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Migraine News for February 2005


First OTC Migraine Abortive Treatment Now Available at Drug Stores for Migraine Sufferers


Michael John Coleman & Terri Miller Burchfield

WAHINGTON, DC February 15th, 2005 -- "Now I realize not only the full extent of Migraine's severity, but also that I'm not alone in my suffering, and that there are ways to effectively treat Migraine," wrote Shawnra, a young woman who recently discovered MAGNUM's website www.Migraines.org

We founded MAGNUM as a non-profit organization in 1994 for the very reasons suggested by Shawnra's feedback - to promote awareness and understanding of Migraine, to advocate for Migraineurs and to provide accurate and useful information on Migraine disease and its treatment.

MAGNUM has long promoted a "multifactorial" approach to Migraine management.  This approach involves addressing all four aspects of Migraine health care: preventive treatment, trigger management, abortive treatment, and general pain management.  This approach recognizes that addressing only one aspect of Migraine disease is often insufficient for the 32 million people in America seeking to regain control over lives disrupted by Migraine. 

The multifactorial approach recognizes Migraine as the complex disorder it is. Adopting a model similar to that employed in the management of diabetes, we believe effective disease management must include patient education on the disease itself, trigger management, treatment options, and the most appropriate use of those options. Without such education, treatments that might otherwise be effective often fail or, at best, provide less benefit than could be realized.  

Education for the Migraine sufferer should begin by providing a basic understanding of Migraine disease - an important first step in improving the sufferer's quality of life. By recognizing the four phases of Migraine - prodrome, aura, acute attack, and postdrome, individuals can best determine how to employ various treatment options in their disease management. Abortive medications are useful during and immediately prior to the acute attack - pain management medications during the acute attack phase - preventive medications and trigger management to help prevent or lessen the frequency of attacks.

One new treatment option that has recently become available is GelStatTM Migraine. It is the first Migraine abortive available over-the-counter (OTC). While it is important for those with Migraine to be made aware of this medication, our multifactorial approach suggests that each Migraineur will most benefit from any medication only as they better understand Migraine and the medication's possible role in their treatment arsenal.

Focusing on abortive treatments, the mid-90's saw the introduction of a new class of effective prescription drugs called triptans, the first of which was Imitrex® (sumatriptan), introduced by GlaxoSmithKline. Triptans are thought to work by constricting dilated (swollen) blood vessels in the brain that are associated with Migraine pain.

For many Migraineurs, the advent of this drug was a remarkable, life-changing event. For many others, however, the drug (and other triptan-class drugs later introduced) did not prove to be as useful as hoped.  As with any Migraine medication, triptans - for whatever reason - simply don't work for some. Others are deterred by side effects such as heart palpitations and fatigue. For many, however, the main problem is incorrect use of the drug leading to ineffective response and abandonment of what might otherwise be a valuable therapy. Likewise, some might wrongly conclude after a single treatment that "triptans don't work" for them. No medication works for every patient and, even when generally effective, no medication will treat every Migraine attack with the same degree of efficacy.

Therefore, patients must use medications in the most appropriate manner, and must try any new medication more than once before reaching a conclusion as to that medication's possible role in their treatment. Were patients provided with better education on their disease and the appropriate use of these medications, it is likely that triptans would prove beneficial for many more patients, and could be employed as a part of a treatment regimen to help them gain better control over Migraine. Those who have rejected the use of triptans after a single use should consider another trial with this class of medication.

Triptans are available only by prescription, and thus all are expensive for those with high co-payments or whose medications are not covered by insurance. An additional problem arises when purely economic considerations lead insurance companies to limit (wrongly) the number of these valuable drugs that may be obtained by Migraineurs during a given time period.  

Most recently entering the marketplace is GelStat Migraine, the first abortive treatment available over-the-counter (OTC). The availability of an effective OTC abortive is significant, in part, because 60% of those with Migraine rely exclusively on OTC products and over 90% of Migraineurs make use of OTC products as part of their treatment regimen. As an OTC product, GelStat Migraine is less expensive than prescription abortives. Its availability is an important development for those who prefer or employ OTC products and for those whose access to prescription medications such as triptans is limited - either by inadequate insurance or because other medical conditions or side effects preclude their use.

