Headache Therapy Reaches Threshold

After years of suffering, Stephen Silberstein finally discovered that the throbbing in his head was a migraine headache. And he didn’t learn that by going to a doctor, but rather by listening to his own patients.

He is Dr. Silberstein, a neurologist, who came to diagnose his own malady only by comparing his symptoms with those of his migraine patients. This curious lapse is a classic example of how medicine has given headaches short shrift despite their widespread prevalence.

“In medical school, they stressed interesting rare conditions like myasthenia gravis, but I don’t think we had more than one lecture on headaches,” Silberstein said. “In practice, you’re lucky to see one patient a year with myasthenia gravis, but several every day have migraines.”

Medical science’s tendency to ignore the plain old boring yet excruciatingly painful migraine headache is over, and what was once too mundane for researchers to fuss with has become a hot new topic of study that promises to deliver a black bag full of potent new remedies in the next few years.

One drug company considers this new information so important that it has constructed an amusement park ride to drive home the message when the American Academy of Family Physicians holds its annual meeting next week in Chicago.

Doctors will be invited to step inside a flight simulator and take a ride through the brain on something called the “Trigeminal Express,” which provides a view from inside the brain of the nerve system and chemical receptors thought to play a pivotal role in migraines.

The fact is, said Silberstein, a professor of neurology at Thomas Jefferson University Hospital in Philadelphia, most family doctors haven’t heard about the new migraine research and don’t have time to keep up with developments in neurology, cardiology and all the other research specialties that constitute modern medicine.

Attracting attention at a meeting of 15,000 physicians who spend their days attending lectures and staring at slides, posters and TV video programs isn’t easy.

“If we can get their attention with the gimmick of getting into a simulator for a ride, then we can educate them about migraines, and that’s what is important,” said Silberstein, who helped produce information for the simulator, which is sponsored by Zeneca Pharmaceuticals, a British firm.

While the medium may be a bit unconventional, the message is solid, other neurologists said.

Even though scientists don’t yet fully understand how migraines are made, they have enough confidence in new theories to discard the widely accepted notion that migraines stem from blood vessel spasms. Migraines are neurological disorders related to an imbalance in the brain chemical serotonin.

“There’s no question that there is an absolute explosion in neuroscience research, including migraines,” said Dr. Judd Jensen, professor of neurological sciences at Rush-Presbyterian-St. Luke’s Medical Center in Chicago.

“Speaking as a specialist, I find it difficult to keep up with the developments, and I don’t know how primary care physicians do it with so many fields to follow.”

In the current era of managed care, though, family doctors are called upon to treat more afflictions themselves and often find insurance companies don’t allow them to refer patients to specialists for conditions like migraine headaches.

“It’s very clever of this drug company to target family physicians for education about migraines, because they are the ones who make treatment decisions,” said Dr. Michael Merchut, an associate professor of neurology at Loyola University Medical Center near Maywood, Ill.

“The great thing is that we now have a scientific rationale for what we’re doing,” he said.

There have been real breakthroughs in disproving accepted wisdom about migraines in the past two years, said Dr. James Tonsgard, a pediatric neurologist at the University of Chicago.

“There are now people within neurology departments across the country who specialize in headache treatment,” he said. “That is a relatively new phenomenon.”

The drug company sponsoring the migraine simulator, Zeneca, has some new migraine drugs in the final phases of testing and hopes to raise physician awareness of new developments in the field so they will be receptive to using new drugs when they are available.