weight gain

27 April 2020

CGRP Drugs and Weight Gain

Do CGRP injections cause weight gain? If so, what can I do about it?

This is a (somewhat belated) response to a question from Char in the United States. If you have a question, use the button on the right to fill in the form.

Char was specifically asking if there is a CGRP injection that doesn’t cause weight gain.

One of the concerns that doctors have had regarding the new CGRP medications is that they are – well, new! Of course, every medication has to be new at some point. But what that means is that long term testing is really only starting. (For some of the concerns expressed early on, check out At Stake: The Possible Long-Term Side Effects of CGRP Antagonists. Weight change is one of the questions that is highlighted.)

So at this moment in history, we are waiting for long term trials, and also watching carefully clinical experience – that means your experienced with the drugs.

Many people are being helped by the new medications, but there are reports of weight change – not just weight gain, but weight loss. The Robbins Headache Clinic reported on some of the early experiences they had with the CGRP medications. Here’s what they’ve written about weight changes:

Bloating & Weight Changes: weight gain can be a problem, and if significant enough we stop the medication. This does not appear to be as much a problem as with other medications such as Lyrica, Depakote, gabapentin and the tricyclic anti-depressants, but we are seeing it. This could be because our feeding and hunger is centered in the hypothalamus which is not protected by the blood-brain barrier. A few people have lost weight, and if it is significant then we stop the medication.
CGRP QUESTIONS/ANSWERS

So in short, they saw both weight gain and weight loss. However – and this is important – CGRP related medications don’t seem to be the worst offenders when it comes to weight gain.

The Pain News Network also reported on a survey of those using the new medications. According to the survey, 12% of patients reported some weight gain (see New Migraine Prevention Drugs Making Inroads).

We have to remember that these are not controlled studies. And so we come to a very important question – are these drugs directly causing weight gain?

Here’s a simple example. If you are constantly nauseous, and a CGRP injection significantly improves your health, what just might happen? You might eat more.

This is the argument that Drugs.com makes for Aimovig. “Does Aimovig cause weight gain or loss?” – no, but changing migraine symptoms may. You may think that their answer is a little overconfident, but the fact remains that there may very well be a complex set of reasons why you gain or lose weight on a CGRP drug.

So back to Char’s concern – what to do?

First, be sure you are communicating your concerns with your doctor. This is a case when customized medical help is very important. Your doctor can help you find the best solutions for you.

Second, and this will help your doctor, be sure to keep a detailed diary of your symptoms and any changes that you notice.

Third, try another CGRP medication. Unfortunately, we simply do not know enough at this point to give you a list of CGRP related medications that are least likely to cause weight gain for you. Like many classes of drugs, it can make a significant difference if you try another drug of the same class.

And, of course, as your symptoms (hopefully!) lessen, take the time to learn and re-learn some basic healthy habits.

We would love to hear your experiences and suggestions – leave a comment! 🙂

28 March 2019

What Side Effects Do You Want to Avoid?

James Discoveries & Stats, Tips 0

Migraine patients are an intelligent lot. They know that medication is not just about relieving migraine symptoms. There are also complex risks and side effects that affect our choices.

A study in the USA, published this month in the journal Headache, investigated some patients’ priorities when it came to side effects of preventative medications. What would you be willing to trade off?

Some examples from the study of 300 patients:

Patients were willing to put up with some major side effects if it meant reducing migraine symptoms by 50% instead of 10%. Anyone who has experienced moderate to severe migraine attacks will understand that – in the case of these patients, that could mean 6 fewer attacks in a month – a big deal!

Although neither was desirable, patients were more likely to choose some thinking problems as a side effect over memory problems.

But patients were willing to put up with some cognitive side effects (memory, fuzzy brain) than they were with a 10% weight gain! Patients were also willing to pay US$84 more a month if they could avoid that 10% weight gain.

Patients would rather have a monthly injection than a daily pill. However, they would pick the daily pill over twice-monthly injections.

These patients are not you, of course. In fact, if they looked at they survey results, they themselves might re-evaluate their own choices.

But here’s the take-away. Today, there are many choices when it comes to migraine treatment. It’s worth your time to think over what your priorities are, and discuss them with your doctor. Do you want to avoid weight gain (by the way, here are some of the worst offenders when it comes to migraine medications)? Do you have a job that requires sharp thinking, and you would rather have some other side effects rather than lose your intellectual edge?

Check out the abstract below for more statistics. But remember, more importantly is what your priorities are. And if your doctor doesn’t know, she can’t help you with those choices.

Study abstract: Patient Preferences for Preventive Migraine Treatments: A Discrete-Choice Experiment.

6 March 2017

Candesartan for Migraine

James Medications 6

Recently a HeadWay subscriber mentioned a treatment that has been working well for her, and I realized that I haven’t mentioned it before. So here is a brief description of candesartan and its use in migraine treatment.

Candesartan is sold under the brand names Atacand, Amias, Blopress, and Ratacand, although it’s also available as a generic drug. It’s classified as an angiotensin II receptor blocker (ARB). ARBs are often used to treat hypertension, and candesartan is no exception. But antihypertensive drugs are also used as migraine preventatives.

