Week: 609.6 Pt. 2
Guest: Dr. C. Phillip O’Carroll, Neurologist, migraine specialist
O’CARROLL: The history of migraine....it’s probably the oldest medical
condition ever described, I think the first mention of it is about 8 thousand years ago,
in some ancient codec. So, human beings have been suffering from migraines from ancient
times. And it is a truly terrible affliction; it is a biologic disorder, it is genetic,
and it leaves the sufferer not only with a violent headache, but with nausea, vomiting,
and in many cases, an inability to function. And they say there’s perhaps 26 to 30
million Americans who suffer from this disorder. And these are usually relatively young
people, highly functional, mothers taking care of little kids, or executive going to about
their work. And it strikes and can incapacitate them. I think one study shows that
there’s about 4 to 5 million Americans who cannot work one to two days every month
because of migraine.
NEMA: What about the causes of migraine?
O’CARROLL: Well, a good way to think of migraine is that you inherit a genetic
tendency. When I’m explaining it to my patients, I say, "Well, it’s like
someone has given you a stick of dynamite in your genes". So, genetically,
you’re kind of loaded. But, that doesn’t mean to say that you’re
predestined to have a headache every day of your life. You need the trigger, you need the
match...and the match comes in the form of fluctuations in hormones for the women, which
is why the overwhelming majority of patients going to a headache clinic are female,
because of the fluctuations in hormones. Stress and one’s environment...sometimes
just strong smells - perfumes, strong lights, climatic changes - going up into altitude,
certain foods...all can be the match that activates the dynamite. And once this stick of
dynamite has exploded, so to speak, then a complex series of events occurs within the
brain, within the blood vessels...and I won’t bore you with all those details, but
suffice it to say that the end result is that you’re left with the blood vessels of
the head swollen, dilated, and extraordinarily painful. And this medicine, imatrex, that
was developed, is really the first antidote for migraine, because not only does it cure
the pain....many drugs in the past have done that - narcotics, etc... But imatrex works by
actually relieving the blood vessels’ dilatation, or swelling. It tightens the blood
vessel, it constricts them...and that’s the mechanism of how it works. So, think
about it as an antidote, or a designer drug that does one thing...it tightens or
constricts the blood vessels of the head and neck.
NEMA: Tell me more about the drug itself...
O’CARROLL: Imatrex is....it’s generic name is sumatrypten, and for all the
health care professionals listening, pay good attention to the ‘trypten’.
Because in the next decade, we’re going to see a tremendous amount of medicines
released with this title of ‘trypten’. But the prototype, the first one, is
Imatrex, or sumatrypten. And basically is as follows: there’s a very powerful
chemical neurotransmitter in our brain, in our bloodstream, called seratonin. And
seratonin has a pivotal effect on mood and pain control... and it has been known for
generations that if you can give seratonin in the middle of an attack, that you can stop
the attack. The problem is seratonin has so many effects on the body, that very frequently
you would create unbearable side effects. So, from the early 70’s, the hunt has been
on for a medicine that mimics the biologic effects of seratonin, but does so in a very
selective way. And it was quite frankly thought to be impossible. But we have now evolved
a medicine that activates, or locks onto only the blood vessels of the head and neck, and
tightens them, and that is the method by which it relieves the pain...and fortunately does
not interact with blood vessels elsewhere in the body. So, it’s a very selective
mimicker, if you will, of seratonin.
NEMA: So, Imatrex is pretty widely used....and is something a migraine sufferer can
talk with their doctor about?
O’CARROLL: Yes, when it was first released, Steve, back in 1992, it was in the
form of an injectable. And then in ‘95 it came on the market as a tablet. And the
excitement recently has been due to the arrival of the nasal spray, which has been
available for about a month. And the reason people have been excited about it is that
it’s faster acting than the tablet, and does not have the unpleasant effects of the
injection...and by that I mean that some people are just downright paranoid about needles,
and no matter how bad a problem is, they will not inject themselves. So, the spray offers
almost the speed of the injectable, but without the discomfort.
NEMA: When someone comes to your headache treatment center, what are the other types of
treatments you use?
O’CARROLL: The medicine is a tremendous ally, but it is part of the team approach.
Much of the time, patients are taking too much over-the-counter medicines: aspirin
containing compounds, caffeine-containing compounds...and they’re actually suffering
from so called ‘rebound’ headache, where the actual medicine is causing the very
problem they’re trying to solve. So, we try to get them off of all harmful medicines,
get them off of all narcotics, get them into a physical exercise program, aerobic exercise
program. We get them into the hands of a psychologist - not to do any extensive
psychotherapy, but to give them a few sessions on how to handle stress. Because you know,
one of the problems with the chronic headache sufferer, unfortunately, is that we all tend
to be very perfectionistic, very compulsive, hyper-responsible type of individuals. So,
giving us a little handle on stress is very, very important.
NEMA: You may have seen ads for Imatrex on TV...and there are disclaimers advising
there are reported side effects...and though Dr. O’Carroll hasn’t found them in
his patients, you must talk about these with your physician. Our thanks to Dr. C. Phillip
O’Carroll...who, by the way put me in touch with a distant relative in Ireland, with
whom I share a last name who has extensive genealogy on our family.
Thanks for joining us for today’s program. If you have any comments or
suggestions, contact this station. Or visit our home page at:
...for a look at transcripts of this or past programs, or to find out more about the
National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.