Headache and Migraine News » medications

New Clues about Medication Overuse Headache and Opioids

James — Tue, 10 Jan 2012 02:29:01 +0000

In the video below, researcher Dr. Julie Wieseler discusses new research into the opioid medications.

Opioids include medications such as codeine and meperidine (Demerol). They’re common when it comes to migraine treatment, but they’re also highly suspect when it comes to Medication Overuse Headache (MOH). Meaning – taking them for migraine symptoms can temporarily help, but make symptoms worse later on. (Actually, most medications can do this – but opioids seem to be among the more likely)

Researchers have noticed that taking opioid medications can make symptoms of cutaneous allodynia worse – but why?

The investigation began to see why exactly this migraine treatment was causing more symptoms in the long run. Their results, discussed in the video below, may help researchers find better treatments, or use opioids more safely, or find ways to prioritize treatments that are less likely to cause MOH.

Find out more about this new research here: Why Opioids Enhance Migraine Pain: The Puzzle Points to Glia

From the Headache and Migraine News Blog

New Clues about Medication Overuse Headache and Opioids

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Triptans and Heart Disease – A Dangerous Mix!

James — Thu, 15 Dec 2011 16:49:41 +0000

Triptan medications such as Imitrex, Frova, and Relpax are still an important part of migraine treatment. But for people with a risk of heart disease, they can be dangerous.

At the annual meeting of the American Neurological Association in September, a surprising and disturbing study got a lot of notice. It was all about the prescription of triptan medications.

The study included 120,000 migraine patients. Now, triptans are not recommended for those with certain types of heart disease. Did doctors follow this recommendation?

The surprising result was that 1 in 5 patients with heart disease was prescribed a triptan medication!

That’s right, 1 in 5. Why? Did the doctor not know about the patient’s medical history? Was the doctor not aware of the dangers triptans pose to these patients?

Triptans can narrow blood vessels by 10-20%, and those of you with experience with heart disease know just how dangerous that can be.

Not only should your doctor know your medical history, she should also know your risk of heart disease. If you know you have multiple risk factors, even if you’ve never had problems with heart disease, you should think twice about taking triptan medications.

Dr. Arthur Elkind, president of the National Headache Foundation board of directors, particularly notes that you should be aware of elevated lipid levels, hypertension, a history of smoking, history of angina pectoris, and heart attack.

Though triptans are considered generally safe for most migraineurs, there is a lack of care being taken for patients who are at risk.

From the Headache and Migraine News Blog

Triptans and Heart Disease – A Dangerous Mix!

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Too Much Tylenol – Over Time?

James — Sat, 03 Dec 2011 01:42:56 +0000

Hopefully most people are aware of the dangers of taking too much paracetamol / acetaminophen. Sometimes people are taking different products that both contain acetaminophen – and inadvertently take too much. It can be very dangerous.

But what about a "staggered overdose"? That is, people who are taking a little too much over a period of time – could they be just as bad off, or even worse off?

Yes, say researchers – a little-by-little overdose could be even more serious than a one time large overdose – and it could be just as life-threatening.

Researchers at Edinburgh University studied the cases of 161 patients who had come to the hospital there over a 16 year period. They also looked at cases of 663 patients with paracetamol/acetaminophen overdose. Those with the gradual overdose were more likely to develop liver and brain problems, need kidney dialysis, or help breathing. The overdoses were also more likely to be fatal.

To make matters worse, the blood test that would identify a one-time overdose will not identify the staggered overdose. Meaning that it will be easy for your doctor to miss.

The message is clear – follow the instructions on the label, check the ingredients of medications you’re taking, and if you need more pain relief, see a doctor. Just taking "a little more" of something to see if it relieves the pain is not the answer.

From the Headache and Migraine News Blog

Too Much Tylenol – Over Time?

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Why Migralex was Developed

James — Tue, 22 Nov 2011 00:39:37 +0000

This is a very brief video from Dr. Alexander Mauskop of the New York Headache Clinic explaining why Migralex was developed. Migralex is an abortive that many of you are familiar with. It’s been helpful for many people with migraine and headache, and it’s available without a prescription.

Migralex works well for some because the whole is more than the parts. Very often, an individual ingredient (ie aspirin, magnesium…) won’t help. But a carefully measured combination of ingredients can make all the difference.

It’s important to emphasize that this is not an excuse to avoid seeing a doctor! But Migralex may be helpful for someone under a doctor’s care, or someone who has the symptoms that so far are not being effectively treated by their doctor.

Read more reviews of Migralex here. It can also be purchased through the link.

From the Headache and Migraine News Blog

Why Migralex was Developed

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Botox and Quality of Life: Does it really help?

James — Thu, 10 Nov 2011 14:28:59 +0000

Of course there is no treatment that helps everyone, but another study (published in Neurology) has shown that Botox treatment for migraine does help some – and help them in real ways.

You see, some treatments and medications can really cut down on the number of migraine attacks someone has, and yet not really be worth it – because of the side effects. So this study set out to check on patients’ "health-related quality of life". Overall, is their health really better?

