost miraculous, improvements,” he said.
New Drug Treatments
Two things in particular — the standardization of diagnosis and the advent of the triptan drugs –have improved treatments for the 28 million Americans who suffer from migraines, according to Tepper.
In fact, the triptan drugs, which provided millions with a new, faster way to relieve migraine pain and side effects, were so important that headache specialists such as Tepper refer to the 1990s as the “triptan revolution.” Three second-generation triptan drugs, each slightly different than those currently on the market, are due out early next year, Tepper says.
For now, Imitrex (sumaptriptan), the first of the triptan drugs, is still the most widely used because it’s fast acting, the most powerful and the most versatile. It comes in injectable, pill and nasal spray forms. Growing in popularity, though, are newer drugs, like Maxalt (rizatriptan), which comes in a mint-flavored pill that dissolves on the tongue.
“One thing we’ve learned is that taking the triptans very early on is key [to keeping migraines short lived and less painful]. So, a melt form is good because if you’re in the board room giving a talk or in the car, you don’t need water, you can just go ahead and take it right then,” Tepper said.
In fact, reports have shown that the 60 percent to 70 percent effectiveness for these drugs could raise to 80 percent to 90 percent if patients would take them earlier, according to Seymour Diamond, M.D., executive director of the National Headache Foundation and founder of the Diamond Headache Clinic, both in Chicago.
A Brain Chain Reaction?
But it has been research into what actually causes migraines that has given specialists the most hope for better treatment and even prevention.
“We always thought this was a vascular disease ? but with the latest research showing there is a brain aspect to this — that there are triggers that affect the cranial nerves and set off the whole process — there’s now a lot of interest in anti-convulsant drugs,” Diamond said.
In fact, the process that sets off migraines is very similar to what brings on an epileptic attack, and the two illnesses have many of the same triggers — menstruation, alcohol and sleep deprivation, Tepper says.
That discovery has led the U.S. Food and Drug Administration to approve drugs such as Depakote, an anti-epilepsy drug first used in the 1960s, for migraine treatment and prevention.
“There’s a tendency of physicians to trivialize headaches, maybe because it’s a disease of women [70 percent of migraine sufferers are women]. They try to say it’s sinusitis or tension headaches … but it’s extremely difficult to find disabling sinus or tension headaches. The best definition I heard recently is that if there’s a stable pattern of recurrent, episodic disabling headaches, it’s a migraine until proven otherwise,” he said.
Patients should remember that migraines are characterized by severe, throbbing pain, often on one side of the head, and frequently accompanied by nausea, vomiting and sensitivity to light and noise. They can last anywhere from hours to several days.