In a recent publication in the international headache journal Cephalagia, a renown group of headache researchers published an article which, among headache circles, is at the same time both ground-breaking and controversial. In it, they showed that sumatriptan (commonly known as Imitrex) has a significant constrictive (narrowing) effect on the small blood vessels in the scalp. While at first glance this doesn’t seem very noteworthy, it is, and I’ll explain why.
Triptan medications are a mainstay of treatment of acute migraine, and are commonly thought to act within the brain to alter the perception of pain in migraine headache. Its action on blood vessels within the brain has been debated. It has been shown that during a migraine attack, the blood vessels within the brain (specifically the middle cerebral artery) were unaffected by Imitrex but many headache doctors think that Imitrex affects pain receptors in the vessels and nerves and that this affect is responsible for the pain relief patients get from it.
Now, however, in this small study of 18 healthy patients, it is clearly demonstrated that Imitrex exerts its effect mainly on the blood vessels OUTSIDE the brain – in the SKIN of the head. This data was convincing enough that the authors stated that they no longer think that Imitrex enters the brain in high enough levels to exert any effect within the brain at all, and instead acts solely on outside tissues. There is still some question whether Imitrex acts on nerves outside the brain (the trigeminal nerve), but this was not addressed in this study.
Why this is exciting for migraineurs and cluster headache patients everywhere:
It has long been thought by some headache specialists that dilation (enlargement) of arteries of the scalp is responsible for the headache pain felt in many types of headache. A group in South Africa has been performing arterial ligations for migraine and cluster headache for years, and has amassed a group of patients numbering well over 1000 whose headaches have largely been eliminated. Personally, I have recently begun using their techniques myself, and have been astounded that each and every patient who has been a candidate and undergone arterial surgery has seen complete elimination of their headaches with a relatively quick outpatient procedure. I have even done a few of these procedures with local anesthesia alone in the office.
Who will benefit from arterial surgery?
I’ll be the first to admit that not every headache sufferer needs surgery. However, based on the results of this recent study on the effects of Imitrex and the long-term surgery results published by Dr. Shevel in South Africa, I feel that there is a growing group of patients who may benefit. If Imitrex helps control or eliminate your headaches, or if there are specific spots on your head that you can press to briefly eliminate your headache pain (or if a tight hat or headband helps), then arterial surgery may help reduce or eliminate your need for medication. Click over to the headache pages of the website or contact me through the “Learn More” box to see if this option may be right for you.