MXPA99008735A - Method of treatment of migraine - Google Patents

Abstract

The present invention relates to, among other things, methods of treatment of migraine headache in humans with reduced side effects by the topical administration of a migraine-ameliorating effective amount of an opioid, singly, or in combination with other pharmacological agents, including vasoconstrictors, antiinflammatory agents, antimicrobial agents, decongestants and non-opioid migraine drugs.

Description

METHOD FOR MIGRAINE TREATMENT Migraine headaches (also referred to as "migraines") are generally described as severe recurrent headaches, and are suffered by approximately 70% of adult women and approximately 6% of adult men. Mizell et al., JAMA 276: 319-321 (July 1996). They can be incapacitating, with each migraine lasting approximately 4 to 72 hours, often accompanied by nausea and photophobia. The headache can be unilateral or bilateral, and is usually not controllable by simple analgesic agents. Non-pharmacological treatments include identification and avoiding triggers, such as particular foods, traumas, abandonment of caffeine and stress. Common pharmacological treatments include the administration of pizotifen, beta blockers such as propranolol and valproate, or tricyclic antidepressants such as amitriptyline, dotiepin, metilsergida and flunarizine. Pizotifen inhibits the 5-hydroxytryptamine receptor ("5-HT (2)"). See Davidoff, Migraine: Manifestation, Pathogenesis, and Management (1995) in 242; Hiner, and collaborators, Annals of Neurol. , 19:51 1 -513 (1986). Propranolol is an antagonist of the beta adrenol receptor and has some antagonistic properties against 5-HT (T2) receptors. Valproate inhibits neural trajectories that are mediated by gamma-aminobucric acid. The most common prophylactic drug used to treat migraine is the methylmerged drug, which acts on a number of 5-HT receptors.

For treatment of acute migraines, other non-specific treatments are commonly used, such as the administration of analgesic and anti-inflammatory drugs, including aspirin, paracetamol, naproxen, and the like. The systemic use of analgesics associated with codeine, however, promote migraine, and the overuse of such analgesics causes migraines that are difficult to treat. Also, stronger analgesics acting on the central nervous system, including morphine and pethidine (meperidine) are at risk of addiction and their systemic administration is generally contraindicated for the treatment of migraine. There are also specific antimigraine treatments, which include ergotamine and its related compounds, such as sumatriptan and dihydroergotamine, which are 5-HT (1B) and 5-HT (1D) receptor agonists. Sumatriptan is administered orally, by subcutaneous injection, or as a nasal spray. Dihydroergotamine is administered intramuscularly, or as a nasal spray. These treatments are associated with the risk of coronary vasospasm. Although the cause of migraine is not fully understood, it is believed that migraines may be related to the trigeminal innervation of the cranial circulation. Davidoff in 136; Taran et al., Neurosurgery, 31: 658-663 (1992). The pain-sensitive innervation of the cranial blood vessels is derived from the first division of the trigeminal nerve and ophthalmic branch. The stimulation of the trigeminal ganglion in K animals and humans produce the peptides related to the neuropeptide calcitonin-G vasodilator. Edvinsson, Cephalalgia, 1: 175- 179 (1981). The release of such peptides related to calcitonin-G can be blocked by administration of sumatriptan, which inhibits trigeminal neural firing through the activation of 5-HT (1 D) receptors. Davidoff in 218; Weber et al., Synapse, 4: 168-170 (1989). It has previously been postulated that the sphenopalatine ganglion ("SPG") is the site of group headache, and such headache was inhibited by transneural application of cocaine. Barr, Journal of Headache, 22: 69-73 (1982). The SPG is located immediately posterior to and immediately above the posterior tip of the turbinate (ethmoid bone) midway behind the nasal mucosa. It is postulated that SPG plays an important role in the trigeminal system because changes in cerebral blood flow can be triggered by trigeminal stimulations, which are mediated by the SPG. Kudrow et al., Headache, 35: 79-82 (1995) and Mizell et al., JAMA 276: 319-321 (July 1996). It has recently been shown that sustained relief of a migraine can be provided by intranasal application of a 4% solution of lidocaine, a local anesthetic, in approximately 55% of patients. It is postulated that idococaine acts on SPG. Id. Although the intranasal application of lidocaine provides relief, it also has side effects, which include a burning sensation or numbness in the nose or in and around the eyes. More seriously, it can also cause numbness in the throat, creating a sense of obstruction. If the patient eats or drinks, aspiration into the pharynx, and misdirection of the food into the lungs can occur rapidly, with the possible consequence of aspiration pneumonia. There is also the possibility of an allergic reaction to lidocaine and other local anesthetic agents. It is also known that repeated local administration of local anesthetic agents can be toxic to mucosal cells. Marr et al., Am. J. of Opthalmology, 43: 706-710 (1957). There is therefore a need for an effective means to treat migraine without these side effects, to which the present invention is directed.

