migranal Archives - Headache and Migraine News

19 January 2010

Levadex – inhaled migraine drug on the way

Levadex is something new, and it isn’t. It’s a new formulation of dihydroergotamine mesylate (DHE), known by many as DHE 45 (an injection) or Migranal (a nasal spray where the drug is accompanied by caffiene). DHE was introduced in the 40s, so it’s been around in various versions for a long time.

This new version known as Levadex is an inhaled version, brought to you by MAP Pharmaceuticals. Levadex will use the Tempo inhaler, designed especially for asthma and migraine patients.

In the United States, Levadex took a big step forward when the FDA decided not to ask for another phase III study. MAP Pharmaceuticals will go right ahead with their study of long term safety.

This part of the study is expected to be completed this year (2010).

So far Levadex looks promising for some patients, dealing not only with pain but other common symptoms – nausea, and sensitivity to light and sound. It’s believed that in a few years Levadex will be a major player in the migraine market. Then again, our understanding of migraine is changing and increasing at such a rapid rate, it’s hard to say what will be going on in a few years.

via FDA Clears the Way for MAP Pharmaceuticals

20 February 2009

DHE Migraine Treatment: Why some people still use it

James Medications 125

To get some background on DHE migraine treatment, we need to go back to the days before DHE, or dihydroergotamine, was used. It was actually in 1925 that the first migraine patient got an injection of ergotamine tartrate. It worked – stopping the migraine that just wasn’t going away.

In 1943 came the next step for "ergot treatment" – DHE, the long name being dihydroergotamine. It was first used at the Mayo Clinic.

Yes, 1943.

Since then, our understanding of migraine has been completely transformed. And yet, some people are still using DHE to stop migraine attacks. Why?

Earlier this week I asked on Twitter who had used DHE lately, and got a helpful response from @maxjerz, who had used IV treatment to stop a migraine that, again, was not going away – 24/7 pain.

Photo courtesy of BlueGoa

That answer is actually typical – DHE is often given for migraine attacks that aren’t being stopped using more common medication. DHE IV therapy isn’t the only way to go – it can also be injected intramuscularly or subcutaneously. I’ve used it myself, and let me tell you sticking a needle in your body when you’re more sensitive to pain than ever isn’t fun (and for me wasn’t any help) (read Robert’s experience with DHE).

Just last month a report came out of the Cincinnati Children’s Hospital Medical Center in Ohio, USA about using DHE migraine treatment on children and adolescents with status migraine (again, migraine that ain’t going away – an attack lasting more than 3 days). The results were encouraging – almost 3/4 of the patients became pain-free (excellent considering their normal medication wasn’t working). Read the study on DHE migraine treatment for children and adolescents.

So DHE (sold as DHE-45 and Migranal) is still given to patients who aren’t being helped by other medications, and because it’s an injection it can be used for patients who have nausea. It also may help with allodynia (sensitive/painful skin – a common symptom of migraine).

So – why don’t MORE people use it?

So maybe our question should be – why isn’t DHE migraine treatment used more often? Here’s why dihydroergotamine is no longer at the top of most doctor’s lists:

Side effects: Serious side effects are rare, but they’re serious enough to make one cautious. Possible problems include cardiac events, increase in blood pressure, and spasms of blood vessels.
Drug interactions: There are a large number of drug interactions that you need to worry about with DHE, such as certain antibiotics, triptan drugs, and protease inhibitors. It’s recommended you carefully go through any drugs you’re taking or may take and let your doctor know before using DHE migraine treatment.
Other cautions: Like many drugs for migraine, DHE can’t be used by pregnant or nursing mothers. There’s also concern about patients with hypertension, certain types of migraine, and patients with peripheral arterial disease (to name a few).
Rebound headache: Taking DHE may lead to rebound headache, where the migraine attacks start coming stronger and faster because of the medication itself.

Obviously other drugs have many side effects, and other cautions, but the concerns with DHE may be higher compared to the benefit, depending on the patient. For most people, other treatments will work better. But a doctor who knows your medical history may suggest DHE for your case individually.

So, although your doctor will have good reasons for recommending other medications first, DHE may still be the perfect thing to end the migraine symptoms in certain patients.

Read more technical details about dihydroergotamine msylate here.

19 January 2009

Migraine Nasal Spray – Should You Try One?

James Medications, Tips 5

Of the many methods we have to get migraine medication into the body, one of the earliest and best to be used on a mass scale is the migraine nasal spray (also called a nasal inhaler). Part of the reason is that the technology was fairly simple, as opposed to some of the advance methods that are now being tried. But why not just take a pill? Is a nasal spray really worth it?

One of the most obvious problems with taking a pill during a migraine is the nausea. I’ve had migraine attacks where I throw up again and again (sorry to be graphic, but that’s migraine!). It’s almost impossible in some cases to get a pill to stay down.

But perhaps an even more widespread problem is something called gastric stasis. A very common but little known impairment in migraine patients, gastric stasis causes your digestive system to slow down, meaning that the medication isn’t properly absorbed. Imagine, taking all those pills (spending all that money!), and most of the medicine never gets into your system!

A migraine nasal spray (such as Zomig, Imitrex or Migranal) gets the medicine into your system faster, and hopefully more of the medication is actually absorbed.

But is faster better? Traditional wisdom says that the sooner you can stop the migraine attack, the better. Though some research has questioned just how fast you need to take the medication, it seems clear that the faster you can stop the migraine chain reaction the better.

Other methods are being developed to get the medicine you need into your system quickly. But while we wait, a migraine nasal spray early in an attack may be one of the best "delivery methods" early in an attack. Some migraineurs carry a dose with them, so they can head off a migraine attack early.

Preventative medicines may also be good candidates for nasal spray. Some research suggests that gastric stasis may be a feature of migraine disease that’s always there, not just during an attack. But the development of preventative drug delivery is still behind the abortives.

Meanwhile, ask your doctor what kinds of delivery options you have. A migraine nasal spray may give you more migraine-fighting power for your money.