In 2013, a study compared candesartan with a more common migraine preventative, propranolol. The study concluded that 16mg daily of candesartan was comparable to 160mg of propranolol – both led to fewer days with migraine symptoms. (see A comparative study of candesartan versus propranolol for migraine prophylaxis)

Sometimes we make the mistake of thinking that just because we’ve tried a certain kind of drug, we shouldn’t bother trying similar drugs. But the truth is that every drug – even sometimes different versions of the same drug, can have a different effect on an individual. That’s why candesartan can help a patient when propranolol might not, or vice versa.

As always, talk to your doctor before trying any medication. You may not need 16mg – a lower dose may be helpful. Candesartan is NOT for use by anyone who may be pregnant.

Another bit of good news is that candesartan may be a better option for patients concerned about weight gain.

If you’re interested in trying a new preventative medication, talk to your doctor about candesartan. It’s now an often recommended option.

17 July 2014

Will new Migraine Med fight Obesity and Diabetes?

James Discoveries & Stats, Medications, News 1

The high expectations for CGRP-blocking migraine medications could turn into a craze before they even get to the market. New research has raised the hope that this type of medication could fight obesity and diabetes, and help the patient to live longer in general.

Before you start looking to these new meds as the fountain of youth, there are a few things you should know about the study, published this May in the journal Cell.

First, this is a very early study, using mice, not humans. And it all revolves around TRPV1 pain receptors.

When these pain receptors were destroyed, the mice actually did better as they aged. In fact, they lived 14% longer than the other mice. More insulin became available, and blood glucose lowered.

What would that mean for a human being? Less chance of obesity of type 2 diabetes, because your body would easily be able to get rid of sugar.

What does this have to do with the new series of migraine drugs that researchers are working on? Well, the calcitonin gene-related peptide neurotransmitter – CGRP – is blocked using the new medications. CGRP is triggered by the TRPV1 pain receptor. Meaning that the blocking of CGRP may be the real key.

Interestingly, this particular pain receptor is sometimes called the “capsaicin receptor”, because it’s activated by capsaicin, the active ingredient in hot peppers. When the receptors are activated enough by capsaicin, they can stop working – and so pain messages are interrupted in the body.

Capsaicin has been a common treatment for headache and migraine in the past. Could it be that they work the same way – by blocking CGRP in the body? If so, we may have more evidence than ever that these medications will work.

Expect to hear more and more about these meds as they get closer to market. The promotion machine will go into full gear. But remember, they are unlikely to work for everyone. Our hope is that they will help a few people that haven’t been able to find help so far, or those who have found help but are dealing with side effects. And maybe instead of weight gain (a common side effect in many migraine medications) they can enjoy some weight loss.

Meanwhile – pass the peppers.

For more:

TRPV1 Pain Receptors Regulate Longevity and Metabolism by Neuropeptide Signaling (study summary)
Pain killers may improve health of diabetics and the obese (press release)
Anti-migraine Medication May Treat Obesity, Diabetes (short article)

20 September 2013

Should I Lose Weight to Fight Migraine?

James Discoveries & Stats, News 16

It’s in the news yet again, thanks to a study from Johns Hopkins University School of Medicine. This time, it’s a link between obesity and episodic migraine (as opposed to chronic migraine).

The study concluded that the obese population was 81% more likely to have episodic migraine (EM) than the general population. Or, about this many in a group of obese subjects would have episodic migraine:

So – naturally – what’s the solution that’s being proposed? Exercise and a healthy diet, of course!

And no one wants to discourage anyone from a healthy diet and exercise, do they?

Well, of course not. And neither do I. In fact, I would suggest that those two things might just out-do any pill that has been invented. Maybe.

But I’m afraid there’s a real danger in over-simplifying the connection.

The study, in fact, shows that there’s an increasing risk of EM as you become more obese. So – the more weight I lose, the fewer migraine attacks I’ll have – right?

Here are a few reasons why we shouldn’t be hasty to draw this conclusion.

Which is a result of which? Does the obesity increase the chance of migraine, or is it the other way around? Just because there’s a correlation does not mean that one causes the other.
Obesity is clearly not the one risk factor or cause of migraine. If it’s one factor in 100, there could be 99 other things that are more important to deal with first. We don’t know. But we can see from the chart above that obesity â‰ migraine.
What about migraine medications? Many meds are known to promote weight gain in some people. Could that alone explain the results of this study?
Dr. Tobias Kurth, interviewed by Reuters, pointed out that historically obesity is on the rise but migraine is not. If there was a strong correlation, why aren’t both rising together?
What about conditions that are comorbid with migraine? Could they be causing the obesity, and not migraine itself?
There are a number of other factors we don’t know about. Would these statistics hold true with younger migraineurs? What about different types of body fat?

So let’s not raise an eyebrow at the overweight person with migraine – assuming that it’s all their fault that they have migraine – if only they’d just get it together….

No no no. There could be many factors leading a person to be obese – in fact, following a doctor’s treatment plan for migraine could have even contributed to the weight gain. So let’s be real careful here before we act like we know what the problem is.

Now, before you run for another bag of candies or a Peppermint White Chocolate Mocha with Whipped Cream, let’s remember a few things. There does seem to be a connection, and it could actually be that weight gain does contribute to your risk. And there’s no doubt at all that a healthy diet and exercise are two of the best migraine fighters out there.

No, we shouldn’t pin all our hopes on weight loss, and aim to lose the pounds at the exclusion of all other goals and at all costs. However, improving our health, including aiming for a healthy weight, simply has to be a part of our overall treatment plan.