Posted by Bob Johnson (12.19.49.2) on June 13, 2000 at 09:32:39:
Cluster's Last Stand?
Migraine drug brings relief to many with rapid-onset headaches
MONDAY, May 8 (HealthSCOUT) -- The repeated lightning strikes of cluster headaches can be relieved, in some people, by taking a drug aimed at migraines, new research shows.
Nearly half of 124 cluster headache sufferers got relief by taking tablets of zolmitriptan, reports a group led by Dr. Peter Goadsby of the Institute of Neurology in London. Their findings are in the latest issue of the journal Neurology. The drug is sold as Zomig by AstraZeneca Pharmaceuticals, a company based in Wilmington, Del.
"It's a nice thing to have," but zolmitriptan is far from the perfect treatment, cautions Dr. Alexander Mauskop, director of the New York Headache Center in Manhattan and associate professor of neurology at the State University of New York Downstate Medical Center. It's only in tablet form, which means it takes longer than a nasal spray or shot to work. And it doesn't work on people with chronic cluster headaches, say the researchers.
About 1 million Americans have cluster headaches, which strike suddenly and usually cause a penetrating pain behind one eye, often accompanied by redness and swelling of the eye. An attack can vanish as quickly as it strikes, in anywhere from 30 minutes to two hours.
though migraines can be debilitating, the pain of cluster headaches is much more severe, say the researchers. The headaches get their name because they occur in episodes, striking often for six to 12 weeks and then going away for as long as a year.
Cluster headaches now are treated with injections of the headache drug sumatriptan, a member of the same chemical class as zolmitriptan, or by having the patient breathe pure oxygen. Zolmitriptan has been approved for use against migraine in the United States, but physicians can also prescribe it for cluster headaches.
In the study, Goadsby and his colleagues gave oral doses of either 5 milligrams or 10 milligrams of the drug to patients when their headaches began. The 10-milligram dose gave relief 47 percent of the time, meaning that the pain died away in 30 minutes or less. The 5- milligram dose was only a bit less effective, while placebo, inactive pills, worked 29 percent of the time.
Dr. Gerry Torres, a neurologist with AstraZeneca, which helped fund the study, calls the results "interesting and promising," but says, "We don't have information that would lead us to apply for approval" by the Food and Drug Administration for use of zolmitriptan against cluster headaches.
Mauskop says he has used the drug to treat some patients. The major drawback to zolmitriptan, he says, is that it takes some time to do its work.
"A tablet will take half an hour," he says. "For some people, that is not quick enough. A nasal spray would provide quicker relief."
Zolmitriptan and other members of the triptan family may relieve pain by constricting blood vessels in the brain and by preventing the release of the brain molecules that cause pain, Torres says.
"An injectable like sumatriptan works faster although it does have more side effects," says Mauskop. Those side effects include a feeling of intense pressure on the side of the chest and an annoying pins-and-needles feeling, he says.
About 60 percent of cluster headache patients can get quick relief by breathing oxygen. "We often try oxygen because many attacks occur at home at night, and [the gas] has no side effects," Mauskop says.
What To Do
This drug has limitations. It doesn't work on people who have these headaches year-round. Goadsby also says it shouldn't be given to people who have more than two attacks a day. Ask your doctor about this drug if you have cluster headaches and other remedies aren't working.