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17 April 2013

Levadex – Rejected Again

Levadex, an inhaled version of dihydroergotamine mesylate (DHE), has been rejected again by the FDA in the United States due to manufacturing concerns.

Levadex was recently at the centre of a deal worth almost a billion, when Allergan bought MAP Pharmaceuticals, the developers of the drug. Just over a year ago, with MAP at the helm, Levadex was not approved by the FDA due to concerns about the inhaler.

Allergan is probably best known for manufacturing Botox, also used for migraine treatment.

DHE is an old migraine treatment, but many still find it helpful. Often given in a hospital intravenously, many patients hope that an inhaled version will be a help at home.

Patients with chronic daily headache may also benefit from Levadex, assuming it gets to the market.

And it probably will. Allergan is hoping to apply for approval again before the end of the year.

via: F.D.A. Rejects New Drug for Migraines

16 April 2013

Massage for Migraine: Are we talking about it enough?

James Treatments 7

There are many migraine treatments that have been well studied. There are some that have been studied only a little bit, and that may be because the results aren’t all that encouraging.

Massage for migraine is something different – it has been studied, some, with encouraging results. But it hasn’t been studied nearly enough.

Yes, researchers are very positive about massage when it comes to migraine. Health practitioners do recommend it – sometimes. But could it be that this is a very effective treatment that we’re not talking about nearly enough?

Back in 2011, researchers published a review in The Journal of Headache and Pain, reviewing studies about physiotherapy, chiropractic, and massage therapy. The studies on massage therapy were small and not well designed. And yet clearly migraine patients saw improvement through this type of treatment.

Massage therapy is also frequently recommended for pregnant women with migraine, who are wanting to avoid most drug therapies.

One of the challenges with studying massage therapy is that there are so many different types. Of course there are actually head massages, such as champissage. But it could be that a shoulder, neck and back massage is even more effective. In fact, foot massages seem to be very helpful for migraineurs, even if it’s self massage using a good quality foot massager.

So with so many types of massage, and so many types of migraine and other headache conditions – where do you start?

In spite of the challenges, we should not be afraid to study massage, as both a migraine preventative and a treatment during some types of attacks. We will probably be pleasantly surprised to find that this safe, non-drug treatment is very helpful. It could be helping many more people, and there are already a lot of migraine patients who would tell you to try it.

The study mentioned above: Manual therapies for migraine: a systematic review

15 April 2013

What is Allodynia?

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Cutaneous (skin) allodynia (skin sensitive/painful to the the touch)
Most often on the scalp (hurts to comb your hair!)
Also on other parts of the body (hurts to wear a shirt!)
A common symptom of migraine and cluster headache
May occur during a headache, or as a “warning signal”

For more information, read My Hair Hurts! Migraine and Allodynia

8 April 2013

5 Migraine Aura Myths

James Information 5

(Click image for a larger version)

Anytime you try to summarize anything in a graphic like this, there’s a lot you’re going to miss. I decided to make this graphic about Migraine Aura Myths anyway, but below is a bit more information.

Migraine Aura: Neurologic symptoms that often precede a Migraine Headache, typically by about 60 minutes.

Part of the challenge with migraine aura is the definition. If you include every symptom that may come before migraine (including symptoms that may occur 2-3 days ahead of time), that’s a lot different than the more classic definition of a very short-term symptom (20-30 minutes) (typically) right before a headache. Early symptoms of a migraine attack can be divided into various categories, or all lumped together.

Myth: Migraine Aura is always a visual disturbance.
Reality: Visual disturbances are the most common Auras, but there are other Aura warning signs.

This is a whole topic of its own, but an example of a non-visual aura would be a tingling feeling (“pins and needles”) and numbness.

Myth: If your attacks are preceded by Aura, they will always will be preceded by Aura.
Reality: If you experience Migraine Attacks with Aura you will usually experience Migraine Attacks without Aura.

Myth: A true Migraine attack always involves some kind of Aura.
Reality: Only about 20% of Migraine Attacks include Aura.

This is an important one. Most migraine attacks do not include aura. Many people with migraine will never experience aura.

The 20% statistic will vary with age and gender. Some have suggested that this number is too high, because doctors may use a broader definition of aura than what we’re using here, or may diagnose any kind of visual issue that happens to occur around a migraine attack as “aura”.

Myth: Migraine Aura is always followed by a severe headache.
Reality: Aura may be followed by a severe headache, or a mild headache, or no headache.

Yes, just a reminder: many migraineurs do get aura and no headache at all.

Myth: Migraine Aura can be disturbing but never disabling.
Reality: Migraine Aura may be only an annoyance, or it can be disabling.

Migraine aura can be extremely disabling, even when there is no pain at all in the migraine attack.

The symbol is a proposed international symbol for hidden disability. For more information, please visit the Hidden Disability Facebook page.

Most of this information is pretty well known, but special thanks to the following books: Migraine and Other Headaches, Migraine and Your Child, The Migraine Brain, Menstrual Migraine, Imitators of Epilepsy, Second Edition

5 April 2013

Warning: Generics and “Brand Names” are NOT (always) the same…

James Information, Medications, News, Tips 5

Yes, there are differences between brand name migraine drugs and generic migraine drugs. And those differences might make all the difference.

We talked about this back in 2009. Dr. Alexander Mauskop from the New York Headache Center had written about a study that had been done on Topamax and its generic counterparts.

Last week he wrote a little more about his patients’ experiences with brand name and generic medications.

This is not necessarily about brand name manufacturers wanting to make you pay for their products (although I’m sure they do want that – can you blame them?). The fact of the matter is, due to differing manufacturing processes, differing ingredients, and differing policies from country to country, brand name meds can be slightly different from the generics. And slightly may be all that is needed between “it works” and “it doesn’t work”.

Dr. Mauskop shares some wise advice in his post, which you can read here:

I have also seen this with sumatriptan â€“ my patients tell me that some generics do not work very well or at all. Out of about 10 generics of sumatriptan, I would guess that two are of poor quality. Once you find a generic that works for you, try to stick with the same generic manufacturer. The name of the manufacturer is printed on the bottle the pharmacy gives you. If one pharmacy does not have your generic, try another one.

He goes on to share a note from a patient dealing with pharmacies and changing availability of medications.

Of course, this involves pharmacies, drug companies, and insurance companies (oh, patients too!). One change anywhere along the line, and something that worked well for you can disappear.

If you run into trouble, share these posts with those you’re talking to, so they’re aware of the issue. Again, many times it may make no difference, but sometimes it will.

The most frustrating part of this story is that there are surely patients out there who have tried a triptan, and have given up on it, even though the very same triptan of a different brand might work.

So it may be worth your while to not only try different triptans (yes, one may work well when another doesn’t work at all), but try different brands of the the same triptan. And of course this goes for other medications too, like Topamax (topiramate) and whatever you may be trying.

Pharmacies and insurance companies need to understand that this isn’t just hype – in some cases the difference is very important. How can you in the industry better serve your patients?