Backpack

SWEET RELIEF

MARK NICHOLS December 16 1996
Backpack

SWEET RELIEF

MARK NICHOLS December 16 1996

SWEET RELIEF

HEALTHWATCH

The piercing pain flares on the left side of John Webb’s head and, left untreated, can force the 47-year-old Halifax civil servant to remain for days in a darkened room with cold cloths pressed to his skull. Webb’s migraine headaches began when he was 4 and, until a few years ago, his only relief came from overthe-counter remedies that merely dulled the pain. Then, in 1994, his doctor prescribed a powerful new drug called Imitrex, which can cure most—though not all—of Webb’s headaches. “It’s made a big difference to my life,” says Webb. He is not the only one. After years of suffering, a growing number of Canada’s 3.2 million adult migraine patients are finally gaining a measure of control over their headaches as a growing understanding of their mysterious malady enables scientists to design better, faster-acting drugs. Imitrex, which became available in Canada in 1992, has already made a huge difference for thousands of sufferers. Says Dr. Gordon Robinson, a Vancouver neurologist: “You can pretty well divide migraine treatment into before and after Imitrex.”

Other new drugs are expected to reach the market soon, thanks to scientists’ progress in unravelling the intricate chain of events inside the brain that produce migraines. Doctors have known for years that migraines run in families, and last month Dutch scientists identified a gene that could yield important new insights into migraines. Meanwhile, drug companies are scrambling to emulate the success of Imitrex, developed by the British-based drug giant Glaxo Wellcome after researchers discovered a protein that plays a key role in causing migraines. Another new migraine product was introduced last month when Montreal-based Sandoz Canada Inc. began marketing a fast-acting nasal-spray version

of an older medication called DHE (for dihydroergotamine).

The sudden surge of drug-company activity is just one of the trends that is making the lives of migraine sufferers less painful. Another welcome development is the gradual crumbling of the stigma that branded migraine sufferers as victims of their own neuroses. Says Dr. Werner Becker, a Calgary neurologist: “This is a physical illness with a neurochemical basis that can result in significant disability.”

The latest clue turned up by Dutch scientists could prove equally important. What University of Leiden researchers found was a defective gene that causes migraine headaches accompanied by temporary paralysis on one side of the body. That form of migraine is extremely rare. But the Dutch finding may have wider implications, because the gene’s normal function is to create calcium channels on cells. That might explain why some migraine sufferers fend off attacks by using calcium channelblocking drugs originally designed to treat heart problems. Rune Frants, the geneticist in charge of the Dutch team, thinks it is likely that the same gene plays a role in other types of migraine. Says Frants: ‘We believe this is extremely important.” Even with the advent of better medication, ¡2 some migraine patients’ ÿ headaches seem unbeatable. Gloria Daly, a Toronto technical instructor in her 40s who had to stop working two years ago, has tried dozens of drugs— without finding anything that really helps. “The pain is like something being hammered straight into my head,” says Daly. “I get angry that nothing has been found that will stop the pain.” Now, as scientists come closer to cracking the mystery of migraines, lasting relief for even the hardestto-help cases may finally be in sight.

The lives of migraine sufferers can be a nonstop ordeal. Attacks, frequently accompanied by nausea and vomiting, can be set off by changes in the weather, lack of sleep or a missed meal—or by a variety of food triggers that vary among individuals and include chocolate, cheese, nuts, food additives, some vegetables, red wine and other alcoholic drinks. About two-thirds of sufferers are women between 25 and 45. But migraines can strike people of either sex at any age. Eight-year-old Julian Bowers, who lives

in Gibsons, 40 km northwest of Vancouver, endures three-day migraine attacks almost every week (because of his age, doctors are reluctant to give him prescription drugs). “The headaches hurt a lot,” says Julian, “and my stomach gets upset—both at the same time. It’s pretty awful.”

During the past decade, scientists have made progress in discovering clues to the neurological events that cause blood vessels in the scalp and brain lining to expand and, by pressing against nerve endings, bring on the lacerating pain of migraine. One of the biggest breakthroughs came in the mid-1980s when researchers in the United States and Europe found that the process could be interrupted by targeting certain blood-vessel proteins. These proteins can trigger a chemical cascade that in turn leadè to migraines—a discovery that made Imitrex possible.

MARK NICHOLS