BRIEF DESCRIPTION OF THE INVENTION The invention provides a method for migraine treatment in humans. The invention further provides a method for treating migraine comprising topical administration of an effective amount of an opioid that improves migraine. Preferably, the opioid is morphine or a morphine derivative. More preferably, the opioid is loperamide hydrochloride. In a preferred embodiment, the opioid is administered intraconjunctively. In another preferred embodiment, the opioid is administered transdermally. In yet another preferred embodiment, the opioid is administered intranasally. In yet another preferred embodiment, the opioid is administered in a physiological saline solution, preferably comprising from about 0.01% to about 0.5% opioid. The invention provides methods of intranasal administration in the form of drops for nose, nasal spray, gel, emulsion, and ointment. In a preferred embodiment, if the migraine is unilateral, nose drops are administered in the pit on the same side of the pain as that of the headache, or in both nostrils if the pain is bilateral. The invention further provides a method of treating migraine comprising topical administration of an effective amount that improves migraine of an opioid in combination with a vasoconstrictor. In a preferred embodiment, the vasoconstrictor is neosinephrine. The invention further provides a method of migraine treatment comprising the topical administration of an effective amount of an opioid that improves migraine in combination with an anti-inflammatory compound. The invention further provides a method of migraine treatment comprising the topical administration of an effective amount of an opioid that improves migraine in combination with an anti-inflammatory compound which is a spheroid. Preferably, the spheroid is glucocorticoid. The invention further provides a method of treating migraine comprising topical administration of an effective amount of an opioid that improves migraine in combination with an anti-inflammatory compound that is nonsteroidal. Preferably, the non-steroidal anti-inflammatory compound is ketorolac tromethamine or diclofenac sodium. The invention further provides a method of treating migraine comprising topical administration of an effective amount of an opioid that improves migraine in combination with an antibiotic. The invention further provides a method of treating migraine comprising topical administration of an effective amount of an opioid that improves migraine in combination with a non-opioid antimigraine drug. Preferably, the non-opioid antimigraine drug is sumatriptan. The invention further provides a method of treating migraine comprising topical administration of an effective amount of an opioid that improves migraine in combination with a decongestant. Preferably, any other drug administered in combination with the opioid is administered simultaneously or sequentially with the opioid by an effective clinical means. Further objects and advantages of the present invention will be clear from the description that follows.

DEFI N IC ION ES The following terms shall have the meaning stated below: • Agonist - A chemical substance capable of combining with a nerve receptor and initiating a reaction. • Analgesic - A chemical substance capable of causing decreased sensitivity to pain. • Antagonist - A chemical substance capable of inhibiting the action of an agonist. • Anti-inflammatory agent - A chemical substance capable of improving inflammation. Antimicrobial agent - A substance produced by or a semi-synthetic substance derived from a microorganism and capable in diluted solution of inhibiting or killing another microorganism, including bacteria, fungi, viruses and the like. Migraine - A medical condition marked by severe headache, frequently recurring, and often accompanied by nausea and vomiting. • Opioid - A natural or synthetic chemical that is like opium or morphine in its analgesic properties; that is, a substance capable of acting as an analgesic, for example, by interacting with an opioid receptor. - Systemic - Of or related to the entire organism. Topic - From or related to external local area (s) of the human body, including, but not limited to, the skin, nasal mucosa, and conjunctiva. Vasoconstrictor - A chemical substance that induces narrowing of the lumen of blood vessels.

