When Judy comes down with a migraine headache she cancels all her appointments and hibernates for three days. The pain is so overwhelming she doesn't bother to cook, answer the telephone or open her mail.
At least Judy gets a migraine only three or four times a year. Barbara has bouts of unbearable pain almost every week. She has considered suicide and even went so far as to purchase a gun.
We made her promise not to use this drastic last resort until she's had a chance to try sumatriptan, an effective new migraine medicine that should become available soon.
Those of us who only experience an occasional tension headache don't appreciate the agony people like Judy and Barbara suffer. First there may be a visual aura _ gold or silver lights flashing almost like lightning.
Some people see shimmering colors or geometric images that float by during the 20 minutes to two hours that it lasts.
Others may actually lose partial vision in one or both eyes.
In some people, the principal warning of an oncoming migraine is nausea and vomiting. Others feel a numbness or tingling sensation that works its way from fingertips to shoulders over 10 minutes.
Over the next several hours the headache builds in intensity. Light, smells or sounds may become exceptionally bothersome. The sufferer often becomes irritable and unable to concentrate. He may not want to do anything but climb into bed and sleep until it goes away.
Until now the best treatment doctors could offer for an acute attack was the drug ergotamine. To be effective it has to be taken early, before the headache has established a firm foothold.
But people who are nauseated can have a terrible time keeping the pills down. It's not always well absorbed from the stomach, so many patients must resort to a suppository containing ergotamine and caffeine.
Overuse of this medicine can lead to rebound headaches and other serious adverse effects. It can cause constriction of blood vessels leading to numbness and in the worst case, gangrene. Ergotamine may also produce nau-sea, vomiting, weakness and changes in heart rate.
Although ergotamine can be helpful for some, not everyone benefits. A new medication, Imitrex (sumatriptan), may be far more effective.
Studies indicate that more than three-quarters of migraine victims get rapid relief when Imitrex is administered by auto-injector. Americans may be a little queasy at first about giving themselves a shot, but if the benefits experienced by Europeans are any guide, even timid souls might become enthusiastic.
Imitrex works by affecting a substance in the brain called serotonin. This chemical messenger appears to be involved in migraine headaches in several ways, so interrupting the cycle is an important new advance.
Side effects have generally been mild and temporary. Feelings of warmth and tingling have been reported. Other people have noted sensations of heaviness or pressure, especially on the chest or neck. Some researchers worry, however, that patients with high blood pressure or heart problems may be at increased risk of angina.
The Food and Drug Administration is expected to approve Imitrex shortly. For millions like Judy, it should improve the quality of life dramatically. And for those few as desperate as Barbara, it could literally be a lifesaver.
Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert. Their newest book is Graedons' Best Medicine (Bantam Books).In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of: the Times, P.O. Box 1121, St. Petersburg, FL 33731-1121.