preventative medication

10 September 2020

CGRP Inhibitor – but, I hate injections!

James Discoveries & Stats, Medications 0

CGRP Inhibitors, as preventives, have a lot of advantages. Sure, they may be injections, but they’re not taken every day like most preventatives for migraine.

I mean, in the case of Ajovy, you’re looking at an injection every three months.

But I know, some of you are saying – seriously, I don’t care how often it is. I don’t do injections!

You might want to keep an eye on a new preventative that may come out in 2021 – atogepant.

Now if you remember our discussion of different types of “CGRP drugs”, you’ll recall that the “gepant” drugs are generally being marketed for acute treatment – to take once a migraine attack has already started. But this one, taken orally, is being tested for prevention.

Part of the phase 2 trial was published online in August. 825 patients received atogepant, but they were divided up to receive varying doses – 10, 30 or 60mg once or twice a day. 5% or less experienced nausea or fatigue with certain doses – that number may be lessened significantly once we figure out which dose is best. But overall, there were no serious side effects, and over 12 weeks the patients saw a significant decrease in their days with migraine symptoms.

Phase 3 results are already being reported as well, and results look similar. Patients got back several days each month – several more migraine-free days. A slightly better result seems to come with the higher dosages.

Although this will be a once or twice a day dose, it’s oral – no injections! So keep your eye on this one.

For more on the study, see Safety, tolerability, and efficacy of orally administered atogepant for the prevention of episodic migraine in adults: a double-blind, randomised phase 2b/3 trial. For more history, check out Allergan: atogepant. (Note that Allergan is now owned by AbbVie, so don’t get confused.)

12 March 2020

Vyepti to fight Migraine – How is it different (and what’s with the name?!)?

James Medications 0

In February, Vyepti was approved in the USA as a new migraine preventative. An application has been submitted for approval in Canada, and the European Union will be next later this year.

Vyepti (eptinezumab-jjmr) is yet another “anti-CGRP” medication, so it’s important to understand what is unique about it. Of course, as with any class of medications, one may work well for you even when another similar drug does not. And Vyepti does have a specific biological mechanism that is different than the other anti-CGRP drugs.

However, there’s more to it when it comes to Vyepti.

The key difference with Vyepti is the way you take it, and how often. As you may know, other medications in this class that have been approved are given by injection on a monthly basis (Aimovig, Emgality, and Ajovy). Now Ajovy is an exception, in a way, because it can also be taken quarterly (although it may be slightly more effective if taken monthly).

Vyepti, however, is specifically to be taken quarterly (every three months). It’s attractive for many patients that they only need to take a preventative only four times a year – especially those of us who have endured the two-or-three-times-a-day routine for some medications.

Vyepti is unique in that it is given as intravenous (IV). The usual recommended dose is 100mg (although some patients may need 300mg). This amount is diluted, and given via IV over 30 minutes.

This may sound more extreme than an injection, but many patients might prefer an IV given by a doctor to having to do their own injections.

A positive for this drug is that there seem to be few side effects. The most common ones (which weren’t all that common) occurred actually during the IV. A “stuffy nose” was probably the most common issue.

You may wonder, if this drug is taken so occasionally, how long it takes to start working. The good news is that it seems to start working on “day 1”. Clinical trials have shown that Vyepti reduces the number of migraine days per month, even for those with chronic migraine.

To read more, you can visit the official Vyepti site here. Also check out this helpful article: Breaking News: Eptinezumab-jjmr (VYEPTI™) Approved by FDA.

But in closing we have to ask, what’s with the name?? On the Vyepti website, the authors insist on capitalizing the word (VYEPTI – does that stand for something?), although on other sites the writers resist shouting at their readers. And the official logo is all lowercase.

To some, Vyepti may sound like a mysterious furry creature that roams the mountains.

How drugs get their names is a fascinating study. And I would love to hear more about how VYEPTI got its name. Do you know?

14 January 2020

Aspirin: Cliché or Real Treatment?

James Discoveries & Stats, Medications 0

There’s no doubt that aspirin has become a cliché – almost a symbol of all that is wrong with headache treatment.

You know, the doctor who just tells you to “Take two aspirin and call me in the morning”. He doesn’t take your symptoms seriously, he doesn’t differentiate between different types of migraine or headache. No recognition of the cutting-edge medications or complimentary treatments.

Aside from that, it can be dangerous to take over the counter “painkillers”, especially if you’re taking them every week, without an expert diagnosis and observation.

That being said, the evidence still points to aspirin as a helpful treatment for headache and migraine. It’s become so cliché that it ends up being overlooked. But a new study is reminding us again that aspirin may still be one of the best drug treatments for migraine.

This is actually a review of 13 randomized trials showing the use of aspirin in thousands of patients with migraine. The review came from Florida Atlantic University’s Schmidt College of Medicine. Here’s a summary of their findings:

Their findings, published in The American Journal of Medicine , suggest that high-dose aspirin, in doses from 900 to 1,300 milligrams given at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, some but not all randomized trials suggest the possibility that daily aspirin in doses from 81 to 325 milligrams may be an effective and safe treatment option for the prevention of recurrent migraine headaches.
Migraine Headaches? Consider Aspirin for Treatment and Prevention

You may remember that we wrote about aspirin as a preventative in 2012, when it came out as a winner against preventatives such as propranolol (Inderal) and topiramate (Topamax). Considering the side effect that may accompany preventatives such as these, aspirin is an attractive option.

