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Migraine Medicine: The Sooner, the Better

Studies find taking triptans early stems headaches

TUESDAY, June 18, 2002 (HealthDayNews) -- Migraine sufferers often delay taking their medication, even when they sense an attack is imminent.

Now, new studies suggest the traditional approach to medicate when the pain is at its worst may be wrong. In fact, taking the medicine sooner rather than later seems to be the best route to pain relief, at least for those whose migraine symptoms include skin hypersensitivity.

"In patients whose skin becomes hypersensitive, if you treat early, you still have a chance of aborting it," says Rami Burstein, an associate professor of anesthesia and neurology at Harvard Medical School. He will report his findings at the American Headache Society's annual meeting later this week in Seattle.

About 28 million Americans suffer from migraine, usually described as intense, throbbing pain in the head, along with visual disturbances and sensitivity to light and sound. Roughly four of five migraine sufferers develop the skin sensitivity as their migraine progresses.

In his study, Burstein evaluated 51 migraine attacks in 28 people. About half were given triptans, common medications for migraine, before or at the first sign of skin hypersensitivity. The others were not given the medicine until the skin hypersensitivity was established.

When the medicine was taken before or at the first sign of skin hypersensitivity, it blocked progression of the sensitivity and completely eliminated the headache in 91 percent of the people, Burstein says. In those whose medicine was delayed, the headache was only relieved by the medication in three instances.

"Your skin becomes hypersensitive because neurons in the central nervous system have become involved in the migraine attack," Burstein says. It's evidence that the peripheral nervous system, which is initially involved in a migraine attack, has handed over the leading role to the central nervous system, he explains.

What's new with this latest study is the finding that the crucial timing of medication is tied to the skin symptom. In the past, "it was believed that if you treat early it works because the pain intensity is lower," he says.

At the meeting, researchers from the Palm Beach Headache Center in Florida will report another study that lends support to early treatment. They found that two-thirds of those who took medicine at the first sign of a migraine were pain-free within four hours.

A typical migraine pattern, Burstein says, starts with the throbbing pain. One hour after onset of pain, the skin starts to become sensitive in most patients.

"Take the medicine as soon as the pain starts," he advises. "The traditional wisdom was, 'Don't rush it, don't take it if you don't need it.' "

Dr. Fred Freitag, associate director of the Diamond Headache Clinic in Chicago, calls Burstein's research "a good study. It would have been nice to have a control group, but for a first trial it's a very good look-see at the relationship," he adds.

"It's very provocative," agrees Dr. Steven Graff-Radford, co-director of The Pain Center at Cedars-Sinai Medical Center in Los Angeles. "This is really a study that turns everything on its head."

Burstein hopes both doctors and migraine sufferers will pay attention to his findings. While patients need to consider taking their medication earlier, he says doctors should pay attention to whether their patients have the skin hypersensitivity symptom.

What To Do

For more information on migraine, see The American Medical Association, or the National Institutes of Health.

SOURCES: Rami Burstein, Ph.D., associate professor, anesthesia and neurology, Harvard Medical School, Boston; Fred Freitag, D.O., associate director, Diamond Headache Clinic, Chicago; Steven Graff-Radford, D.D.S., co-director, The Pain Center, Cedars-Sinai Medical Center, Los Angeles; June 21-23, 2002, presentations, American Headache Society's 44th Annual Scientific Meeting, Seattle
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