DETAILED DESCRIPTION The present invention is directed, inter alia, to methods of treating migraine by topical administration of an effective amount of opioid to improve migraine. Opioids include opium derivatives such as phenanthrenes (including morphine, codeine and thebaine) and benzylisoquinolines (such as papaverine and noscapine); semisynthetic derivatives such as apomorphine, diacetylmorphine, hydromorphone and the like; non-opium derivatives with actions similar to morphine, including morphinan, benzomorphan, methadone, phenylpiperidine, and propionanilide; and synthetic compounds with opium-like or morphine-like actions, including pentazocine, butorphanol, buprenorphine, meptazinol, and the like. Preferably, the opioid is morphine, or a derivative thereof, semi-synthetic or otherwise. In a preferred embodiment, the opioid is loperamide hydrochloride, a phenylpiperidine. It should be understood that "an effective amount to improve migraine" refers to an amount of opioid that effects a prophylactic or therapeutic response in the patient in need of such response in a reasonable time frame, which causes either a decrease or an eradication of one or more of the symptoms of migraine. Although the precise mechanism by which topical administration gives an effective amount of opioid to improve migraine relieves migraine is unknown, without limiting the invention to any particular theory, it is believed that the treatment is effective because the opioid affects the ganglion. sphenopalatine ("SPG"). Thus, it is readily apparent to one skilled in the art that the effectiveness of topical application is correlated with maximizing the degree to which the opioid is absorbed and affects the SPG, and minimize the degree to which the opioid is absorbed systemically. Thus, topical administration in and around the sinus cavity is preferred, including administration of the opioid conjunctively, intranasally, or transdermally in the region of the sinus cavity. The administration of "an opioid" must be understood to refer to the administration of any opioid or combination of opioids. The administration "conjunctively" must be understood as meaning the administration to the conjunctiva, that is, the mucosa covering the eyelids. Administration "intranasally" should be understood to mean administration to the nasal mucosa. The "transdermalmerite" administration should be understood to mean administration to the skin in a preparation that penetrates the skin, at least partially. One advantage of such topical administration is the effectiveness of low concentrations of opioids, which reduce any effect to the central nervous system even if it is absorbed systemically completely. A further advantage of such topical administration is the low absorption through a systemic route reducing the systemic side effects. An advantage of opioid administration is the elimination of side effects such as burning or numbness in the nose and throat caused by the administration of local anesthetics. A further advantage is the elimination of allergic reactions to local anesthetics. A further advantage is the decreased risk of toxicity to mucosal cells known to be caused by the repeated application of local anesthetic agents. Preferably, the opioid is administered intranasally and is absorbed through the nasal mucosa. One skilled in the art will appreciate that suitable methods are available to administer an opioid intranasally, and, although more than one route can be used to administer a particular compound, a particular route may provide a more immediate and more effective reaction than another route. The pharmaceutically acceptable excipients are also well known to those who are skilled in the art, and are readily available. The selection of excipient will be determined in part by the particular opioid, as well as by the particular method used to administer the composition. Accordingly, there is a wide variety of suitable formulations of the pharmaceutical composition identified in the context of the present invention. The following methods and excipients are purely exemplifying and are not in any way limiting. Formulations suitable for intranasal administration may consist of (a) liquid solutions, such as an effective amount to improve migraine of the agent dissolved in diluents, such as water or saline.; (b) suspensions in an appropriate liquid; "" and (c) suitable emulsions, all of which can be administered in suitable forms, including nasal drops and nasal sprays. The formulations can also include gels, ointments and the like, which contain, in addition to the active ingredient, such excipients as are known in the art, all of which can be administered in suitable forms, including touches on the nasal mucosa, or spraying on the nose. The opioid, alone or in combination with other suitable components, can also be made in aerosol formulations to be administered via a nasal spray or nasal inhalation. These aerosol formulations can be placed in acceptable pressurized propellants, such as dichlorodifluoromethane, propane, nitrogen and the like. They can also be formulated as pharmaceuticals for non-pressurized preparations such as in an atomizer. Preferably, the opioid is administered intranasally in liquid form, more preferably in a physiological saline solution. In a preferred embodiment, the solution is administered as nasal drops. In another preferred embodiment, the opioid in liquid form is administered as a nasal spray. The dose administered in the context of the present invention must be an effective opioid amount to improve migraine. One skilled in the art will recognize that the dosage will depend on a variety of factors, including the strength of the particular compound employed, the condition of the patient, the patient's body weight, as well as the severity of the migraine. The size of the dose will also be determined by the existence, nature and extent of any adverse side effects that may accompany the administration of a particular compound. The preferred dosage is the amount that results in significant elimination or eradication of symptoms, without significant side effects. Given these parameters, the unit dosage may vary from about 0.1 mg / ml to about 10 mg / ml. In a preferred embodiment, the opioid is administered as a solution comprising from about 0.01% to about 0.5% opioid, although each compound with opioid may have its particular optimal concentration, which can be readily determined by one skilled in the art. . More preferably, the solution is a physiological saline solution. Preferably, the amount of solution administered is about 0.01 ml to about 5 ml. More preferably, the amount of solution is approximately 0.5 ml.

Preferably, the symptoms are alleviated in about 5 to about 120 minutes after the administration of an opioid dose, and more preferably in about 5 to about 10 minutes, and if they are not alleviated in about 5 to about 120 minutes, it can be administered. a second dose.

