Brain Storm : Migraine Breakthrough Leaves Family Doctor Heady From Attention

Morris Maizels was not a likely candidate for medical celebrity. He was not a specialist working on a high-tech frontier and he was not associated with a renowned research institution.

Maizels, 44, was a family practitioner who had a career very much out of the spotlight, seeing patients with a variety of run-of-the-mill ailments at Kaiser Permanente Medical Center in Woodland Hills.

Then last year, on his own time and with no funding, Maizels headed up a study based on his observation that lidocaine--a common, inexpensive drug long used to ease sunburn pain--could help migraine headache sufferers.

When the results were published last month in the Journal of the American Medical Assn. (JAMA), Maizels was suddenly no longer working in obscurity. His study had become one of the big medical stories of the year.

“Life was so simple before,” said Maizels, with a smile and a laugh, walking through the lobby of the hospital last week. This was supposed to be his day off. But he had come in to do yet another interview--he had already been on the front page of several major newspapers, including The Times, and on the newscasts of CNN and all the major networks--and catch up on paperwork.

His study was, he concedes, not a large-scale scientific inquiry, but it did indicate that lidocaine could very well be a major advance in migraine treatment: effective, free of significant side effects, easy to use and as an added bonus, inexpensive.

“I used to go to work, go home, bicycle, play tennis three days a week, do bonsai,” continued Maizels, who lives in Woodland Hills with his wife and stepdaughter. “Now I can’t even get through my e-mail.”

All this attention has been a heady and even seductive experience, he said, as he prepared to talk in depth about how the study came about. But it has not erased his self-effacing humor.

As Maizels walked, a hospital volunteer recognized him and gave him an ebullient greeting. The volunteer heaped on the praise, ending with, “You’re the best-looking one we got.” Maizels smiled and waved as he continued down the hall.

“That man,” he confided when a safe distance away, “has a problem.”

Three years ago a woman came to him with a very real problem: crippling migraines, accompanied by nausea and a painful sensitivity of the eyes to light. Her condition was severe but not uncommon. Approximately 17% of adult women and 6% of adult men in this country suffer from migraines. The cause is still a mystery.

One drug, sumatriptan, which came on the market in 1991, helped many, but it has to be injected, has side effects and costs about $35 a shot.

The woman who came to see him was holding a small newspaper clipping. It mentioned that a drug company was going to bring out lidocaine in nose-drop form to treat cluster headaches--a condition most experts believe is not related to migraines.

Maizels agreed to drop a bit of lidocaine solution into her nose, and it did seem to help. He suspected the drug might be deadening a group of nerve cells known as the sphenopalatine ganglion, which some researchers believe have something to do with cluster headaches.

Maybe, Maizels thought, these cells also played a role in migraines.

He began trying it on several patients. When the lidocaine worked, the results were often quick and dramatic.

“The pain was just gone,” said Wendy Cohen, a doctor at Kaiser who tried the treatment herself. “It was unbelievable. We would give it to patients and they would say, ‘It’s a miracle.’ ”

Said Maizels: “It was about one to two years before I got it through the thick part of my skull that maybe we should do a formal study on this.”

Other doctors were on the same path, most notably Lee Kudrow, a renowned headache specialist and founder of the California Medical Clinic for Headache in Encino (and father of actress Lisa Kudrow, known as “Phoebe Buffay” to fans of TV’s “Friends”).

In 1994, Kudrow did a small study of lidocaine involving 39 migraine patients, and obtained an impressive 70% success rate.

The results were published in the Journal of Headache medical periodical. But it got little attention, partly because it was an “open label” study--meaning it did not include a control group given a placebo--and partly because the journal circulates only among a small group of specialists.

“They don’t have the big public-relations department like the American Medical Assn. does,” Kudrow said, referring to the publicity given Maizels’ later study by the AMA journal.

Hearing about Kudrow’s study, Maizels contacted him and was delighted when Kudrow, with more experience in research, offered to help design the Kaiser study. “He’s my mentor,” Maizels said.

Administrators at Kaiser approved the study, which was administered in the hospital’s emergency room. Starting in December 1994, migraine sufferers were asked if they wanted to participate in an experimental study. By last October, they had results from 81 people--53 who were given lidocaine in a liquid nasal spray and 28 who received a placebo, plain saline solution.

The drug was administered by Cohen and another doctor in the emergency room. Because there was no funding for an assistant, Maizels prepared the solutions himself, coding them so that neither emergency room doctors nor patients would know who got the lidocaine.

By September, when Maizels attended the International Headache Symposium in Toronto, he knew the preliminary results looked promising. He said he spoke about the study with several doctors, but most showed little interest.

After all, Maizels was just a family doctor.

“I was like a kid in Hollywood with a script no one would read,” Maizels said.

When the final results were in, the study’s success rate was 55%, which--given the vast number of migraine sufferers--offered considerable promise. “At that rate, we are talking about tens of millions of people this could help,” Maizels said.

The AMA agreed to publish the results under the “brief reports” category in its prestigious journal.

“It’s for short studies on promising therapies that look as though they might examine an important area,” said a JAMA editor, Phil Fontanarosa. “But the reports still go through a rigorous peer review before we accept them for publication.”

Fontanarosa said he was not surprised at the wide coverage of the report in the mainstream news media. “I think it addressed a problem for which a lot of patients have tried a lot of therapies without help,” he said.

The AMA’s public-relations people realized it too. Before the journal came out, they arranged for videotaped interviews in Woodland Hills with patients who had been treated successfully with lidocaine, distributing the tapes to television news operations for use immediately after publication.

Maizels admits he didn’t mind all the media attention. “It was so exciting,” he said with a laugh. “Now I’m going through media withdrawal.”

Maizels is planning a larger follow-up study that he hopes will have three primary results: to repeat the success of the first study, show that the drug can be self-administered in a home setting, and show that repeated applications will help patients whose migraines returned shortly after the initial lidocaine treatment.

Maizels is confident that Kaiser, which was certainly not hurt by all the favorable publicity, will give him a favorable response when he asks for funding to pay a research assistant and statistician.

But even if that study is a success, Maizels said he plans to remain a family doctor, ignoring the temptation to become a headache specialist.

“Do you know,” he asked, “what it’s like to see even a half-day of nothing but headache patients?”