effective as a treatment for the headache itself . Lidocaine drops or nasal sprays have been used to treat cluster headaches .”
Sumatriptan patches that use a tiny electrical current to deliver sumatriptan through the skin are also under development , Dr . Cady notes . The disposable patch works by applying a mild current to the skin , through which medicine flows to the tissues . The Headache study revealed that the patch could bring relief from nausea within one hour and relief from migraine in two hours . NuPathe ® , whose previous transdermal sumatriptan patch Zelrix™ was not approved by the FDA , is currently developing a new patch called NP101 SmartRelief™ that has not yet hit the market .
Another delivery method still under investigation is anti-inflammatory gel . The gel contains ketoprophen , a nonsteroidal anti-inflammatory drug ( NSAID ), and can be rubbed on the gums during a migraine attack . Researchers have been investigating the theory that the NSAID in the gel will interfere with pain signals running along the trigeminal nerve , which has branches in the gums . “ If researchers are going to conduct studies on the gel for treatment of migraine , they ’ re going to have to show that it actually relieves migraine , not just the symptoms of migraine , in order to get FDA approval for the treatment of migraine ,” Dr . Cady says .
Whether you ’ re treating headache or associated symptoms , Dr . Cady says the most important thing is to keep multiple tools at your disposal to treat each headache type . “ Most of my patients have a tablet that ’ s their mainstay of treatment , but it ’ s an uncommon situation that a pill is the only tool a patient needs ,” he says . “ Health care professionals and patients need to discuss those times when their migraine medications didn ’ t work as well as they ’ d hoped . In that discussion , the need for alternate delivery methods becomes obvious . I try to build a therapeutic toolbox for my patients so they know how to select the right therapy for each headache .” HW
RENDERING COURTESY OF E-ALGOS
A Stimulating Treatment
Headache disorders are prevalent , and while medical therapy provides relief to many headache sufferers , a significant number find their headaches unresponsive to treatment .
A new therapy shows promise for people with headache who are unresponsive to medical therapy : occipital nerve stimulation ( ONS ). The treatment , discussed in the January 2012 issue of the journal Therapeutic Advances in Neurological Disorders , was first used in 1999 . It requires surgery to place electrodes in the back of the neck that connect ( via a thin wire ) to an implantable battery-driven pulse generator elsewhere in the body . The patient then controls the rate and intensity of pulses by using a handheld control .
Several studies have shown ONS to be beneficial . In one study of 25 people with treatment-resistant migraine , 88 percent reported at least a 50 percent reduction in headache days after the device was implanted . In a study of eight patients with cluster headache , 15 months after the ONS procedure , two patients reported their pain was gone ; three reported a 90 percent reduction in the frequency of attacks ; two had improved about 40 percent , and one person reported no benefit .
While the treatment shows promise , more information is needed regarding the most effective surgical techniques , the optimal electrical stimulation and which patients would benefit most .
BY THE NUMBERS
Of headache patients treated with Botox ® in a recent study :
47 % had at least a 50 % reduction in headache days
after 24 weeks
68 % had a 50 % reduction in headache days after 56 weeks
14 % had injection site pain 2.7 % reported adverse events ( negative side effects )
Source : January 2012 issue of the journal Headache
www . headaches . org | National Headache Foundation 11