Headache and Migraine News » medications

From Current Studies: What Migraine Treatments Work?

James — Wed, 02 May 2012 00:03:06 +0000

New guidelines have just come out based on the evidence we currently have for migraine treatment. We’ll talk about some of the guidelines in a moment, but first there are some key things to remember.

Caution: Dangerous Waters Ahead!

These guidelines were created by checking out the studies that have been published to date. This means that we do or do not have high quality studies that show successful treatment using [whatever medication or supplement]. If we don’t have enough quality studies, the item will be lower on the list.

We should also note that the guidelines are talking about what works in general, NOT what works for you or what is best for you. Some treatments high on the list are also high in side effects. Or they may be dangerous for certain people. Or they may not work well for your particular type of migraine. Do not take this as a list of what to try first. Something lower on the list may be something far better for you that something on the top.

This list also doesn’t address combo-treatments, such as MigreLief (with magnesium, feverfew and riboflavin).

The list does help doctors prioritize what to consider. If you’ve tried a number of things and haven’t tried something high on the list, it may be time to ask your doctor about it.

Highest rated treatments

Here are some of the highest rated treatments for migraine. There are four categories:

Over-the-counter: Petasites (butterbur) (such as Petadolex)
Triptans: frovatriptan (especially recommended for menstrual migraine)
Antiepileptics: divalproex sodium, sodium valproate, topiramate
beta-blockers: metoprolol, propranolol, timolol

Lowest rated treatments

These are the items that had a negative rating, meaning that they’re not recommended at this time: Lamotrigine, Clomipramine, Acebutolol, Clonazepam, Nabumetone, Oxcarbazepine, Telmisartan, montelukast.

Everything in-between

Of course, just because something isn’t on the top of the list doesn’t mean it’s not an excellent, helpful treatment for many people. For example, very close to the top were well-recognized treatments such as amitriptyline, zolmitriptan, feverfew, naproxen sodium, riboflavin (vitamin B2), and magnesium.

It should also be noted that Botox migraine treatment was not a part of these studies.

For some of the medications that are being used today, check out Migraine Medications: So many choices.

From the Headache and Migraine News Blog

From Current Studies: What Migraine Treatments Work?

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Botox and Magnesium for Cluster Headache?

James — Wed, 11 Apr 2012 01:33:06 +0000

Yesterday Dr. Alexander Mauskop reported on a man who has been taking Botox and magnesium for cluster headaches for three years. He’s found it very helpful, although the treatment is not alone. Here’s what he’s taking:

verapamil
intravenous magnesium (every 3 weeks to one month)
Botox injections (every 2-4 months, usually between 2-3)
To take for an attack, he usually uses rizatriptan (Maxalt) tablets or zolmitriptan (Zomig) nasal spray. If he needs more he takes sumatriptan (Imitrex) injections

Dr. Mauskop says he has found that about 40% of cluster patients are magnesium deficient, and respond to the magnesium injections. The Botox also seems to be helpful, but there are few long term cases. The interesting thing about this case is that the man has taken Botox over the course of 3 years.

All of these medications are also used for migraine, though verapamil is one of the less common ones.

For more, read Dr. Mauskop’s post: Botox for chronic cluster headaches

From the Headache and Migraine News Blog

Botox and Magnesium for Cluster Headache?

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Watch for it – Ketamine for Migraine and More

James — Fri, 30 Mar 2012 15:26:53 +0000

Using ketamine for pain is not a new idea. But I think we’re going to see it get an increasing amount of attention in the months ahead.

A few weeks ago, NPR featured a news story on the use of ketamine for depression. Ketamine, originally developed as a human anaesthetic, has since been used for various applications in medicine.

It’s also used as an illegal drug, gaining fame as "K", "Vitamin K" or "Special K".

In recent years there has been sporadic interest in using ketamine for pain. It’s a difficult drug to study, because it tends to be rather obvious that you’ve taken it.

But it has been suggested as a treatment for cluster headache, familial hemiplegic migraine, chronic daily headache, and migraine, as well as other types of pain.

Ketamine is a neurological drug, classed as a NMDA (N-methyl-D-aspartate) receptor antagonist. It is believed to work in a number of different ways in the brain – relating to calcium channels, serotonin, and glutamate – terms that will be familiar with migraine researchers in particular. In fact, ketamine has been especially useful in the treatment of headache or migraine that just won’t go away and isn’t responding to other kinds of treatment (refractory). It’s given as an IV or intranasal treatment. Of course, this means it’s way down on the list of treatments that will be given – it’s rare and even when it’s tried it’s often not successful.

However, with the growing interest in ketamine for depression, the game changes. You can bet that there will be increased interest in ketamine for chronic pain conditions, which often come hand in hand with depression.

Although increased interest doesn’t mean this should be the drug of choice for most people, it does mean that more research will be done. It may be a treatment that will help a few patients whose pain is seemingly unstoppable.

For more on the background of ketamine, read Ketamine and MDARs in the treatment of neuropathic pain from Dr. Jan M. Keppel Hesselink. For a review of the studies on ketamine for other types of pain aside from headache, read Ketamine in Chronic Pain Management: An Evidence-Based Review

From the Headache and Migraine News Blog

Watch for it – Ketamine for Migraine and More

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Coming Migraine Treatment: Lasmiditan

James — Tue, 06 Mar 2012 18:03:20 +0000

Lasmiditan is a new drug that is being investigated for the treatment of migraine attacks. It’s in a new class of drugs known as ditans, which are serotonin receptor agonists that selectively bind to the 5-HT1F receptor.

Lasmiditan has been the subject of numerous studies already. The advantage of Lasmiditan is that it doesn’t seem to constrict blood vessels, and there have been no reports of cardiovascular effects or chest symptoms. This is very important because of the increased risk that migrainuers already have for heart issues and stroke. Those in particular who can’t take triptan drugs may find relief with Lasmiditan.

Like the very popular triptan class of drugs, Lasmiditan would be taken for a specific migraine attack.

Recent trials showed significant improvement in migraine patients over a placebo. Over 60% of headaches were reduced to nothing or almost nothing within 2 hours. Sensitivity to light and sound were also significantly reduced. Interestingly, nausea was also reduced, but this took more time.

The company that is testing Lasmiditan, CoLucid, is planning trials throughout 2012, 2013 and 2014, hoping to have a product ready for 2014. Already, a recent survey in the USA suggested that 10% or neurologists would prescribe Lasmiditan. As you might imagine, the financial experts are keeping an eye on statistics like these, in the highly competitive world of migraine medication.

This is what CoLucid has to say about the drug:

Lasmiditan is a first-in-class Neurally Acting Anti-Migraine Agent (NAAMA) designed to deliver efficacy in migraine without the vasoconstrictor activity associated with previous generations of migraine therapies. Lasmiditan is a member of a novel chemical class called "ditans" and, unlike triptans, penetrates the central nervous system (CNS) and selectively targets 5-HT1F receptors expressed in the trigeminal pathway. Lasmiditan does not interact with vasoconstrictor 5-HT1B/1D receptors activated by triptans.

From the Headache and Migraine News Blog

Coming Migraine Treatment: Lasmiditan

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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?