GelStat Migraine is a sublingual feverfew combination product. Sublingual means the treatment is applied under the tongue and is absorbed directly into the bloodstream. This is beneficial because it results in faster relief and because a great many Migraineurs suffer severe nausea upon Migraine onset, sometimes followed by vomiting, either of which can make taking pills quite difficult.  GelStat Migraine retails for around $6.00 a box (and a coupon for $1.00 off is available on the manufacturer's website).

GelStat's OraDoseª System includes not only a patent-pending dispenser, but also a product formulation specifically designed to enhance and enable sublingual delivery. Active ingredients pyrethrum parthenium (feverfew) and zingiber officinale (ginger) are combined with proprietary adjuncts to ensure rapid, effective absorption. GelStat Migraine is classified as a Homeopathic Drug.

"I am very optimistic about GelStat Migraine," noted MAGNUM's Information Services Officer Susan Moeller Denny. Ms. Denny went on to say, "We (at MAGNUM) have already seen promising results from our small sample of Migraineurs who have tried the product. I believe it could be particularly useful in children, those who are highly drug-sensitive and others who have concerns about side effects associated with current drug treatments."

GelStat Migraine is intended for use as a first line, early intervention therapy. As a first line therapy it can be used early and, if not effective for that particular Migraine attack, can be followed by other prescription or OTC medications. While for many it provides relief even when taken later in the course of an attack, it is best employed early - at the first sign of Migraine headache pain or even during the aura phase.

"We have used [GelStat Migraine] on approximately 200 patients and many have found it a very useful addition to their treatment program" noted internationally renown Migraine researcher Dr. Roger K. Cady, Medical Director of Missouri's Headache Care Center and a board member for the National Headache Foundation. Dr. Cady goes on to say "Most use it as their first line intervention and then if need be can rescue with standard treatment.  Patients like this because of its efficacy, extremely good tolerability, and cost savings."

We here at MAGNUM have been working with GelStat to evaluate the product and its effectiveness. As with other sample OTC products, we disseminate them to the Migraineurs on our staff, volunteers, and other Migraineur members of MAGNUM. This is, of course, a non-scientific in-house study. Nonetheless, this offers us a chance to see if we want to consider highlighting an OTC product marketed to Migraineurs. Having said that, we find that many individuals who have used the product report success with it, and plan to continue using GelStat Migraine as part of their overall treatment plan. A typical response is that of a local auto mechanic (and Migraine sufferer), who reports that he finds it more effective than a prescription mediation he has used. 

Author and About.com Migraine & Headache guide Teri Robert, Ph.D. observed "It's especially important to me to have options such as GelStat Migraine now that I can no longer take triptans." A Migraineur, Dr. Robert, who is also MAGNUM's Support Advisor goes on to say, "Standard pain medications, including narcotic analgesic compounds do not relieve my pain, so I'm left with very few treatment options once Migraine pain becomes moderate to severe. I use GelStat Migraine early in the course of a Migraine attack, and find that by doing so I am very successful in preventing the development of full-blown Migraine."

Dr. Sheena Aurora, co-director of the headache clinic at Swedish Medical Center in Seattle reported, "I have used it on approximately 100 patients and have found it to be very useful in practice."  Dr. Aurora goes on to tell us "It sometimes will take the place of their prescription medications which allows them to "save" their drug for a more refractory Migraine."

Dr. Paul Rosen, a New York City family physician and psychiatrist who treats a large number of Migraine patients reports, "I started trying GelStat Migraine on a number of patients, including those presenting with acute Migraine. To my surprise (I tend to be skeptical of new products, particularity OTC ones) many of my patients, including some who were refractory to most other remedies, had a very plosive response to GelStat Migraine. In several instances I was able to treat the acute Migraine in the office to obliteration of all symptoms. Clearly, this product has great potential."

As our young friend Shawnra noted, "Studying full time in college and working a full time job, I don't have the time or strength sometimes to deal with these attacks. Now I can seek treatment and take control of it before it takes control of my life. I'm grateful for your site [www.Migraines.org] for helping me see the light in this matter. Thank you."   We could not have said it better, and we appreciate her praise of our website!

Results will vary. MAGNUM is very interested in hearing your thoughts if you try GelStat Migraine. For more information, contact the manufacturer or visit their website at: http://www.gelstat.com/

View medical study: "GelStat Migraine¨ For Acute Treatment of Migraine Pain and Associated Symptoms" Study By Curtis P. Schreiber, M.D. & Roger K. Cady, M.D. © 2004.