Headache Remedies for Billionaires
Regular readers of this blog know headache is an important issue here. That’s partly because it’s the only thing I sometimes suffer from as well as billions of people all over the World. Nearly every drug features headache among its adverse effects, although I’ve always believed that, in this case, part of the problem lies in the irrational fear that many experience once they’ve swollen their prescription drugs: they believe so firmly they’re going to have nasty adverse effects, they immediately feel ill or sick (nausea comes close second after headache as the most common reported drawback).
There is an amazing class of drugs, which has rapidly become the drug of choice to treat acute migraine attacks but, for some reason, I’ve never properly “reviewed”: Triptans.
Perhaps, however, it’s not too late as the patents for most of their preparations are all about to expire in the next two years and, therefore, generic Triptans are likely to become a massively (ab)used headache remedy.
Let’s start from what usually comes last: drawbacks. Amazingly, despite being as effective at relieving acute migraine as dangerous ergot alkaloids, Triptans present a set of almost innocuous adverse effects, which encompasses mild sense of warmth, dizziness, weakness and minor muscular pains (especially whenever parentally administered at the injection site). The main problem with Triptans, hence, isn’t their toxicity, but is rather a direct consequence of their mechanism of action, which makes them contraindicated to people suffering from angina or coronary artery disease, as Triptans are capable of triggering vasospasms.
Like ergot derivatives, in fact, they induce vasoconstriction of meningeal vessels through selective agonism on serotonin receptors. This counterbalances the characteristic vasodilatation of cerebral and meningeal vessels taking place during migraine episodes. Both ergot derivatives and Triptans are symptomatically helpful as they also act as serotonin agonists on pre-synaptic terminations of the trigeminal nerve, which, in turn, leads to the inhibition of the release of CGRP and substance P, which would otherwise stimulate vasodilatation.
However, because their spectrum of action is limited to serotonin receptors, Triptans amazingly manage to deliver all this without the uncontrollable power of Claviceps Purpurea’s products.
Nevertheless, a subcutaneous injection might be appealing only if looking at very high bioavailability as it is, by a large margin, the least liked by patients. And although a spray is a nice alternative, the research on these compounds focused on increasing oral availability and, fortunately, it has produced a number of derivatives which covers a range that goes from 40% (Zolmitriptan) to 74% (Naratriptan).
All this amazingness, predictably enough, doesn’t come cheap, with generic formulation oddly not hitting the market yet. In particular, you would imagine that because its patent expired in 2006, injectable Sumatriptan is available in low-cost version(s) or, at least, it has become cheap. You are badly wrong: surfing through Drugstore.com you find out 5 vials of Imitrex (American, commercial name for the oldest of the Triptans) can be yours for $366.23 and nine 25 mg tablets (lowest dosage available) are only $202.97 (thanks to a special offer), which means each tablet costs more than $20 and other Triptans are only marginally better on this front, with an average cost of $10 per dose. Maybe 2009 will be the turning point as Sumatriptan won’t be “protected” by any patent any more.
In the meantime, if you have headache and your name isn’t Donald Trump, you’d better stick to aspirin.
Imitrex was remarkably effective. I used to get bad headaches (out of commission headaches), perhaps as you have experienced, and this drug worked wonders (9 out of 10 times). Granted, nobody wantes to inject themselves and the first 10-20 mintues after injection made me feel 10x worse, followed by soothing warmth and headache was gone with minor "sluggishness", probably more of a don't shake the boat syndrom though. Diet works (especially liquids) wonders for headaches. I wish frequent (or infrequent migraines) on no-one.
Well, I usually suffer from headaches on Saturday mornings (i.e. tomorrow morning) after going out on Friday nights (that will happen in about two hours time from now) to drink my misery away. In these cases I found that lots of coffee and an abundant brunch is the remedy of choice, but maybe I should try one of those indoles if that doesn't help (althugh alcohol-induced headache could perhaps be a different case...).
Too tired for going out tonight: 5 days of 10-hours-long chromatin immunoprecipitation have worn me out (and caused me headache on Thursday too).
Tonight is just hot bath, TV and perhaps writing something for the future.
Thank you for sharing your personal experience, fng.
As a retired neurologist who used tons of triptans (and also ergots) to treat migraines -- several points
l. They work well for many (but not all)
2. They ARE vasoconstricting drugs and should NOT be taken by people over 50, as everyone over 50 has some degree of atherosclerosis (e.g. boiler scale in the pipes), even those without symptoms.
3. As a chemistry grad student in the 60s, I had the pleasure of hearing Albert Hofmann describe his adventures after inadvertently making LSD in the lab while working on bigger and better headache remedies