expectations Patients’ expectations influenced the effects of both medications and placebos in a recent study and highlighted the importance of the power of suggestion in the field of medicine. Researchers studied 66 migraineurs over the course of more than 450 migraine attacks and found that when they provided positive information about a placebo and the common migraine medication Maxalt (rizatriptan), the effectiveness of both increased. This observation suggested that a positive message and a powerful medication are important in improved quality clinical care.

Adolescents who suffer from migraine may find relief with a combination of sumatriptan and naproxen sodium (suma/nap), according to a study published online last month in Pediatrics. Researchers studied 600 teens, ages 12 to 17, who experienced two to eight migraine attacks per month for at least six months. The first migraine during the study period was treated with a placebo. If the pain persisted two hours later, the teens were assigned to a placebo group or to a group receiving different doses of suma/nap: 10/60 mg, 30/180 mg or 85/500 mg. Researchers then evaluated who was pain-free two hours later.

Approved by the FDA in July, SUMAVEL DosePro is being launched this month by Zogenix in partnership with Astellas. The first-of-its-kind needle-free injection system delivers a liquid form of sumatriptan (Imitrex®) directly through the skin (subcutaneously). It is indicated for the acute treatment of migraine attacks, with or without aura, and the acute treatment of cluster headache episodes in adults.

By Donald W. Lewis, M.D. Pediatric Neurologist, Children’s Hospital of The King’s Daughters, Norfolk, Virginia Doctor: “Pretend that you are a firefighter.” Child: “Okay.” Doctor: “Which is easier for you to put out, a small brush fire or a raging forest fire?” Child: “The small brush fire!” Doctor: “Okay, think of your headaches as fires. It is much easier to put out a small headache as it’s beginning, than a big one that has been hurting for hours or days!”

Migraine occurs more often in women than in men. Although migraine headaches are equally common in young girls and boys, the number of girls affected increases sharply after the onset of menstruation. It seems clear that certain hormonal changes that occur during puberty in girls, and remain throughout adulthood, are implicated in the triggering and frequency of migraine attacks in women. The finding that 60% of women sufferers related attacks to their menstrual cycle supports this link between female hormone changes and migraine headaches. Attacks may occur several days before or during the woman's menstrual period. There are women who also get the headache mid-cycle, at the time of ovulation. Estrogen levels fluctuate throughout the menstrual cycle. The headaches typically occur in association with drops in the estrogen level. Few women (less than 10%) have headaches only with menses. Therefore, in most women, hormones are just one of many migraine triggers.

More than 29.5 million Americans suffer from migraine, with women being affected three times more often than men. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70% to 80% of sufferers have a family history of migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider. Migraine is often misdiagnosed as sinus headache or tension-type headache. Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.

Zomig® is in a class of medications known as the "triptans." It is a specific medication for aborting migraine headaches. Zomig® is indicated for the acute treatment of migraine in adults. It is not intended for the prophylactic treatment of migraine and Zomig® has not been approved for the treatment of cluster headache. Zolmitriptan has been available in the United States since 1997. Currently it is available in 2.5 and 5 mg tablets as well as a nasal spray. It is also available as Zomig-ZMT 5 mg which is an orally disintegrating tablet that dissolves on the tongue without water. This formula is particularly helpful when nausea and vomiting accompany the migraine pain.

Relpax® (eletriptan hydrobromide) is used for the acute treatment of migraine. Relpax® is in the class of medications known as triptans. More than 9,000 patients participated in the clinical trials and they treated in excess of 70,000 migraine attacks. Relpax® was effective in relieving migraine...