1,384 patients were involved in the analysis using a migraine related quality of life questionnaire and the Headache Impact Test (HIT). Compared to a placebo, the quality of life of migraine patients was significantly improved while taking Botox (onabotulinumtoxinA).

Now, this study was funded by the makers of Botox, which is not unusual, but important to note. The company has certainly had its ups and downs when it comes to this migraine treatment.

However, this does support other studies and the testimonials of specialists who are treating patients. And the study was carefully done by well known experts in the field. Botox certainly seems to be a real help to some, and yet there are still important questions about who will benefit most from treatment and how treatment should be done. And in spite of the evidence, many insurance companies are still reluctant to cover a treatment which tends to be expensive.

Hopefully studies like this will provide them with the evidence they’re looking for.

The study can be found here: OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine
via: Botox improves quality of life

From the Headache and Migraine News Blog

Botox and Quality of Life: Does it really help?

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To Flush or not to Flush: Disposing of Medicine

James — Fri, 07 Oct 2011 22:14:58 +0000

This may or may not be news to you, but a lot of people meticulously flush their unused and/or expired medication down the toilet. But recently the practice has come under fire, and the public is being encouraged to dispose of their medicine in other ways. But what way is really the best?

First, some countries actually put disposal instructions on the label or in the instructions that come with the medicine. These instructions provide a "best practice" for that country, and often represent agreements that have been made within that country (and so they are not necessarily helpful outside of the country).

So it’s best to follow those directions if they are available.

First, why would anyone flush their unused medication?

One of the most important reasons is that drugs are simply being taken by people who shouldn’t be taking them. Pets rummaging through the garbage are taking them, children are finding them and taking them, drug addicts are even hunting for them. Worse, some people actually give their prescription medication to a friend or family member who has not been subscribed the same thing.

As you might guess, all this is very dangerous, and an easy way to for the most part avoid the problem is to flush.

Sounds great – so why the outcry against flushing?

Concerns have arisen recently because trace amounts of drug residues have been found in drinking water. Could these drugs that are flushed down the toilet actually end up in a glass of water that a child drinks at bedtime?

So far, the answer seems to be probably not. And for two reasons:

The "residues" found in drinking water are so minuscule, there’s no evidence that they could have any negative impact on anyone. We’re talking a very very very small amount, not anything close to a dose of medication.
Did this really come from flushing medication? Maybe, maybe not. Much of it probably came from other things that normally end up in the toilet. That’s right, even after you take the medication, some of it is likely to still end up coming out again.

Further, if we make drug disposal too complicated, it just won’t happen, and then we end up with a worse scenario.

Still, why not be on the safe side if you can be? There are other methods for disposing of drugs. Here are some suggestions:

First, follow any instructions on the label.
Check to see if there is a program for drug disposal in your area. Contact the waste disposal authority in your city or town and ask, or check their website. In the USA, start here. In Canada, start here. For the UK, read here. Australia? Start here.
Check with your pharmacy to see if you can return the drugs there (not for a refund, of course!).
If you’re going to throw them in the garbage/trash/rubbish, take them out of the package and mix them with something yucky (how about kitty litter? mmmmm). Then seal them in a seal-able bag, and dispose.
If flushing, again, remove the medication from the package. In the USA, the FDA suggests that specific drugs be flushed (the list can be found here). However, check for other options first.

In the end, remember to go through your medicine once a year to get rid of what you don’t need or whatever is expired. Include non-prescription medicine and even herbs and other supplements in your search. And dispose safely.

Lots of useful information (especially for the US) on this site. Thanks for the reminder from How To Cope With Pain.

From the Headache and Migraine News Blog

To Flush or not to Flush: Disposing of Medicine

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Generic Medications – The same but different?

Cluster Headache and Sleep: is sodium oxybate the answer?

James — Tue, 13 Sep 2011 22:47:18 +0000

A new study in Neurology suggests that sodium oxybate may be one of the future drugs for cluster headache sufferers.

We’ve long known about the connection between sleep disorders and cluster. But typical medication for sleep has not been the miracle solution for cluster. But sodium oxybate may be the exception to the rule.

Sodium oxybate is a type of drug known as a central nervous system depressant. It’s used to help prevent daytime sleepiness in patients with narcolepsy (a sleep disorder – read about narcolepsy here). Though we don’t know exactly how it works, it does help with sleep patterns.

The four patients in this long term study responded very well to the drug – their cluster attacks during the night drastically decreased and were less intense when they came. Obviously, patients also slept better!

The results are very positive, and there’s great hope that this will help many other cluster patients. Though the study was small, it must be remembered that this is a rare condition and, again, the results were very promising in all four patients.

Be sure to talk to your doctor about this option, and only get the drug from recognized sources, where it is pure and properly labelled.

via: New drug for cluster headaches

From the Headache and Migraine News Blog

Cluster Headache and Sleep: is sodium oxybate the answer?

