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Doctors test eye drops for glaucoma to relieve migraine attacks

September 15, 2014


KANSAS CITY — For migraine sufferers who’ve had a hard time taming the throbbing pain of migraine attacks, two Kansas City-area eye doctors are suggesting a new route to relief.

It’s the eye drops that they’ve prescribed routinely for years to their glaucoma patients. Although more research is needed, for at least some people one or two drops in each eye just at the start of an attack appears to stop migraines in their tracks, the doctors say.

In the latest edition of the journal Missouri Medicine, ophthalmologists Carl V. Migliazzo and John C. Hagan detail the experiences of seven patients who’ve gotten complete or nearly complete relief from their migraines by taking the eye drops.

All of the patients are women, as are most migraine sufferers. Some use the eye drops alone; others take them along with conventional pain medications. All had suffered from migraines for years, even decades, before trying the eye drops.

One 61-year-old in their report has had migraines for about 30 years. They start on the right side of her head with throbbing pain that radiates to her neck and shoulders. Left untreated, the migraines can last as long as two days.

The woman had tried medications but had stopped taking them because they didn’t provide enough relief. The eye drops, she said, eliminated the pain.

Migliazzo said he discovered this use for the drops through serendipity more than a decade ago. One of his specialties is glaucoma, a condition in which fluid buildup in the eyes can destroy vision. The drops reduce production of the eye fluid, and Migliazzo prescribed them routinely.

"People would report to me spontaneously. ‘You know, doctor, my headaches started getting better after I started on this medication,’" he said.

Since then, Migliazzo has prescribed them to eye patients who complain about migraines. He has recommended them to nurses with whom he works.

"My wife uses them," he said. "She swears by them. She keeps them in her purse."

But the eye drops can’t be considered a sure thing, as the doctors themselves are quick to admit.

Migliazzo and Hagan haven’t reported any data on how often the eye drops actually work. And among the patients who said they were helped, there’s always the possibility that the placebo effect played a role in turning the eye drops into a migraine killer — even sugar pills can reduce pain if you’re told ahead of time that they will be effective.

"Case results like this aren’t really science," Migliazzo said. "It’s all anecdotes, and anecdotes people don’t pay much attention to."

Migliazzo wants to see the eye drops put through controlled studies, where migraine sufferers get the real drops or "sham" placebo drops so the effects can be compared. "It doesn’t have scientific validity unless it’s controlled," he said.

Migraine attacks may start with flashes of light or visual disturbances that give the appearance of looking through a broken mirror. Then comes pain, like an explosion in the head. Along with the throbbing headaches may come nausea and vomiting.

There are about 38 million migraine sufferers in the U.S. That includes about 18 percent of women and 6 percent of men. While some people experience migraines only occasionally, chronic sufferers may have several per month or many more.

The dozens of medications used to treat migraines range from over-the-counter ibuprofen to prescriptions that can run more than $30 per pill. But patients often have a hard time finding satisfactory relief. They may try alternative treatments such as acupuncture, chiropractic care, special diets, even copper bracelets.

One survey found that nearly 80 percent of migraine sufferers were willing to try new treatments.

The eye drops may have a number of things going for them. Their long history in eye patients has shown that they’re safe, and the side effects, aggravating asthma and lowering the heart rate, are already well known. And they’re cheap. The drops go for about $4 per bottle, a small fraction of the cost of some popular migraine medications. 

There also is a reasonable scientific explanation for why the eye drops may work, and that’s attracting the attention of researchers. Hagan has been in contact with a neuroscientist in Luxembourg about pursuing a study. And a neurologist at the University of Kansas Medical Center also is expressing interest.

"I feel it would be a good project for our team," said KU neurologist Manoj Mittal. "It has a good rationale behind it."

That’s because the drops contain beta blockers, a group of drugs first developed to treat high blood pressure and other heart conditions. 

Through another case of medical serendipity, beta blocker pills have become a first-line drug for the prevention of migraine headaches. During a study of one beta blocker, a patient told researchers that he not only had fewer chest pains, but fewer migraines as well. His migraines returned only after he was switched to a placebo.

About 50 percent of migraine sufferers who take beta blocker pills are able to reduce the number of migraines they experience each month by more than half.

But research has failed to show any benefit from the pills for stopping migraine attacks once they’ve started.

The beta blocker pills may not get into the bloodstream fast enough to stop a migraine, Mittal said. But the eye drops quickly drain into the nose, where they’re rapidly absorbed into the bloodstream through the mucus membrane.

"If you can get something in their system as soon as possible, you have a better chance" to stop migraine attacks, Mittal said.

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Mittal would like to run tests to see what dose of the eye drops is most effective, and whether it’s quicker and safer to put the drops in the eyes, under the tongue or sprayed into the nose. After those questions are answered, it will be time to match the eye drops against a placebo to see how well it works.

"It sounds like it deserves further study. It may be an inexpensive way to treat an attack," said Cathy Glaser, founder and president of the Migraine Research Foundation. "But is it a slam dunk? No. I don’t think so."

There are many kinds of migraines with many different symptoms, so a variety of drugs is required, Glaser said. 

Glaser said Mittal and other researchers who want to study the eye drops may find it hard to get funding.

Beta blocker eye drops are old generic drugs. Pharmaceutical companies are unlikely to invest in research that won’t give them a drug they can market exclusively, she said.

And the largest source of government funding for medical research, the National Institutes of Health, budgeted only $19 million for migraine research last year, Glaser said. "We need more money in the field."

Hagan is still hopeful that someone will pursue the research needed to determine the eye drops’ value. Before the article that he and Migliazzo published, doctors in four previous case reports in medical journals going back to 1980 said they had success treating migraines with the beta blocker drops. None led to further studies.

"This might help a lot of people," Hagan said. "But no one has picked up the torch and run with it." 

 

 


McClatchy-Tribune Information Services