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19 January 2009

Migraine Nasal Spray – Should You Try One?

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.

16 January 2007

Intranasal Zolmitriptan for Cluster

James Medications 0

As you may know, the triptan class of drugs not only benefit those with migraine, but also those with cluster. Cluster, most commonly hitting men, usually causes an intense, boring stabbing headache that comes and goes several times a day. The search is on for better treatments. Meanwhile, various types of triptans are being tested. The November issue of Neurology reported on a study of Intranasal Zolmitriptan (funded by the makers of Zomig, of course). The study was hopeful, though not exactly overwhelming.

The obvious benefit of Zomig in a nasal spray is that it’s fast – it gets into your system quickly, something that’s all the more important for those with cluster. The study tried a placebo as well as 2 different doses of Zomig – 5mg or 10mg. 10mg was most effective – 80% of those with episodic cluster (that’s pretty good) and 36% of those with chronic cluster (that’s not too bad – chronic cluster is nasty, the cycle goes on and on instead of stopping for months or years). The smaller dosage gave 47% or 28% of sufferers relief. But the placebo gave 30% or 14% of people some relief (that’s pretty good for a placebo!).

That sounds ok, although it makes you wonder when the placebo has such good results (for those who don’t know, you need to know what a placebo is). This also wasn’t necessarily complete recovery, but just a reduction to mild (or no) pain. Finally, we still don’t know how effective this treatment will be over time – more studies are needed for that.

Calling all clusterheads – have you tried triptans? What have you found to be most effective? How effective was the treatment? I would be very interested to hear your comments.