Another Option for Adolescents with Migraine

Children and teens with migraine tend to have fewer options when it comes to approved medications for migraine. But this month in the USA, the FDA approved a new abortive medication – a pediatric version of Treximet.


Treximet (adult version)

We’ve talked about Treximet before – it’s a combination abortive drug, containing sumatriptan succinate (Imitrex) and naproxen sodium (Aleve). But the approved medication for 12-17 year olds will have a lower dosage than the adult version – 10mg of sumatriptan and 60mg of naproxen sodium (the adult version is 85mg/500mg).

Although it’s great to have another option, there are concerns that may put Treximet lower on the list of things to try. As a combination medication, it may be more powerful, but there also could be side effects from either medication. And although it is certainly convenient to take a single pill, you might want to check and see if one or the other medication will work just as well – and check the difference in price.

Of course many medications have their special “selling points” that they will promote. For Treximet, it’s “RT technology“, which helps the tablets disintegrate and absorb faster. It’s a possible advantage over a generic sumatriptan.

Everyone is different – talk with your doctor (and insurance company!) and keep track of your symptoms.

For more information:


Silent Seizure with Headache?

Unfortunately, seizures and headaches often go together. But what about silent seizure and headache?

Headaches commonly occur after a seizure, sometimes before or even during. Epilepsy may also increase your risk of other headache disorders, such as migraine.

A child in the parkSilent seizures usually refer to one of two things. First, it’s a somewhat outdated term for what we now call absence seizures. Many people are familiar with the older term, petit mal seizures. These are seizures commonly seen in children that last only a few seconds. The child blanks out but does not fall or convulse.

Silent seizure may also refer to seizures that can be seen by an EEG in the brain, but that produce no visible symptoms (although there is some evidence that this type of seizure may affect some brain function). (Read about silent seizure activity in autism)

That being said, having silent seizure with headache (whichever type of “silent seizure” you’re referring to) is not common, if we’re talking about headache as a symptom of the seizure. There should be no headache before, during, or after the seizure. If there is, it may be a sign that there has been a misdiagnosis.

It is common to see headache in another type of childhood epilepsy, called benign epilepsy of childhood with occipital paroxysms (BECOP). The symptoms of BECOP can vary, so you’ll need to discuss symptoms with the doctor and have an EEG done by an expert.

There are some cases where a headache may be the only symptom of a seizure. If you suspect this is the case, as always, an EEG will need to be done to confirm what’s happening in the brain.

So is there any case in which it could be common to have silent seizure with headache? It is possible to have a headache disorder along with absence seizures, for example. The headache attacks probably won’t come right along with the seizure, but may happen at any time.

As with most headaches with seizure, the epilepsy and the headache will be treated separately. For example, if you are diagnosed with migraine, you may take medication for migraine, and for epilepsy. However, in the case of migraine, some medications for epilepsy are used as migraine preventatives. You may be able to take the same medication to treat both, even though you’re treating two different things.

It is very important to discuss your symptoms with your doctor, and keep an eye on when headaches and seizures happen, and what other symptoms may be present.

For more information, read Seizures and Headaches: They Don’t Have to Go Together. Also see Migralepsy Symptoms.


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

There have been some fascinating stories breaking over the past few months. Here’s your chance to catch up – the most popular stories first, and the ones with the most likes on Facebook are in bold.

  1. Do you really have “Migraine”?
  2. Have You Tried the Icekap for Migraine?
  3. A Migraine Trigger You Shouldn’t Ignore
  4. More Evidence that Green Veggies Fight Migraine
  5. Now You can Fight Weather related Migraine with the Migraine Barometer
  6. Should Migraine Patients Drink More Coffee? (and a note about aspartame)
  7. Headache? Instead of a pill, rub this on your skin…
  8. Migraine: Doubling the Risk of Stroke?
  9. Can this Procedure Teach Your Body to avoid Migraine?
  10. More Concerns About Narcotics in a Migraine Emergency

Headache and Watery Eyes

There are actually a number of disorders that may lead to headache and watery eyes. Although sinus infections are blamed more often than not, a chronic sinus infection (sinusitis) is actually a more unusual cause of watery eyes.

