A migraine can pack the wallop of .357 magnum. It's not your ordinary run-of-the-mill headache. Most us suffer the occasional garden-variety - caused by tension or muscle contractions - but they're usually treated successfully with a couple of aspirin, then happily forgotten.
The migraine, on the other hand - and the nausea that accompanies it - is a neurological illness that hammers and throbs its way into the heads of 20 percent of the population - up to 30 million Americans - with unerring regularity. It makes work unbearable, noise and light intolerable.Relief though, appears to be at hand. Research by Dr. Stephan Peroutka, assistant professor of neurology at Stanford University's School of Medicine, indicates that a potent new drug - sumatriptan, has proved an effective remedy for migraines. Researchers are hopeful there will be no side effects.
Since the 1920s, neurologists have been using antimigraine drugs called ergots, a remarkable group of drugs that are effective and versatile. Ergots are derived from plant alkaloids found in a fungus that grows on rye and other common grains. Among other things, ergots contract blood vessels and inhibit the release of certain neurotransmitters in the brain - chemicals that pass information from one cell receptor to another.
Unfortunately, while very effective, they produce a host of side effects, including nausea and vomiting, and, because of their effect on blood vessel contraction, cannot be used by pregnant women or people with peripheral vascular disease.
"Ergot drugs are very non-selective," according to Peroutka. "They are known to work on as many as 10 different cell receptors - thus the side effects. What's exciting about sumatriptan is that it seems to act on only one receptor, a tongue-twister called serotonin 5-hydroxytryptamine-subset-1D, informally called the 1D-receptor."
Cell receptors are sensory nerve-endings that transmit or receive information from the shuttle-like neurotransmitters - serotonin, acetylcholine, norepinephrine, etc. Peroutka's research has centered around the neurotransmitter serotonin, a chemical transmitter commonly associated with many diseases, depression being principal among them.
Because of the selective nature of sumatriptan, side effects caused by unnecessary random receptor stimulation should be considerably reduced.
"On a milligram to milligram basis," he says, "sumatriptan is just as effective and potent as the ergots. It's really a big step forward in terms of selectivity."
Scientists previously thought migraine headaches were caused by changes in the blood vessels and attributed the pain to the dilation and pounding of the vessels.
Peroutka's recent study, however, indicates the blood vessels themselves may be perfectly normal and specific chemicals surrounding the blood vessels may be the culprit. When released, they may be signaling a situation interpreted by the brain as painful. Effective drugs, like sumatriptan, could shut off the release of these chemicals.
Regardless of the potential efficacy of sumatriptan, some medical experts go one step further and claim the drugs themselves are becoming major contributors to the longevity of headaches by shutting down our body's natural protective pain-controlling mechanisms.
Dr. Debra Elliott, assistant professor of neurology and head of the Headache Center at Tulane University Medical School in New Orleans, says, "Drug-induced headaches are becoming more common, and we have to detox most patients off their pain-relieving analgesics."
Elliott is concerned about the public's tendency to overly depend on both prescribed and over-the-counter pain relievers.
"People have to realize," she said, "that aspirin, acetaminophen and ibuprofen are drugs. We have to break this cycle of `Got a pain - take a pill.' When you take a pain pill you're telling the brain it doesn't have to work on the pain itself; the pill will take care of it."
Many physicians, she said, are also overtreating with analgesics. "Patients are coming into the Headache Center extremely dependent on these medications."
A migraine headache usually concentrates on one side of the head, lasting anywhere from hours to over a day. In its worst form, for some unfortunate individuals, the migraine makes an initial painful appearance and then, like an unwelcome guest, seems to linger on interminably.
Targeting mainly people between the ages of 20 and 40, the primary victims are overwhelmingly female - at least 70 percent. Research indicates that in some women, menstruation brings on regular, painful monthly headaches; and it's estimated that 1 in 400 people a year seek out a neurologist for treatment.
Although rare in the elderly, the migraine does plague children, when it is often called a "sick headache.
Elliott cautions, "Children may not exhibit all of the normal adult symptoms, and if a child complains of three to four headaches a month, or has headaches that don't respond to acetaminophen, they should be seen by a physician.
Although she, like other neurologists, is awaiting the final word on sumatriptan, Elliott said the Tulane University Headache Center tries to avoid the use of narcotics in treating patients. "We use both pharmacological and non-pharmacological approaches for headache treatment and management, but try to stay away whenever possible from analgesics."
Although still in its final stages of testing and presently unavailable, the effectiveness of sumatriptan as a weapon against migraines signals some electric news in the world of headaches and neuropharmacology.
More importantly, it offers hope that researchers may be one step closer to precisely pinpointing the functions of the various cell receptors, making it easier and pharmacologically cleaner to treat a whole variety of illnesses.