Blast up the nose to ease migraine agony fast
ADEVICE that uses gas to blast medicine up the nose could help treat migraine.
The hand-held gadget contains a propellant, a liquid that turns into a gas, to fire tiny molecules of a pain-killing drug deep into the upper nasal cavity. This area is packed with tiny blood vessels, called capillaries, that are able to absorb medicine rapidly, providing quick relief for migraine sufferers.
Tests show that within 20 minutes of using the nose blaster, which is about twice the size of a standard nasal spray, patients get the same relief as they would if the same painkilling medicine was injected.
Migraines affect around one in ten people. An attack can last up to 72 hours and might be preceded or accompanied by flashes of light or aura, tingling, nausea and increased sensitivity to light and sound.
Patients are usually prescribed triptans, that can be pills, injected or sprayed up the nose. These can’t prevent attacks but help alleviate symptoms. The issue with pills is that they are broken down in the stomach and gradually absorbed into the bloodstream. This can prolong the time it takes to get relief.
Injections are rarely popular because of discomfort, and existing nasal sprays deposit much of the drug in the nostrils, where there is much less absorption because of fewer blood vessels.
CONVENTIONAL nasal sprays rely on a manual pump to squirt liquid medicine up the nose. This limits the effectiveness, so only about 5% to 10% of the medicine reaches the upper nasal cavity, where it is more likely to be quickly absorbed.
The new device, developed by US firm Impel Neuropharma, not only acts as a powerful propellant, but it also contains a more powerful painkiller that until now has only been available in injection form. The device contains three chambers — one holds liquid dihydroergotamine, a powerful painkiller sometimes used to treat severe migraine.
Another chamber contains a liquid called hydrofluoroalkane, the same propellant used in modern asthma inhalers to propel droplets of medicine deep into the lungs. The patient places the gadget’s nozzle into either nostril at the first sign of a migraine.
At the press of a button on the device, a small dose of the drug is released from its storage chamber into a third ‘mixing’ chamber; at the same time, a tiny amount of hydrofluoroalkane is pumped from its chamber into this mixing chamber, where it instantly gets turned into a pressurised gas.
Pressing a second button blasts the pain-killing medicine in a fine aerosol stream through the nostril into the upper nasal cavity. The whole process takes a couple of seconds. Testing the gas-powered gadget is still at an early stage. But the results of a small trial on 36 migraine patients by the company (but not yet peer reviewed and published in a journal), showed those using the device had similar levels of pain relief within 20 minutes to those who had the drug injected.
The company now plans to investigate whether it could also be used to improve delivery of drugs for Parkinson’s and other diseases that affect the brain.
Dr Andy Dowson, a headaches specialist, said inhaling the drug with the device could in principle bring rapid pain relief if larger trials show it works.
He said: ‘The question is, how good is the delivery system?’
MEANWHILE, a new injection can also reduce migraine attacks. In a trial, around 1,100 patients were given monthly or quarterly injections of fremanezumab or placebo, and monitored for three months.
Fremanezumab is thought to work by blocking a chemical called CGRP (calcitonin generelated peptide) to prevent blood vessels on the surface of the brain dilating during a migraine attack, triggering pain.
Results showed those who were given the drug had significantly fewer days with headaches, according to the New England Journal of Medicine. Further studies are planned.