According to the results of the fourth phase of the MAZE* (Migraine and Zolmitripan Evaluation) survey presented at the European Federation of Neurological Societies meeting today, the majority of migraine sufferers have tried and failed on several analgesics and anti-emetics before finally seeking medical help. Yet when migraine patients do consult, many doctors continue prescribing these non-specific treatments, despite the widespread availability of effective triptans such as 'Zomig' (zolmitriptan).

"The MAZE survey started in 2000. It is now in its fourth phase and is ongoing," says the MAZE Medical Steering Committee Chairwoman Dr Anne MacGregor from The City of London Migraine Clinic, UK. "The results have helped us to increase our knowledge of this common, yet often under recognised and under treated disorder."

MAZE IV

MAZE IV is an on-going, Internet-based survey of migraine patients, as defined by the International Headache Society diagnostic criteria or by their doctor's diagnosis. Data from a total of 3,072 UK migraine patients have been analysed to date.1

Patients were asked how they treated their latest migraine attack. Most patients (89%) used medication; one half (52%) used an analgesic and anti-emetic and only one fifth (20%) used a triptan. Of patients using medication, 72% required another dose of medication or treatment, but this was significantly lower in patients who initially used a triptan. In addition, among patients receiving a prescription medication, triptan users were significantly more satisfied with treatment than non-triptan users. The main drivers for choosing a triptan to treat a migraine attack were the need for fast control of symptoms (71%) and the severity of the attack (70%).

Similar findings were found in an ongoing French study, FRAMIG**. This study showed that 91% of all migraine sufferers self-medicate and that overuse of analgesics is very frequent. A quarter of French migraine patients have never seen a doctor about their migraine and 59% have consulted a doctor, but have no ongoing medical follow up.2 Only 7.6% of French migraine sufferers were found to take a triptan to treat their migraine attacks. Not surprisingly, in the majority of cases, symptom relief was judged to be insufficient.3

In other countries, the situation is not much better. MAZE I, carried out in the UK, Germany, France, Italy and the US in 2000, showed that approximately half of those suffering from migraine do not consult a doctor despite a high level of pain and disruption of their lives. On average, only 1 in 10 of those seeking medical help received a triptan with the situation being better in the US and worse in Europe.4

"Triptans should be first-line therapy for migraine attacks and should not be reserved for the 'big headache' only", explains Dr Andy Dowson, Director of Headache Services, Kings College Hospital, London. "The MAZE survey has shown that patients are not satisfied with their current care. Physicians and patients should develop a treatment plan based on patient needs, preferences and treatment experience. In addition, physicians should also educate patients about migraine-specific acute treatments and the specific benefits of triptans."

'Zomig' Nasal Spray

MAZE IV revealed that speed of action was a key driver of patient preference for migraine treatment. Data presented at the EFNS congress show that 'Zomig' Nasal Spray has the earliest onset of action for a patient-friendly (non-injectable) triptan.

In phase I of the randomised, double blind, placebo-controlled REALIZE study (n=912), 'Zomig' Nasal Spray demonstrated a significant (p 0.01) headache response from 10 minutes, with a 65% headache response at two hours. In addition, significantly more 'Zomig' Nasal Spray patients experienced total symptom relief (no headache, no nausea, no photophobia or phonophobia) from 30 minutes onwards compared to placebo (p 0.05).5

Phase II of REALIZE (n=851) examined patient satisfaction with the new formulation after treating three migraine attacks. Over three-quarters (76.7%) of patients said they were satisfied or very satisfied with 'Zomig' Nasal Spray overall. In addition, 76.9% were satisfied in terms of speed of relief, and 92.8% were satisfied in terms of ease of use. The majority of patients preferred the new nasal spray to existing treatment (58.5%).5

"Our study has shown that 'Zomig' Nasal Spray achieves high levels of patient satisfaction and is very well tolerated", says Marek Gawel MD, one of the study investigators from the Department of Neurology, University of Toronto, Canada. "Speed of relief, convenience, ease of use and reliability are the major reasons that patients are very satisfied with this new formulation. Patients prefer 'Zomig' Nasal Spray over previous therapies and are willing to continue using this new treatment."

Pharmacokinetic data presented at EFNS show that 'Zomig' is rapidly absorbed intranasally and present in the plasma at two minutes and in the CNS at five minutes post dose. This correlates well with the very fast onset of action seen after 10 minutes, the early pain-free time point (15 minutes) and high efficacy of 'Zomig' Nasal Spray when used to treat acute migraine attacks.6 The intranasal uptake of Zomig is advantageous for patients requiring rapid relief and those with nausea, vomiting, or those who fear needles for self-injection. In addition, 'Zomig' Nasal Spray has a good tolerability profile7 and is supplied in an easy-to-use, convenient device. The formulation was first launched in Sweden in January 2002 and is now widely available in Europe and North America.

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In Neuroscience, AstraZeneca is dedicated to providing medicines that have the potential to change patients' lives. The company already markets several products including Seroquel®, the fastest growing major atypical agent, and 'Zomig'. The Neuroscience pipeline includes leading approaches for the treatment of depression and anxiety, overactive bladder, dementia, stroke, and pain control.