1996_11 Insight November 1996

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NOVEMBER 13, 1996 I
MIGRAINE: Researchers study the causes of migraines, from page 1
Roberts said that when she feels a migraine
attack coming on she usually takes four
Advil, turns off the lighLs and tries to sleep
through it. She said lying in a dark room is
the only thing lhat helps.
"When you have a migraine, it immobilizes you." Roberts said. "I've had to miss
work a lot. I used to work in retail and I've
had managers tell me to take some aspirin
and come into work anyway. I wish I could
just take some aspirin. But over-the:counter
medication just doesn'l make ihem go away,"
Roberts has tried just about every migraine
medication on the market but has not yet
found anything that works. '.'live tried so
many. Pills, shots, nasal sprays. I can't even
remember what I've had and what 1 haven't."
said Roberts.
Roberts' current physician is Dr. Anthony
Molina, a physician at the Student Health
Center for 12 years. Molina said that treating migraines often requires a trial-and-er-
ror approach.
"Every patient is different." he said. "You
usually try to prescribe the medication with
the least side effects. You also have to take
into account the patient's medical history."
Molina has requisitioned Roberts' medical records from her previous doctor in an
attempt to find a treatment. Imitr/k is one of
ihe medications she might try.
A possible solution
In 1993, the Food and Drug Administration approved the use Imitrex in the United
Slates. It was a self-administered injection
lhat sokl for about S80 for two six-milligram
doses.
In December of 1995. Glaxo Wellcome
Inc. gained FDA approval io market Imitrex
in tablet form. Il was easier to take, but not
more affordable. A package of nine pills cost
between SI00 and SI25. Bolh forms of the
drug are only available by prescription.
The prices are slightly lower at the Stu-
• dent Health Center. The Imitrex injection kit
costs S65 and a package of nine pills sell for
S85. Bul migraine sufferers are willing to
pay the price for relief
"It's expensive." Roberts said. "1 don't
have medical insurance right now so I'd have
to pay for it myself. But is it worth it? Yeah,
if it got rid of my migraines, it's worth anything." Other migraine sufferers have expressed similar opinions. '
"Migraines can create large holes in my
schedule, sometimes leaving me completely
dysfunctional for days at a time, causing me
to miss out on family gatherings and work."
said Martha Hodgesmith. who has suffered
from migraines for more than 20 years and
was one ofthe clinical (rial participant for
the Imitrex tablets. "I've been looking for
this for a long time."
Imitrex is the only migraine medication
thai is designed to treat multiple symptoms
of a migraine attack, not just pain.
Although doctors still don't know what
causes migraines, researchers have learned
much about the disease in the last few years.
External triggers
The most widely accepted theory is that
certain substances or events, called triggers,
cause an imbalance in the chemicals that
occur naturally in the brain. This imbalance
causes blood vessels in the head to expand
or swell. The nerve endings around the distended blood vessels become irritated, which
causes the severe pain.
The attacks can last from four hours to
three or four days.
Though some migraine medications must
be taken at the onset of an attack. Imitrex
may be taken at any time during a migraine
attack.
"Im
etlc,
ledicat
with a
proven clinical safety profile as evidenced
by its use. to dale, to treat more than 40 million migraine attacks worldwide." said Dr.
Richard S. Kent, chief medical officer of
Glaxo Wellcome Inc.. in a written statement.
The clinical studies carried out by Glaxo
Wellcome Inc. showed lhat Imitrex injections can relieve symptoms within 10 minutes and the 25-milligram Imitrex pill eliminated pain within one hour in 45 percent of
people tested.
Imitrex is the brand name of the drug
sumatriptan. It works by imitating the neurotransmitter serotonin. The sumatriptan activates the serotonin receptors in the brain.
This causes the swollen blood vessels to constrict, relieving ihe pressure on the nerve
endings and alleviating ihe pain and other
symptoms.
