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Migraine Sufferers Not Getting Best Drugs
WEDNESDAY, May 5 (HealthDayNews) -- Despite clear evidence they are both safe and effective in soothing migraines, many American doctors aren't offering patients the best medications available to fight these intense headaches, an expert panel said. "As many as four out of five people can get symptom relief and pain relief from migraine headache if they take the most effective acute medication available, the triptan class of medications," said Dr. David Dodick, lead author of a consensus statement released by a special American Headache Society panel convened to look at the issue. Speaking to reporters Tuesday, he said too many U.S. patients "weren't receiving the medications from their physicians, despite the benefit they could get from it, because physicians were concerned about safety." Those safety concerns may be exaggerated, the society's panel concludes. They conducted a thorough analysis of the existing medical literature on triptans -- studies involving more than 57,000 patients treated for a total of more than 350,000 migraine attacks worldwide. "While serious cardiovascular events have been reported after the use of triptans, their occurrence appears to be extremely low -- on the order of less than one in 1 million," Dodick said. This level of risk remains far below that seen for nonprescription alternatives to triptans, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, he said. The consensus statement is published in the May issue of Headache. Experts estimate that one in every 10 Americans is affected by painful, recurrent migraines. While the exact cause of migraine remains unclear, the emergence of triptan medications in the early 1990s was hailed as a breakthrough in headache treatment. Studies show that, if taken at the onset of migraine, drugs such as sumatriptan (brand name Imitrex), zolmitriptan (Zomig) and naratriptan (Amerge) can ease symptoms in more than 80 percent of patients, making them far superior to other prescription and nonprescription headache remedies. One of the mechanisms behind triptans' effectiveness is the drugs' ability to induce mild constriction in blood vessels leading to the brain. However, triptans induce a similar narrowing of vessels throughout the body, and "in patients with significant coronary artery disease we would not want to limit the flow in those coronary arteries any more," Dodick explained. In very rare cases, use of triptans has been linked to sudden heart attack or stroke, and the drugs are not recommended for use by patients already diagnosed with cardiovascular disease. Isolated reports of possible links between triptans and heart attack may have made many doctors overcautious, Dodick said. In fact, according to recent studies, just one in every five migraine patients in the United States are receiving triptan therapy. "Most of these patients are young women between 20 and 40 who are at low risk and do not have cardiovascular risk factors," said Dodick, who is also director of the Mayo Clinic's Headache Program in Scottsdale, Ariz. The risk of a triptan-linked serious cardiovascular event in for these young, healthy patients is minuscule, he said. Many alternative therapies used in place of triptans may pose higher risks to users, Dodick said. "For example, prescription NSAIDs contribute to 16,000 deaths per year from people taking them to relieve arthritis pain alone -- mostly due to gastrointestinal bleeding," he said. Dr. Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, agreed with the panel's findings. "There's good evidence that triptans are far superior in fighting migraine than whatever else is out there," he said. Silberstein believes there's always a lag time between the introduction of new medications and their use by doctors working in the field. "It usually takes doctors about 10 years to prescribe any new drugs because they weren't taught about them in medical school," he said. The bottom line, according to Dodick, is that scientific evidence backs the use of triptans in healthy patients. "Many of the drugs that are used in medicine carry some risk that's associated with them," he said. "But if the benefit overwhelmingly outweighs the risk, this should give physicians reassurance that these drugs are very safe in properly selected patients." The panel received funding via an unrestricted grant from triptan manufacturers. However, in a statement, officials at the American Headache Society say these manufacturers "had no input and were not in any way involved in the panel's discussions or the development of the consensus statement." More information For information on headache and how to treat it, go to the National Institute of Neurological Disorders and Stroke or the American Academy of Family Physicians.
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