A Migraine Trigger You Shouldn’t Ignore

When most of us think about migraine triggers, we think of food. Things like caffeine, chocolate, bananas, red wine, and old cheese.

But triggers – those things that set off the migraine chain-reaction for certain people – are a very individual thing. And the truth is, patients report many triggers that aren’t foods.

Migraine Trigger - Change in ScheduleOne of the most common triggers, in fact, is a change in schedule. That includes changes in sleep schedule. Sleeping too little, too much, or even sleeping in.

If you have migraine disease, your body is probably very sensitive to changes. And when you think about it, on any given day a change in schedule is actually a pretty big deal.

Just why a change in schedule makes such a big difference probably varies from person to person. Sometimes it may have to do with a change in meal times. When you sleep in, and eat breakfast later, or even drink that first cup of coffee later, your body notices. This may be one of the reasons why some people tend to get “weekend headaches”.

Sleep disorders may also wreak havoc on your body. You’re always trying to catch up on your rest, taking naps at odd times, waking up tired. If you’re not feeling refreshed from your sleep, it could be a sign of a number of issues, including restless leg syndrome, sleep apnea, problems with medications, even mental health problems.

The bottom line is this. Pay attention to your daily schedule – especially your sleep schedule. Ask yourself, what’s keeping it from being consistent? And what can you do about it?

  • Is it simply a matter of discipline – going to bed and getting up at the same time each day?
  • Could you do certain things to help you get a deeper sleep? Turn of the computer/TV/smart phone a couple of hours earlier? Ease up on the afternoon caffeine?
  • Do you need to talk to your doctor about the medications/”painkillers” you’re taking, and make some adjustments?
  • Do you need to see a specialist about your sleep patterns? Could there be another disorder that’s knocking your schedule off-kilter?
  • Do you need to discuss the problem with your boss, or your family?

Don’t ignore problems with a constantly changing schedule, or interruptions in your normal sleep schedule. These things are actually very common triggers for migraine attacks.

Again, it’s not just a matter of a lack of sleep, although that is a big problem. Even sleeping more than usual could trigger a serious migraine attack. Pay attention, keep a diary, and you may find a powerful new way to fight migraine.

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10 Highlights from the past 3 Months (February 2015 edition)

It’s that time again! Let’s look at the posts which have been most popular with guests to Headache and Migraine News. Once again, the most popular posts come first, but the three that had the most likes on Facebook are in bold.

  1. The “Revolution” in Migraine Treatment (Dr. Peter Goadsby)
  2. Why this Essential Oil may help, but won’t ever be popular…
  3. The Best Medication for Migraine? The AHS Reports
  4. What is Retinal Migraine?
  5. Topiramate + Nortriptyline (and another reason why treatment is not simple)
  6. Fake Supplements at Major US Retailers?
  7. New Migraine Research – MRF Announces Grants (podcast)
  8. 18 Reasons to Suspect Migraine in Your Child
  9. Migraine and Bell’s Palsy
  10. Do You *Hear Voices* during a Migraine Attack?
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Acetazolamide for Migraine

Acetazolamide, sold under brand names Diamox and Diamox Sequels or as a generic drug, has attracted some attention as a migraine treatment. Is acetazolamide for migraine something that should be investigated further?

Finding treatments for migraine is very much like detective work. Finding connections, testing hypotheses, making gradual discoveries. This has been the case in the slow study of acetazolamide for migraine.

The first connection was found unexpectedly in 1978. Patients who had been misdiagnosed were given the drug, and the results were remarkably positive.

Acetazolamide became a choice drug for treating a type of ataxia which is common in familial hemiplegic migraine. This particular type of ataxia includes muscle symptoms – unsteadiness and a loss of coordination – along with vertigo and nausea. This type of migraine and these symptoms have a clear genetic connection.

Now this particular medication is far from a cure for this type of migraine; it’s usually given simply to treat the ataxia (episodic ataxia type 2). But there were some reports of improvement with other symptoms.

No one is sure why acetazolamide for migraine helps in some cases, or even why it treats ataxia. It does share at least one quality with topiramate (Topamax)carbonic anhydrase inhibition. Topiramate is often used as a migraine preventative. And Diamox Sequels is used, like Topamax, as an anticonvulsant.

Some reports were coming in of patients with other types of migraine being helped by acetazolamide, so a trial was designed with a dose of 500mg. Unfortunately, the study could not be completed because more than a third of the patients dropped out due to side effects. Common side effects include nausea, a tingling sensation, diarrhea, drowsiness, and occasional confusion.

Although the research continues, and the drug seems to help some patients, so far it’s not looking like Diamox will be a widespread migraine treatment.

However, the connections to headache remain intriguing. For example, acetazolamide is often used to treat glaucoma, to decrease pressure in the eye. It also helps with other symptoms such as nausea, vertigo, and headache.

It also appears that acetazolamide may interrupt cortical spreading depression, a part of the migraine chain-reaction, and so interrupt migraine aura.

Although acetazolamide probably won’t be prescribed to you because of migraine, it may be prescribed for another reason. If so, watch to see if your migraine symptoms improve, and let your doctor know. Your experience may help us understand why acetazolamide helps fight migraine in some cases but not others.

Read more about acetazolamide for migraine here.

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Whatever Happened to Lasmiditan?

We last talked about Lasmiditan in 2012, with hopes that it would be on the market by now. But although a lot of money is being invested, and trials are still ongoing, it’s not likely we’ll see Lasmiditan for migraine until 2018 or later.
CoLucid
Lasmiditan is a migraine abortive and a serotonin receptor agonist, like triptans. But unlike triptans, it doesn’t seem to cause vasoconstriction – very important for those at risk of stroke and heart disease.

Lasmiditan is going to undergo phase III trials, further investigating the drugs ability to fight headache, nausea, photophobia and phonophobia. The company, CoLucid Pharmaceuticals, also has permission from the FDA to include some patients who have some cardiovascular risk factors.

Another future trial will be a pediatric study.

Lasmiditan remains a very promising migraine drug, which may be a major alternative to the familiar triptan medications. But we’ll probably be waiting until 2018 before most of us will have a chance to use it.

Read more about the development plan for Lasmiditan here.

For more, see Emerging therapeutic options for acute migraine: focus on the potential of lasmiditan

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Whatever Happened to Levadex?

We’ve been talking about the new migraine drug, Levadex, since 2010. But it’s still not on the market. Will it ever be?

AllerganLevadex was still in the news last year, but under a brand new name. Semprana is the new name for Levadex, a new formulation of dihydroergotamine mesylate (DHE). It’s now owned by Allergan, the makers of Botox.

Semprana is an inhaled migraine abortive. It looks especially promising for nausea, and sensitivity to light and sound.

But last summer, Semprana was rejected yet again by the FDA in the United States. That’s the third time. The good news is that the rejection had nothing to do with whether or not Semprana works, or whether or not it’s safe. Instead, the FDA had technical concerns about the manufacturing and functioning of the device.

Semprana remains in Allergan’s pipeline, and is still looking like it could be a big player in the migraine market. But consumers probably won’t be seeing it in the local pharmacy until 2017.

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