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Hitting Them Where It Hurts

Headaches: New drugs offer hope to stop the severe pain of migraines and chronic tension varieties.


"I have a headache."

For 45 million Americans, those words mean much more than take-two-aspirin-and-you'll-feel-better. For them, the harrowing pain of migraines or chronic tension headaches can last for days.

There are dozens of different kinds of headache. Two of the worst, migraine and chronic tension headaches, have symptoms that overlap. Many headache specialists who once believed the migraine and tension headache were separate disorders now believe they may be caused by similar mechanisms in the brain.

The introduction five years ago of sumatriptan, marketed as Imitrex, changed the lives of millions of these people, who found relief from migraines for the first time. But Imitrex doesn't work for everyone, and for others it loses effectiveness over time. Doctors hope that a half-dozen new prescription drugs in various phases of development will dramatically improve the outlook for people tormented by headaches.


Many of the new medications, described by doctors as Imitrex-like, are the result of brain research that identified serotonin as a cause of migraines. The drugs--with names such as naratriptan, zolmitriptan, rizatriptan and eletriptan--are designed to stop migraine headaches with few side effects. Some are expected to be available as early as the next few weeks.

"They're the next generation of Imitrex," said Dr. Alan M. Rapoport, founder and director of the New England Center for Headache in Stamford, Conn., and the co-author of several books on headaches.

One new product, Migranal nasal spray, got a very public tryout at the Super Bowl on Jan. 25 when Denver Bronco running back Terrell Davis retreated to the sidelines with a migraine.

Davis, who has suffered from incapacitating migraines since he was 7, used the spray, a new form of a 50-year-old injectable migraine drug known as DHE, and re-entered the game. He went on to become Most Valuable Player as the Broncos beat the Green Bay Packers.

"To have a big macho strong guy out of the game because of migraine, that was a great public education," said New York headache specialist Dr. Alexander Mauskop. "Most of the viewers were the husbands of women who have suffered from migraines, the men who tell them it's 'just a headache.' "

Most migraine sufferers are women, by a 3:1 ratio, which some experts believe has caused their pain to be dismissed or trivialized.

But sufferers know that the searing pain is anything but trivial. Migraines usually emanate from one side of the head and can be accompanied by dizziness, vomiting and blurred vision.


Tension-type headaches share many of the same triggers as migraines, and many doctors believe they are related. Chronic tension headaches, which occur every day, also can be a sign of depression.

These severe headaches can be triggered by almost anything: airplane trips, too much sleep, too little sleep, stress, wine, cigarette smoke. A recent study cleared chocolate of its reputation as a trigger, but many migraine sufferers stay away from it anyway.

Hormonal swings tied to menstrual periods often trigger migraines in women.

Rapoport said the typical patient at his headache clinic is a 35-year-old woman with a couple of kids. "She may be working, married, and has two really bad migraines a month and five or six tension-type headaches a month," he said.

Migraines tend to be hereditary--if you have them, you probably have a person in your immediate family who does too.

Specialists such as Rapoport said medications are only one part of the solution to banishing severe headaches.

Exercise, good sleeping patterns and a careful diet are essential. Doctors also recommend limiting caffeine and taking daily supplements of magnesium and B-vitamins.

Mauskop said he often recommends alternative therapies, such as acupuncture, which has a good track record.

He also recommends that migraine patients take a daily supplement of 400 to 600 milligrams of magnesium because studies have found that the brains of migraine sufferers have low levels of the mineral.

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