Migraine patients often hope for the best while denying the worst: Maybe this time it's just a sinus headache or allergies. Maybe I won't be nauseous, blinded by pain, unable to stand up for days. "Many of my patients tell themselves, 'It's just a tension headache. It'll go away,' " says Jan Brandes, a neurologist in Nashville. "But then they're paralyzed, and spend three days in bed." So skip the hope and go right for the drugs. Treating migraines while the symptoms are still mild usually stops the headache in its tracks, according to a study Brandes just presented at the American Headache Society meeting in Vancouver.
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People who suffer from migraines—and there are 28 million of them in the United States—would love to believe that an oncoming headache is really something else. For instance, another study at the headache meeting focused on 100 people who said they suffered from sinus headaches. More than half really turned out to have migraines, reported Eric Eross, a neurologist affiliated with the Mayo Clinic in Scottsdale, Ariz. The misdiagnosis means these people don't get the most effective treatment, he says.
Today, one of the most effective migraine treatments is a drug class called triptans. Migraines seem to get started when blood vessels in the head dilate, causing extreme pain, and triptans shrink them back down. Tests with triptans developed about a decade ago, such as the drug Imitrex, showed they reduced pain in many patients. Brandes wanted to see what would happen if one of the newest, fast-acting triptans, called Relpax, was administered when a migraine was still mild, before symptoms spiraled out of control. "I have migraines myself, and I call it mild when you just feel an aching, nagging pain," she says. "You don't have nausea. It just feels like something is not right in your head. On a pain scale of 1 to 10, it might be in the 1 to 3 range."
She and her colleagues at Vanderbilt University School of Medicine and elsewhere looked at about 600 migraine sufferers ages 18-65. The doctors were trying to see how many people reported they were free of pain two hours after taking a pill. "Two hours is the gold standard. The earlier you feel pain-free, the more likely you are to remain pain-free," Brandes says. Among people who took a placebo, or dummy pill, when their headaches were moderate or severe, only 21 percent felt pain-free two hours later. People with moderate or severe migraines who took real medication, a 40-milligram Relpax pill, did a little better: 39 percent were pain-free within two hours.
But the real difference showed up for people who took Relpax when the pain felt mild: 71 percent felt free of pain within two hours. "Most people get pain-free within one hour, and the headache doesn't return," Brandes says. If more people were aware that mild pain was part of a migraine and took steps to treat it, they could prevent it from escalating and ruining days out of their lives. Brandes notes that the maker of Relpax, Pfizer Inc., funded her study. "But other triptans should also work well if they're given when symptoms are still mild."
There's also a big financial benefit to treating mild migraines: People achieved freedom from pain with just one pill. When a migraine blows up into a full-fledged attack, people take as many as four pills. A six-pill pack of Relpax costs about $92, or $15.33 per pill. Do the math—it shouldn't make your head hurt.
