By Peggy O'Farrell
The Cincinnati Enquirer

A new medication could offer relief to some migraine sufferers.

Frovatriptan succinate, marketed as Frova by Irish drug maker Elan, is the latest generation of triptans sold for the treatment of migraine headaches. The drug provides another option for patients who need a longer-lasting treatment for migraine pain.

Lifelong migraine sufferer Nancy Skirvin of Loveland finds relief with Frova. (Glenn Hartong photo) | ZOOM |

Frova is the latest addition to a long line of medications aimed at both preventing and treating migraine headaches, which affect one out of 10 Americans. Many patients try several medications - or combinations of drugs and other therapies - before they find a regimen that works.

But despite an array of treatments, experts say, migraine remains a chronically under-treated and disabling disease that costs employers and workers millions in lost time and productivity.

"I've seen people lose their jobs because of migraines," says Dr. Vincent Martin, co-director of the Cincinnati Headache Center. "I've seen people get divorced because of migraines. I've seen people have abortions because they were afraid they wouldn't be able to care for the child because of their migraines. People need to realize this is a real disease and it's a real biochemical process in the brain."

FROVA FACTS

• What is Frova? Its full name is frovatriptan succinate and it recently was approved treatment for migraine headaches. • How does it work? It curbs excessive dilation of blood vessels. It binds to serotonin receptors in the brain. The binding action makes the blood vessels constrict, alleviating headache symptoms. • What kind of drug is it? Frova is the latest of the triptan medications, which include Imitrex, Zomig, Amerge and others. • What are the side effects? Dizziness, fatigue, tingling, dry mouth, hot flashes, feeling hot or cold, chest pain and indigestion.

Because a migraine is so different for each individual - for some patients the pain is the worst part; for others, it's the nausea - treating it can be tricky. It's not uncommon for a patient to try several medications before finding one that works.

"Migraine is such a diverse disorder. Everybody's a little different in how they present and how they respond to medication," says Dr. Lisa Mannix, a Kenwood neurologist and headache specialist.

Some patients need immediate relief, which is where Imitrex, the granddaddy of all triptans, comes in. Imitrex is injected and stops migraine pain almost immediately.

Some patients can't take Imitrex because it causes unpleasant side effects. Some don't like it because it doesn't last long enough. Frova is a tablet. It takes longer for Frova to take effect, but it lasts longer, doctors say.

Nancy Skirvin, 51, of Loveland tried Imitrex. It made her heart beat too fast. "It was not pleasant," she says.

When Frova was introduced earlier this year, her doctor suggested she try it. "It seems to do the job," she says.

The triptans, which include Imitrex, Frova, Amerge, Zomig, Maxalt and Axert, act by controlling the expansion of blood vessels in the brain. The action of the blood vessels is what causes migraines, but doctors aren't sure of the exact mechanism that causes the blood vessels to swell in the first place. Most blame defective serotonin receptors on nerve endings in the brain. Somehow, the triptans return the serotonin receptors to normal function, the swelling goes down and the pain stops.

Frova and the other triptans don't cure migraines. They stop, or greatly decrease, the pain and other symptoms until the next headache.

Botox, best known for reducing wrinkles, is showing some success in treating migraines. Researchers at the Cincinnati Headache Center are studying it as a migraine remedy. Some painkillers, including Fioricet and Fiorinal, are routinely prescribed to treat migraine pain. Some patients get relief with over-the-counter remedies such as ibuprofen. Non-drug therapies, including relaxation techniques, behavior modification and biofeedback, can help ease migraines. And some supplements, including magnesium, vitamin B2 and feverfew, have helped to reduce migraine frequency in some patients.

Several medications, including anti-epilepsy drugs, antidepressants and beta-blockers, are prescribed to prevent migraines, but they only have about a 50 percent success rate.

"Unfortunately, we don't have anything as good in migraine prevention as we do for migraine attack," says Dr. Seymour Solomon, a professor of neurology at the Albert Einstein College of Medicine in New York City. "We have a lot of medications to choose from, but they're not the greatest. We consider it significant improvement in using these agents if we can reduce the frequency of attacks by 50 percent."

While there are plenty of medications for treating and preventing migraines, headache specialists say too few patients are getting them. The National Headache Foundation estimates that about half of migraine sufferers don't get proper diagnosis or treatment of their headaches.

"Migraine is still markedly under-diagnosed and markedly under-treated," says Dr. Solomon.

"It's a combination of doctors not having enough education and patients not taking it seriously. Patients will come in saying they've got a sinus headache because they've got congestion in their nose, and 99 out of 100 patients who say they've got a sinus headache have a fragment of a migraine that will respond to a triptan."

Many primary care doctors don't have time to do a full history on headache patients. Most experts recommend that people who suffer from chronic headaches keep a headache journal to track their symptoms - where is the pain, how long does it last - and what seems to trigger their headaches. Patients should also note what medication they're taking, how much of it they take and how often they take it.

And, once people do realize they're suffering migraines, it's hard for non-sufferers to understand why migraine patients dread their headaches so much. Migraine is an ugly medley of sensitivity to light, noise and even smells, stabbing pain, pressure and nausea that can last for days and recur several times a month. Some foods - chocolate, pepperoni pizza, red wine, aged cheeses - can trigger migraines. So can stress. So can menstrual periods and changes in the weather.

And it's hard for non-sufferers to understand how a "little headache" can keep someone home from work or school for two or three days or even a week.

"You have to get almost graphic and tell them that you're physically ill," says Martha Stephen of Kenwood. "They don't understand the concept of how a headache could hurt that bad. But they understand the concept that you're nauseous and in the bathroom and throwing up."

E-mail pofarrell@enquirer.com