BODY WATCH : UPDATE / MIGRAINES : Powerful New Tools Ease the Pain

For millions of migraine patients, the approval two years ago of a powerful injectable drug to quell their painful headaches in about 20 minutes offered an important advance in treatment. But getting that relief from the drug, called Imitrex, meant patients had to inject themselves.

“I loved the drug, but the shots were very cumbersome,” says Kathleen Sindall of Washington, D.C. “I had five headaches in a row, and I looked like a drug addict because of all the needle marks.”

Sindall and others now have a simpler choice: a tablet containing Imitrex went on the market recently, following Food and Drug Administration approval in June.

“Now I can carry the tablets in my handbag, go get a glass of water and take them when I need them without having the embarrassment and discomfort of having to give myself a shot,” Sindall says.

An estimated 20% of Americans suffer from migraine headaches at some time in their lives; three-quarters of them are women. The problem is especially difficult for the 8 million people who experience recurrent migraines.

These people “are willing to do just about anything to escape their blinding pain,” says Seymour Diamond, executive director of the National Headache Foundation in Chicago.

Unlike tension headaches, which feel like the head is in a vise or like you’re wearing a hat several sizes too small, migraine headaches usually cause pain in one side of the head, producing unbearable pounding in the head and waves of nausea.

These excruciating headaches often run in families. They can come on with no warning. Or they may follow the appearance of an aura--seeing a flash of colors or distortion of vision that precedes the full-blown migraine.

The cause of migraines is not fully understood, but the pain comes when blood vessels in the brain widen.

Although not life-threatening, these headaches can be debilitating, forcing patients to curtail daily activities and go to bed in severe cases. They can last from several hours to several days.

What is more, physicians say many people with migraine headaches don’t know about the wide variety of options available to treat and prevent these headaches.

“Almost every migraine sufferer can be helped today, yet [surveys show that] almost half think that nothing can be done to help them,” says Dr. Margaret Abernathy, the neurologist founder of the Georgetown University Headache Treatment Center and herself a migraine sufferer. “As a result, they retreat to dark rooms, suffering in silence, vomiting periodically and feeling exhausted when it is over, rather than availing themselves of treatment.”

Doctors have a wide array of medications to prescribe. Imitrex has grown in popularity among people who could not get help from other medications. An estimated 1 million Americans use the drug.

Doctors will also sometimes recommend other medications, including large doses of fast-acting nonsteroidal anti-inflammatory drugs such as ibuprofen, acetaminophen and naproxen, all available over the counter.

Doctors also use Midrin, a drug that contains a combination of painkillers, mild sedatives and substances that help constrict the blood vessels to control migraines.

In addition to pain medications, doctors have added beta blockers, a standard medication for high blood pressure, and antidepressants to help prevent migraines.

Patients are also often advised to make some lifestyle changes, including eliminating some foods such as peanuts, certain cheeses, chocolate and alcohol from the diet; increasing exercise; reducing stress; and getting enough sleep. Some patients even turn to biofeedback, a technique in which the patient learns how to control blood flow.

Research indicates that in patients who get migraines, blood vessels in the brain “are very reactive,” says Dr. Robert S. Kunkel of the Cleveland Clinic, and thus dilate extremely easily. In addition, brain scans suggest that migraine patients experience increased activity in the midbrain that helps to trigger dilation of the blood vessels, he says.

Exactly what sets off the increased brain activity varies from person to person.

Some people are sensitive to weather changes, others to certain foods and still others to alterations in hormone levels during the monthly menstrual cycle. Some women have fewer migraines when they become pregnant and some stop having migraines completely at menopause. Sufferers typically experience bouts about one to four times a month.