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Telcagepant Finally Shelved

James — Mon, 05 Sep 2011 21:44:03 +0000

Telcagepant was a promising drug for migraine patients, with possibilities as both an abortive and a preventative. But in July, drug company Merck finally ended the clinical trials with no plans to recontinue them. Merck announced:

Merck is discontinuing the clinical development program for telcagepant, the company’s investigational calcitonin gene-related peptide receptor antagonist for the treatment of acute migraine. The decision is based on an assessment of data across the clinical program, including findings from a recently completed six-month Phase III study.

The drug (formerly known as MK-0974) was once a much talked-about drug with a promising future, as the leader of a new kind of migraine drug. Then researchers became concerned when some patients developed high levels of liver enzymes (transaminases).

The trials forged ahead in hopes that telcagepant would work better as an abortive. But Merck finally gave up trials. It had already shelved MK-3207, its other (CGRP) receptor antagonist for migraine.

This may be the end of telcagepant – but it’s by no means the end of this class of migraine medications. Researchers are pushing ahead with this and other types of medication that may fight migraine in the future.

But this is another reminder about the time and expense that’s put into developing new drugs. Though we have almost endless options today, we do pay for those options, and there’s a reason why.

From the Headache and Migraine News Blog

Telcagepant Finally Shelved

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Zelrix Migraine Patch NOT approved by FDA

James — Tue, 30 Aug 2011 13:58:02 +0000

Migraine patients who are waiting for the launch of the new Zelrix Migraine patch, a patch that quickly delivers sumatriptan, will have to wait a while longer.

NuPathe Inc, developer of the patch, has been waiting on the FDA in the United States since October. The plan was to launch the product during the first half of 2012, but now that seems to be overly optimistic.

The Zelrix Migraine Patch

The migraine medication patch isn’t just another drug delivery system. It’s a single use patch that delivers the medication through the skin using an electrical current (iontophoresis). This method is already used in drugs such as anti-inflammatories.

One of the goals of medication such as this is to get it into the system as quickly as possible. Speed may make all the difference. In addition, Zelrix may avoid some side effects due to the delivery method.

But the challenge with a patch like this is that it’s complex – not just a simple pill, but a piece of electronic technology (known by the company as SmartRelief).

The FDA expressed concerns about chemistry, manufacturing, and safety issues. NuPathe quickly assured investors that it could quickly address these issues, likely starting on trials and studies soon. The CEO of NuPathe, Jane Hollingsworth, said in a recent press release:

"This CRL [Complete Response Letter from the FDA] gives us confidence that we can provide the information needed to support FDA approval for our migraine patch in a timely manner. We continue to believe that our patch will address the symptoms of millions of patients who suffer from debilitating migraine headache pain and migraine-related nausea. We look forward to working with the FDA to bring this important product to market."

In spite of the assurance, NuPathe stocks took a major hit this morning. Investors are looking at a very challenging market climate, with so many migraine drugs now available.

And yet, with so many migraine patients still dealing with major symptoms, there’s no doubt much more needs to be done.

Read the full press release from NuPathe here: FDA Requests Additional Information Regarding NuPathe’s Migraine Patch in Complete Response Letter

More about the Zelrix Migraine Patch

From the Headache and Migraine News Blog

Zelrix Migraine Patch NOT approved by FDA

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Ibuprofen and Potassium Deficiency

James — Mon, 22 Aug 2011 16:09:11 +0000

Can too much ibuprofen (in products such as Advil) cause potassium deficiency? A new study suggests that it can, but only at very high doses.

Potassium deficiency (hypokalemia) is a condition that can be life threatening. MedlinePlus has this to say about the condition:

A deficiency of potassium (hypokalemia) can happen in people with certain diseases or as a result of taking diuretics (water pills) for the treatment of high blood pressure or heart failure. Additionally, many medications — such as diuretics, laxatives, and steroids — can cause a loss of potassium, which occasionally may be very severe. You should have your blood levels of potassium checked from time to time if you take any of these medicines. Diuretics are probably the most common cause of hypokalemia.

Based on research at three hospitals in Australia, the series in the Medical Journal of Australia found four patients with potassium deficiency who were long term regular users of ibuprofen. Lead researcher Dr Jennifer Ng expressed concern that ibuprofen alone or with codeine can become toxic.

But before you panic, you need to realize these patients were on very high doses of ibuprofen. One patient, according to this article, was taking "fewer than 10 tablets per day". One woman was taking 50 tablets per day

These are very high doses, and these patients should have been under a doctor’s constant care, including regular tests.

Be sure to check out this ibuprofen dosage information here.

For the average headache sufferer, any kind of regular ibuprofen consumption can be dangerous. The earliest danger is rebound headache, or medication overuse headache. You can soon find that, with regular ibuprofen, the occasional headache turns into regular chronic headache (as Kerrie reminded us here).

If you have regular headaches, please don’t just keep popping over-the-counter medication. See your doctor. Even taking over-the-counter medication a few times a month may cause more problems than it solves.

And if you’re taking even higher doses of ibuprofen, remember there can be more dangers than just potassium deficiency.

From the Headache and Migraine News Blog

Ibuprofen and Potassium Deficiency