anticonvulsant

23 May 2018

Female Sexual Dysfunction and Migraine and Headache Medications

Just how common is female sexual dysfunction? It’s a complicated question. Although it’s extremely common for women to report some kind of problem sometime, it’s a whole different question when you start asking about actual dysfunction and what that is.

Man and Woman But statistics aside, the problem is real, and in many cases it could be caused by your migraine or headache medication.

Migraine patients, and patients with various headache conditions, often have many symptoms to think about. And, of course, there can be many causes of sexual problems. It’s hard to know what to mention to your doctor, and with sexual activity that may be new or not regular, sexual dysfunction from medication may not be something easily recognized.

Medications can especially interfere with both desire and pleasure during sex. Common culprits include:

Antidepressants: Antidepressants are often prescribed for migraine prevention, even when the patient is not depressed. Common examples of these medications are amitriptyline (Elavil, Entrip, Triptaz, etc), nortriptyline (Pamelor, Allegron, etc), desipramine (Norpramin, Pertofrane, etc), doxepin (Sinequan, Sinepin, etc).
Beta-blockers: Another migraine preventative, beta blockers can cause problems with desire and orgasm, as well as vaginal dryness. Examples include propranolol (Inderal) and metoprolol (Lopressor, Toprol XL).
Calcium channel blockers: As with beta-blockers. Common examples are verapamil (Calaptin, Veramil etc) and nimodipine (Nymalize, Nimotop)
Anticonvulsants: Another migraine preventative. Anti epileptic drugs are commonly prescribed for migraine, and some may be worse than others when it comes to sexual dysfunction. Examples include valproate, topiramate, and divalproex sodium.

Although these are some common categories, there are a number of other drugs that may affect sexual function.

It’s worthwhile noting that many of these drugs will also cause problems for men, though often for different reasons.

If you’re concerned, talk to your doctor. There may be another similar medication that will control your migraine attacks but won’t interfere with sex.

20 February 2015

Acetazolamide for Migraine

James Discoveries & Stats, Medications 3

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.

15 December 2014

Topiramate + Nortriptyline (and another reason why treatment is not simple)

James Discoveries & Stats, Medications, Treatments 1

We’ve talked about nortriptyline, an antidepressant commonly prescribed for chronic pain, and topiramate, an anticonvulsant often used for migraine in particular, in the past. As you can see from the comments people leave here, both have been a wonderful help – or haven’t been so great – depending on the patient.

It’s not unusual for someone to try one or the other, discover that they’re still having migraine attacks, and drop the medication permanently. But that may not always be the best option.

A study published in the Journal of Headache and Pain in 2010 tested both of these medications together as a migraine treatment.

Researchers started with patients that had experienced less than 50% reduction in symptoms with either topiramate (Topamax) or nortriptyline after trying either one for eight weeks. 78.3% of the patients improved more when taking both together than when taking just one.

It is not unusual for a combination of treatments to be better – sometimes drastically better – than one or the other. This is just another example.

When your doctor suggests you retry something you’ve already tried – but this time with something else, whether it be a supplement or drug or other type of treatment, don’t brush the idea aside quickly (even if the drug didn’t work in the past at all).

On the other hand, be very cautious if you have experienced significant side effects in the past. For example, when it comes to topiramate watch out for heart palpitations or chest pain, visual changes, weakness, confusion, or a loss of appetite. For nortriptyline, common things to watch for are depression, trouble breathing, seizures, fever, fatigue or weakness.

And remember, never change your dosage without checking with your doctor.

Thanks to:

21 August 2014

Topamax not working? Here’s a Possible Alternative

James Discoveries & Stats, Medications, Treatments 4

Although Topamax (topiramate) has helped many patients, it is by no means the silver bullet to stop migraine. It’s popularity has also been hampered by the side effects that some patients experience.

Of course there are many good alternatives to Topamax, but researchers are looking for something similar that will work for patients that are good candidates for something like topiramate, but who do not respond well to topiramate itself.

A study published in July (2014) investigated a drug called zonisamide as an alternative to topiramate. In this case, patients with episodic migraine with aura were studied. These were not patients who had severe reactions to topiramate, but who simply had not seen more than a 50% reduction of migraine attacks.

Zonisamide (sold as Zonegran)is another antiseizure drug. Like Topamax, side effects are a common reason why patients do not continue with the treatment. In fact, in this study 12% dropped out because of side effects such as dizziness, nausea, insomnia, and drowsiness.

In the end, however, there were two positive results.

First, many of the patients had much better success with zonisamide. Over three months, every month things got better.

Second, side effects did actually seem to be less of a problem with zonisamide. In particular, paresthesia (a tingling or burning feeling of the skin), one of the most common side effects in topiramate, was almost non-existent.

This is only a preliminary study. It was open label (meaning the patients knew what they were taking), and patients directly switched to a steady dose of zonisamide (100mg/day taken in two doses). It will be interesting to see how patients respond to different doses.

One other interesting note – some patients dropped out because they improved very quickly and decided they didn’t need more treatment! That sounds great, although it’s too bad they didn’t understand the value of continuing the study so that the results can be measured.

Zonisamide has not been approved as a migraine medication, but this study shows that it is worth studying as an alternative preventative to Topamax. If you’ve tried it, leave a comment and let us know how it worked for you.

Sources:
Efficacy of Zonisamide in Migraineurs with Nonresponse to Topiramate
Zonegran (Drugs.com)

17 June 2013

Miracle Medication helps 3 in 10 Migraine Sufferers!

James Discoveries & Stats, Medications 8

Yes, there is an amazing medication that helps – 3 in 10 migraineurs! Ok, that doesn’t sound like much. Actually, it isn’t.

It is great for those 3, of course! But for the rest, no so great.

So what is this medication? Actually, it’s not just one medication – it’s most of the common ones you’ve heard of. No, I’m not saying that all medications only help 3 in 10, but that a single medication will probably only help 3 in 10.

This is based on research done at the Minnesota Evidence-based Practice Center. Researchers wanted to pool results from 5,244 clinical trials of migraine medications.

They examined 59 drugs in 14 different drug classes. This would include medications like:

Topamax
Depakote
Inderol
Toprol-xl

…and many more.

The researchers concluded that, generally speaking, individual drugs helped – at least, better than a placebo – about 200-400 people out of 1000.

Of course, whether they helped or not, many medications aren’t continued because of side effects. Some of the worst offenders include topiramate (Topamax), other antiepileptics used off label, and antidepressants.

Some drugs did much better when it came to side effects vs. benefit. These included angiotensin inhibitors (such as lisinopril (ie Zestril)) and beta-blockers (such as metoprolol or propranolol).

Other than the lack of a miracle drug, there were a couple of other things that did not impress the researchers. One was that many trials were of poor quality. Another was that there is a lack in research into the long term effects of these drugs, particularly when it comes to quality of life.

Again, this report is not suggesting that only 3 in 10 migraineurs can be helped with medication. Considering all the various drugs and treatments and combinations, that number is much higher. There is good treatment available!

But once again we’re reminded that migraine is very individual – what helps one person won’t help another.

We’re also reminded that much of the excellent migraine-fighting medication available today is still very new. We don’t have good studies, and we don’t know what the risks are when it comes to taking these meds long term.

A neurologist reflects on these findings: Effective Migraine Prevention per 215 Trials
Also see: Is your migraine preventive treatment balanced between drugs’ benefits and harms?