Despite its effectiveness. Imitrex is not for
everyone. Imitrex is not recommended for
patients wiih high blood pressure, heart disease or high-risk factors for heart disease. It
is also nol recommended for women who
are pregnant Like other drugs that treat migraines. Imitrex also has its side effects.
The most common side effect is pain or
tightness in ihe chest or throat. One migraine
sufferer said il fell like an elephant was standing on her chest for about 20 minutes after
every self-injection.
Other side effects reported include tingling
or flushing sensations, nasal discomfort,
drowsiness, fatigue, dizziness and pain al the
injection site. Imitrex can also cause small
increases in blood pressure.
Although dozens of medical institutes
across the nation study different kinds of
headaches, no one knows, for sure why at
least six percent of men and 18 percent of
women in the United States are predisposed
to migraines. But researchers have identified the triggers that can bring on the attacks.
According to The Migraine Information
Center at Glaxo Wellcome Inc., triggers are
divided into six categories: Dietary, environmental, emotional, activity, medications and
hormonal.
(y One orthe most common triggers is stress
or other strong emotions, such as, anger or
depression. Lack of sleep or abrupt changes
in sleeping patterns can also be a trigger.
Loud noises, glaring lights and strong
odors also trigger attacks. Roberts said her
triggers are primarily environmental, such
as strong odors. "Really strong smells, like
sfnog or the horses' unit on campus, will
give me a migraine," she said. "Or certain
perfumes, like when you're walking through
the cosmetics department of a store and
there's those really strong, obnoxious perfumes. I can't handle that."
Roberts said she is still learning about her
triggers. "I also get them when I'm not getting enough sleep." she said. "I just found
that out."
Dietary triggers are varied. These include
caffeine, alcohol, certain seasonings and flavorings, even peanut butler, cheese and some
fruits. Because triggers are different for each
person. Glaxo Wellcome suggests migraine
sufferers keep* a "migraine diary" lhal documents what they have done, including what
they have eaten, prior to an attack.
Keeping a diary can also help doctors diagnose whether patients are actually hav ing
migraine attacks or some other kind of headache, such as a tension or cluster headache.
Many people use' the word migraine to
describe a particularly painful headache, but
a migraine is much more complex than il
may seem.
Ferocious pain
Migraine is believed to be at least partially
hereditary. About 70 percent of the sufferers have other family members who also
have migraines.
The most debilitating physical symptom
of a migraine attack is the intense, throbbing or pulsing pain, usually located on one
side ofthe head. In fact, the word migraine
is derived from a shortening of the word
"hemicrania." which means "half-head."
But the pain is only one symptom of the
disease. It is usually accompanied by nausea and an increased sensitivity to light and
noise.
Early in a migraine attack, many people
Students are not the only ones who need a break from time to time.
Nine-year-old Kristal Madrid rests after rollerblading with her cousin
on campus. Crystal waits for her mother, who works at the Satellite
Student Union.
experience warning symptoms. These symptoms are called auras, from Ihe Greek word
for wind. Like ihe wind lhat precedes a
storm, the aura precedes the pain.
The warning symptoms are caused by the
electrical and chemical changes going on in
the brain, such as the reduction of blood-flow
through the brain caused by the dilation of
blood vessels. Auras often affect vision. Auras cause the victim to sec flashing lights or
zig-zag lines. Some people experience
numbness, usually in their hands.
Other auras include hallucinations, temporary loss of speech, rapid mood changes
and excessive yawning.
Roberts said that excessive yawning is the
only warning sign she gets before her migraine attacks.
"I start lo yawn a lot and I know I'll be
getting one." she said. "I'll yawn and then
the whole side of my head, my face, my neck,
everything ... I can feel ii all start to hurt."
Roberts said she needs to find a way to
control her migraines.
"I'm going to be graduating. I'll be going
into the real world. 1 can't just not go to work
every few days because I have a migraine,"
she said. "Ny
"Sometimes they last three to four days.
It makes me dizzy, nauseous, tired. But you
still have to go on with life. I don't know
what I'm going to do. It worries me a lot."
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