The methods of the invention further include a migraine treatment method comprising the topical administration of an amount of an effective opioid to improve migraine, in combination with the administration of a vasoconstrictor, both according to the parameters discussed above. One advantage of such a method is the increased opening of the nasal passages by the vasoconstrictor, such as neosinephrine, and the like. The methods of the invention further include a method for treating migraine comprising the topical administration of an opioid, in combination with the administration of an anti-inflammatory compound. Anti-inflammatory compounds include spheroids, particularly glucocorticoids, for example, cortisol, cortisone, prednisolone, dexamethasone and the like; and not spheroids, particularly salicylates (such as aspirin), pyrazolone derivatives (such as phenylbutazone), indomethacin and sulindac derivatives, fenamates, and propionic acid (such as ibuprofen). In a preferred embodiment, the non-steroidal anti-inflammatory agent ketorolac tromethamine in a 0.5% solution or diclofenac sodium in a 0.1% solution is administered. The methods of the invention further include a method for treating migraine comprising the topical administration of an opioid in combination with the administration of an antimicrobial agent, such as neosporin, cortisporin, and the like. Preferably, the antimicrobial agent is neosporin. One advantage of such a method is the treatment of any local infection. The methods of the invention further include a method for treating migraine comprising the topical administration of an opioid in combination with the administration of an antimicrobial agent, such as neosporin, cortisporin, and the like. Preferably, the antimicrobial agent is neosporin. One advantage of such a method is the treatment of any local infection. The methods of the invention further include a method for migraine treatment comprising the topical administration of an opioid in combination with the administration of a non-opioid antimigraine drug, such as pizotifen. propranolol, valproate, amitriptyline, dotiepine, metilsérgido, sumatriptan or flunarizine. Preferably, the non-opioid antimigraine drug is sumatriptan. The methods of the invention further include a method for treating migraine comprising the topical administration of an opioid in combination with the administration of a decongestant. One advantage of such a method is the increased opening of the nasal passages. The administration of another drug "in combination with" an opioid refers to the administration of the other drug either simultaneously or sequentially with the opioid. The suitability of administration of a particular compound of the classes discussed above in combination with the compound with opioid, its method of administration, dosage, and time of administration will be apparent to one skilled in the art depending on the patient and the nature and severity of the symptom. The following example further illustrates the present invention, but, of course, should not be constructed in any way as limiting its scope.

Example 1 This example illustrates a method for administering an amount of an opioid that improves migraine intranasally. The patient rests in supine position with the head hyperextended 45 degrees at the same time as turned 30 degrees towards the side of the headache. 0.5 ml drops of a 0.025% opioid solution are applied to the fossa on the same side as the headache for a period of 30 to 60 seconds. If the headache is birateral, the solution is administered in both pits. If symptoms are not relieved in 5 to 10 minutes, a second dose is given.

Claims (26)

1. CLAIMS I. A method for treating a migraine headache comprising topical administration of an amount of an effective opioid to improve migraine.
2. 2. The method of claim 1 wherein the opioid is morphine or a morphine derivative.
3. 3. The method of claim 1 wherein the opioid is loperamide hydrochloride.
4. 4. The method of claim 1 wherein the opioid is administered intraconjunctively.
5. 5. The method of claim 1 wherein the opioid is administered transdermally.
6. 6. The method of claim 1 wherein the opioid is administered intranasally.
7. The method of claim 6 wherein the opioid is administered in the form of drops for the nose.
8. The method of claim 7 wherein the migraine comprises a unilateral headache and the nose drops are administered to the fossa on the same side as the headache.
9. 9. The method of claim 6 wherein the opioid is administered in the form of a nasal spray.
10. 10. The method of claim 6 wherein the opioid is administered in the form of a gel, emulsion or ointment.
11. I I. The method of claim 1 wherein the opioid is administered in a physiological saline solution.
12. 12. The method of claim 1 wherein the concentration of opioid in the saline is about 0.01% to about 0.5% opioid.
13. The method of claim 1 wherein the opioid is administered in combination with a vasoconstrictor.
14. The method of claim 13 wherein the vasoconstrictor is neosinephrine.
15. 15. The method of claim 1 wherein the opioid is administered in combination with an anti-inflammatory agent.
16. 16. The method of claim 15 wherein the anti-infammatory agent is a steroid.
17. 17. The method of claim 16 wherein the anti-inflammatory agent is a glucocorticoid.
18. 18. The method of claim 15 wherein the anti-inflammatory agent is non-steroidal. 9.
19. The method of claim 18 wherein the antiinflammatory agent is keratolac tromethamine or diclofenac sodium.
20. The method of claim 1 wherein the opioid is administered in combination with an antimicrobial agent. twenty-one .
21. The method of claim 20 wherein the antimicrobial agent is neosporin. "" "
22. 22. The method of claim 1 wherein the opioid is administered in combination with a non-opioid antimigraine drug.
23. 23. The method of claim 22 wherein the antimigraine drug is sumatriptan.
24. 24. The method of claim 1 wherein the opioid is administered in combination with a decongestant.
25. 25. A pharmaceutical composition adapted for topical delivery comprising loperamide hydrochloride in a physiological saline solution effective for treating migraine headache.
26. 26. The pharmaceutical composition of claim 25 in unit dosage form.