RELIEVING HEADACHE PAIN: DRUGS AND CHEMICALS

Doctors blame some headaches on inflammation in parts of the brain and prescribe medicines that calm such inflammation to ease those headaches. Because migraine headaches involve blood vessels, doctors may prescribe a drug such as ergotamine to open up or close down the arteries in the head. There is disagreement about how blood vessels in the brain react to cause headaches. And not all drugs work for everyone. (Note: Never mix any prescription or over-the-counter drugs with alcohol, diuretics, antacids, antibiotics, anticoagulants, tranquilizers, or other medications without your doctor's approval. Seemingly harmless drugs can, in combination, result in severe - even fatal - health problems.)

Knowledge about the chemicals released when tissue is injured appears to be leading to antibradykinin, a new kind of painkiller. Bradykinin is one of the substances made by injured tissue that triggers pain nerves. Antibradykinin chemicals block the trigger. Its use is still experimental, but studies of the substance indicate it has possibilities of becoming a great painkiller for cuts and bruises.

Dr. John J. Bonica of the University of Washington at Seattle almost single-handedly has spurred on the medical profession to take notice of the patient's pain, particularly in cancer cases. He has long exhorted medical schools to teach their students how to treat the problem of pain. He also has urged scientists to do more pain research. He says doctors today are paying more heed to who's hurting and why.

Dr. Bonica estimates that, worldwide, 40 percent of cancer patients die suffering from pain that could have been relieved. And in advanced cancer cases, 60 to 70 percent needlessly endure pain.

Dr. Kathleen Foley, chief of the pain service at Memorial Sloan-Kettering Cancer Center in Manhattan, agrees that there is no reason that cancer patients must suffer from pain. Narcotics such as morphine, Percodan, methadone, and Dilaudid effectively relieve chronic pain.

"People confuse them with street drugs," Dr. Foley says, "and often doctors fear that patients might abuse them." Patients do become physically (but not psychologically) dependent on narcotics, she concedes, and they suffer symptoms like diarrhea and chills when the drug is stopped. However, says Foley, practically none become dependent on narcotics. They may need increasing amounts, but she asserts that's not addiction. And, she notes, after the drug is stopped, the patients do not seek more of it, as an addict would.

"With these drugs, terminal patients can die relatively pain-free," argues Foley. "It is cruel to deny them."

For a while, there was controversy over the medical superiority of heroin, but studies show that, dose for dose, heroin has proved to be no better or worse than morphine. And now morphine can be taken safely and swallowed painlessly, rather than injected, thanks to new slow-release, 8-hour and 12-hour morphine pills.