Of course if we can find ways to treat migraine without a daily drug, that would be preferable. But the strongest evidence seems to be for aspirin as an abortive.

We talked about best options for NSAIDs (which would include aspirin and ibuprofen) here: NSAIDs – Which One Should I Take For Headache? The take-away for aspirin is that is is certainly one of the most effective, with a recommended dose of 1000mg. However, it can be hard on the stomach. So, if possible, take it with food, and certainly use a brand you trust – if possible, a version that is not time release, but that has a coating to protect your gut.

Aspirin is still a good abortive. But remember, if you’re reaching for it regularly, you have a more serious problem and you need to look at other options.

For more information on this recent study, see Migraine Headaches? Consider Aspirin for Treatment and Prevention.

27 May 2014

Do You Make this Medication Mistake?

James Medications, Tips 4

There are some fairly healthy people who have a migraine condition – and they try a medication – and it works well – and life goes on.

I’m happy for you.

But some of us have spent more time looking for treatments that work. But some of us spend more time than we should, because we make a classic mistake.

We don’t keep detailed records.

Most of us, if we have records at all, just have something like this:

I’ve tried

sumatriptan

propranalol

Depakene

Anti-depressant

Well, that’s a good start. But there are some problems with that list.

You tried sumatriptan. Brand name, or generic? Did you know that it could make a difference which you tried? Was it a nasal spray? Or a pill? Injection? Or did you try all three at different times?

Propranolol – that’s a generic name. And you spelled it wrong. 😉 Was it Inderal? Depakene – that’s a brand name for sodium valproate. Was it actually Depakene you took?

Which anti-depressant? Elavil? Paxil? Norpramin? In what form?

This is very important, because another form of sumatriptan may work when this one didn’t. One type of sodium valproate could help, while another doesn’t.

And what about other treatments? Have you been for physiotherapy? Have you seen the chiropractor? Have you taken a magnesium supplement?

Detailed records will help your doctor know what to try next. For example, you may have a better change trying a different form of what you’ve already taken, rather than trying something totally new.

So here are some suggestions of the information that you should have on hand to show a doctor or check yourself when the need arises.

Drug name
Manufacturer (especially if generic)
Dates used
Side effects (and how severe)
Benefits (if you have the dates, you may have this information in your headache diary)
Dosage(s)
Doctor who prescribed
Form (tablet, gel tab, injection, etc)
Preventative or abortive? (eg did you take this as a daily preventative, or when a migraine attack was starting?)

If possible, also include information such as what else you were taking at the same time. It might be handy to snap a picture or scan the actual package of the medication or supplement to catch whatever info you’ve missed.

For those who are more or less new to medications, this may seem a little obsessive. But the better your records, the better off you’ll be in the future. For example, what if a treatment stops working? What if one manufacturer makes slight changes to a medication? What if you develop another condition which means you can’t take this medication anymore? What if you change doctors, or your medical files are lost or damaged? What if you have a severe attack and need to go to emergency – do you really want to rely on your memory and a few scribbled notes?

Keeping track as you go along sure beats trying to remember and locate the files and call the right doctor years later.

Trust me. Been there.

How do you keep track of medications/supplements/treatments? Any suggestions to help the rest of us?

5 November 2012

Could you use Aspirin to Prevent Migraine Attacks?

James Discoveries & Stats, Medications 12

Aspirin is considered by many to be one of the better migraine treatments, both as an abortive and a preventative treatment. Should it be getting more attention?

Aspirin: Your new Migraine Preventative?

Dr. Lidia T. Savi reported on an aspirin and migraine study at the European Headache and Migraine Trust International Congress. The study looked at a number of preventatives, and found that aspirin held its own.

Out of 194 patients with migraine with aura, 90 were given 300mg of aspirin (acetylsalicylic acid) each day. The rest were on a variety of other preventatives, such as propranolol (Inderal) and topiramate (Topamax). How did the patients do?

First question – how many saw a 50% improvement after 32 weeks?

Obviously, the aspirin group generally did much better than the rest. How about a 75% improvement after 32 weeks?

Once again, aspirin out did the others. As expected, there were few problems with aspirin, and no patients had to stop taking it over the 32 weeks due to side effects. Better yet, the patients on aspirin already saw improvement after 16 weeks (just over 3 and a half months).

This study does tell us that we need to seriously consider aspirin as a preventative treatment for migraine with aura. This study does not tell us that aspirin will be the most helpful for you.

This study actually raises a lot of questions. The methods can drastically change the outcome. For example, how were the patients diagnosed? Why were they put on the preventatives – was it random? There is no doubt whatsoever that some medications work better for some than others.

Even the lead researcher admitted that a larger study is needed.

It would be interesting to see more study in this area, especially for two reasons:

Migraine has been associated with increased risk of heart disease and stroke. Would aspirin help with treatment?
Some studies suggest that migraineurs have an increased risk of aspirin resistance. Why is that, and how would it affect treatment?

Meanwhile, this may be an option you’ll want to discuss with your doctor.

For more information: