By Melissa Schorr

NEW YORK, Dec 28 (Reuters Health) - A migraine-fighting medication containing trace amounts of the artificial sweeter aspartame triggered headaches in two patients believed to be sensitive to the substance, according to a case report published in the most recent issue of the journal Headache.

"For those with NutraSweet-triggered headaches, if they were using these medications, it escalates the headache," Dr. Lawrence C. Newman, director of the Headache Institute at Saint Luke's Roosevelt Hospital and an associate professor of neurology at Albert Einstein School of Medicine in New York City, told Reuters Health.

Although the scientific evidence has been mixed, aspartame, or NutraSweet, is believed by some doctors to trigger migraines in a very small percentage of headache sufferers. Newman reported that two migraine sufferers who were thought to be sensitive to the artificial sweetener experienced worsened headaches after switching from tablets to the dissolvable form of the migraine medication.

The wafer version of the drug, known as Maxalt-MLT, melts on the tongue rather than being swallowed like a traditional pill. For added sweetness, the drug's manufacturer, Merck, has added about 3.75 milligrams of aspartame, about one-tenth of the amount found in a single packet of Equal. "We don't think it's enough to give a headache, but it can escalate it," Newman said.

Maxalt, or rizatriptan benzoate, is one of a new class of drugs known as triptans, which are taken to treat migraines as they occur. A second dissolvable migraine drug, AstraZeneca's new Zomig-ZMT, also contains small amounts of aspartame, Newman noted.

Skip Irvine, a spokesman for the New Jersey-based Merck Inc., said the pharmaceutical company's medical experts would have to review the findings before they could comment on the study.

Newman suggests physicians should simply avoid prescribing the dissolvable form of these medications to patients with a known sensitivity to artificial sweeteners. "If you have patients with food sensitivities," he advised, "be aware there are inactive ingredients that are going to make patients worse rather than better."

SOURCE: Headache 2001;41:899-901

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