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