For the more than 23 million Americans who suffer from migraines, the specter of debilitating and excruciating pain haunts them daily.
But new drugs expected to be on the market within the next year, and genetic research that promises to improve diagnosis and treatment, offer new hope of relief.
The drugs will bring more choices of medication and different ways of taking it, said Dr. Steve Wheeler, a Miami-area neurologist who treats hundreds of migraine patients each year.
Migraine treatment was revolutionized with the 1993 approval of sumatriptan, sold as Imitrex, which mimics the action of the brain chemical serotonin and rapidly relieves the pain of a migraine attack. Large numbers of migraine sufferers who had little success with other medications found quick relief that allowed them to continue their normal activities.
It doesn’t work for everyone. Patients with cardiac problems and high blood pressure can’t take Imitrex. The new drugs, eletriptan, naritriptan, rizatriptan and zolmitriptan, are cousins of sumatriptan.
“They will primarily benefit those who don’t respond to currently available treatment,” Wheeler said.
That is good news to the 10 percent to 12 percent of the American population who get migraines. About 70 percent of migraine sufferers are women. Because the headaches are so severe, 92 million workdays are lost each year at a cost to the U.S. economy of more that $11 billion, according to the American Association for the Study of Headache.
A patient’s treatment depends on the frequency and severity of the headache, says Dr. Steven Kobetz, a neurologist and a colleague of Wheeler’s. “A lot of people don’t want to take a medication,” he said.
Some get migraines only once or twice a year. “For some people it happens very, very frequently and can be disabling,” Kobetz said.
Gladys Duran, 48, of Miami, got her first headache when she was 18. She started feeling weak and glaring light and noise bothered her. She began seeing black spots, then experienced tunnel vision and in 20 minutes she lost her eyesight completely.
“My hands started perspiring. I felt weaker and very nervous because you don’t know what’s happening. You feel unsafe, like you’re going to faint,” she recalled.
Her eyesight returned, but she felt nauseated and even weaker. The left side of her body temporarily went numb. Then the sharp pains started in her neck, her left eye and the center of her head.
Fearful of medication, over the years Duran learned to control the migraines by becoming a vegetarian. That helped. But the headaches recurred when she started college to get a nursing degree. One doctor recommended medications that turned out to be ineffective. Eventually, Duran went to see Dr. Joe West, a Miami-area psychotherapist who teaches biofeedback.
West taught her techniques for relaxing to manage stress. “It’s reduced my headaches to once a month, usually when menstruation comes,” she said.
Doctors generally treat migraines by trying to prevent them as well as stopping them once they’ve started. There is a long list of drugs for both kinds of treatment. Almost all of them may cause unpleasant side effects, so they must be closely monitored.
Some migraines can be triggered by certain foods, getting too little sleep, changes in the weather.
Finding the right treatment can be tricky. “Sometimes, it’s a hit-and-miss thing,” said Dr. Harvey Schwartz, a neurologist in Hollywood, Fla. “You try one for a couple of weeks and see if they get some kind of control.”
Dr. Stephen Peroutka, a neurologist and genetic researcher in California, is searching for genes that might make a person susceptible to migraines.
Researchers know that fluctuations in the levels of the neurotransmitter serotonin are associated with migraines in some people. By increasing serotonin, drugs like Imitrex can stop a headache, much like putting on the brakes of a car, he said.
In recent studies, however, Peroutka has focused on the role excess levels of the neurotransmitter dopamine may also play. The development of a new class of drugs that can simultaneously increase serotonin while blocking dopamine in susceptible people may turn out to be the most effective treatment yet for some migraines, Peroutka said.
Through genetic testing, Peroutka hopes scientists can one day single out for treatment those whose migraines may be triggered by a particular sensitivity to excess dopamine and low levels of serotonin.
“Right now, if you have a migraine, you can try 200 different kinds of drugs. We want to get to the point where you can say the patient has a Type A migraine, then they should be given a specific treatment for a Type A migraine,” Peroutka said.
“We’re beginning to understand the basic biological effects of migraines, and which neurotransmitters are involved. This knowledge will help us to create effective diagnosis and treatment.”