Headache and Watery Eyes?First, it’s commonly known that migraine attacks can lead to congestion and watery eyes. This from Johns Hopkins Medicine:

Migraine pain can be felt in the face, where it may be mistaken for sinus headache – or the neck, where it may be mistaken for arthritis or muscle spasm. Complicating a migraine the diagnosis of migraine is that the headaches may be accompanied by other “sinus-like” symptoms, including watering eyes, nasal congestion, and a sense of facial pressure. Most patients who think they have sinus headache in fact have migraines.

But watery eyes, also known as lacrimation (lachrymation) or epiphora can go along with headaches for a number of reasons.

Sometimes, something like the common cold can trigger both migraine attacks and watery eyes. It helps to make a note of when headache symptoms and lacrimation starts – do both always happen at the same time?

Migraine attacks may last for a few hours to two or three days. Other headache and watery eyes conditions may have different timetables.

Cluster headache attacks often lead to congestion and water eyes as well. These attacks are typically shorter than migraine attacks, lasting from a few minutes to two or three hours. The pain is severe, and attacks may come every day or even hit several times a day.

Paroxysmal hemicrania attacks may be even shorter, but also lead to headache and watery eyes. Attacks are treated with indomethacin.

There are other headaches that may last only a few seconds, but look similar. Hemicrania continua headaches may look similar to paroxysmal hemicrania, except that the headache doesn’t go away.

There also may be attacks of facial pain which lead to watery eyes.

This is by no means a complete list of what can cause headache and watery eyes. There are other issues, not as focused around headache, which can lead to lacrimation, such as hay fever and pink eye.

If your headache symptoms have changed, or you’re noticing new symptoms, it is wise to see a doctor as soon as possible. Tell your doctor when the symptoms began, if they symptoms affect both eyes or just one, and if/how headache and watery eyes go together (do they always strike at the same time? Do your eyes water as the headache goes away?). Your doctor should be able to help you narrow down the possible diagnosis and get you the treatment you need.


Headache? Instead of a pill, rub this on your skin…

Which would you prefer – taking a pill for headache pain, or rubbing something on your skin? It might be faster to swallow something, but why send something all the way to your stomach when the pain is in your head?

Of course, that’s a drastic over-simplification, but it does make a point. Often times, pills that are swallowed are not as “targeted” as we would like. Would it work better to apply something right where the pain is – on the head?

TOPOFEN for MigraineAchelios Therapeutics is working on that very thing with TOPOFEN, a gel that can be applied to the skin.

TOPOFEN is actually a formulation of ketoprofen, a nonsteroidal anti-infammatory drug (NSAID) which is sometimes used for hormonal related headache, as well as menstrual pain in general. It’s also used for other headaches, and pain from osteoarthritis.

At the 67th Annual Meeting for the American Academy of Neurology, a report was given on the latest trial of TOPOFEN for use in migraine treatment. 42 adults with migraine with aura and migraine without aura were given the gel. Each person was asked to take a pea-sized amount and rub it on the skin over the peripheral trigeminal nerve ends – that is, six points on the face, both sides (even if they headache pain was only on one side). 49 severe attacks were treated, 22 with TOPOFEN and 27 with a placebo.

77% of patients had some relief using TOPOFEN. After 4 hours, 23% were completely pain-free, and after 24 hours 50% were pain-free (double the success of those using the placebo).

At first these results may not seem too amazing. But remember, this is not a special migraine drug, this is a NSAID (ibuprofen or Advil is a NSAID as well, though a different type). Taking that into consideration, these are actually pretty good results. No pill was taken; all we’re talking about is a little gel rubbed on the skin.

Not only was their pain relief, patients also found relief from other symptoms, such as nausea and photophobia.

After 24 hours, the medication was still in the tissue – it was still working after 24 hours.

So what are the upsides and downsides to this kind of treatment?

The gel did cause temporary skin irritation in some people, usually moderate or mild. It could be there a small percentage of people would not be able to use this drug – but that’s common with any medication or treatment.

But a major downside of NSAIDs is avoided here – stomach problems. Applying the gel near where the actual pain is could be a much more direct way to calm migraine symptoms.

We still have a lot to learn about topical treatments for migraine, but so far TOPOFEN seems to be a great start – quickly absorbed and effective in the treatment of migraine pain and other symptoms.