Doctor Takes His Medicine--Celebrity

Dr. 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 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., Maizels was not working in obscurity any longer. His study instantly became 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 and on the newscasts of 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 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,” said Maizels, who lives in Woodland Hills with his wife and stepdaughter. “Now I can’t even get through my e-mail.”

It all began three years ago, when a woman went to him with crippling migraines, accompanied by nausea and a painful sensitivity 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 a mystery.

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One drug, sumatriptan, which came on the market in 1991, helped many. But it’s costly--an injectable form running about $35 a shot--and had side effects.

The woman patient, though, 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 believed had something to do with cluster headaches. Maybe, Maizels theorized, these cells also played a role in migraines.

He began trying the drug on several patients. When the lidocaine worked, he said, 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 a medical periodical, the Journal of Headache, but got little attention, partly because his 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.

But Maizels heard about Kudrow’s study, 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 October, researchers 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 knew 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,” he 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 in the “brief reports” category of its journal.

“It’s for short studies on promising therapies that look as though they might examine an important area,” said Phil Fontanarosa, a journal editor. “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 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.

Maizels is planning a larger follow-up study that he hopes will have three primary results: to repeat the success of the first one, 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 certainly was not hurt by all the 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?”