Your Medication Didn’t Work: The Surprising Reason Why
Today’s podcast will focus on something everyone taking medication needs to be aware of – gastric stasis. This is especially important for migraineurs – find out why…
Discoveries & Stats
When Menstrually Related Migraine isn’t Alone
Menstrual Migraine is usually split into two categories. First, True Menstrual Migraine which, at least 90% of the time, hits during your period. Second, Menstrually Related Migraine (MRM), which can occur other times of the month, but do seem to be related to hormonal changes.
Obviously the second category is a lot more vague. Are all the attacks you’re getting really related to hormonal changes? Most often, the answer is probably no. Many attacks may be triggered by other things, and so it’s hard to know where to start when it comes to fighting migraine attacks.
One common way to treat menstrually-related migraine is to use hormonal therapy. That might include extended-cycle oral contraceptives, or more often some form of estrogen supplement (this is a simplification – these are sometimes complex treatments of many different varieties). The problem is, there’s no evidence that these treatments will help eliminate migraine attacks that aren’t menstrually related.
A 2008 study from the Department of Neurology at the University of North Carolina set out to discover if treating MRM with hormonal therapy would also cut back on other attacks. They were concerned about chronic migraine and medication overuse headache.
Their study of 229 women found that generally there was a good response to hormonal therapy. Also, a large percentage got over the chronic migraine attacks, and were able to get out of the cycle of medication overuse.
It makes sense that cutting back on even some migraine attacks would help with cutting back medication in general. But it’s even more encouraging that the chronic pattern could be broken, though we’re still not talking about everyone here (59% of women who were helped by the hormonal treatment also went from chronic migraine attacks to episodic – less frequent).
Still, it may be that hormonal treatments have a wider benefit than was previously believed.
Read more in the study entitled Elimination of menstrual-related migraine beneficially impacts chronification and medication overuse. Also, read this summary of menstrual migraine.
ADX10059 – another Migraine Drug in the Pipeline
A couple of weeks ago I mysteriously referred to a drug called ADX10059, but didn’t say much about it. So let’s take a quick look at another new migraine drug that is currently in the testing phase.
As I mentioned in the post The Latest on Tezampanel, a new Migraine Drug, ADX10059 also has to do with glutamate. You can read the previous post for more on the connection between glutamate and migraine, as well as various types of chronic pain.
The technical description of ADX10059: a metabotropic glutamate receptor 5 negative allosteric modulator. Wow! We won’t go into every detail of how it functions, except to say that it inhibits glutamate, though in a different way than Tezampanel.
Testing is still in the second phase. At the very least, the results so far show that ADX10059 is getting rid of migraine pain in some people, so there’s reason to continue with the testing.
As with Tezampanel, it is hoped that this drug will break into the migraine chain-reaction and "interrupt the migraine circuit". Keep an eye on these emerging drugs – they’re different than what has come before, and are opening up a new field of study for migraine and other types of chronic pain.
ADDEX Pharmaceuticals is testing ADX10059, and has a brief explanation of mGluR5 & migraine on their site. Expect to hear more about ADX10059 next year (2010).
Slimmer waistline – fewer Migraine attacks?
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So when the report came out in February about migraine and people’s waistlines, the media was all over it. I’m afraid this is another case when a tiny bit of news became something way too big.
Here’s the story. Researchers studied 22,211 people who were asked to report on their headaches or migraine attacks. Then they compared those stats with total body obesity, and waist circumference or abdominal obesity.
Those 20-55 years of age were more likely to have migraine attacks if they had larger waistlines or more abdominal fat. This was especially true for women.
The twist was that women over 55 had fewer migraine attacks when they had larger waistlines.
Strange, yes. But maybe not such a dramatic discovery.
First, the percentages weren’t drastic as you might think. For example, 37% of women 20-55 with excess abdominal fat reported migraine, while only 29% without body fat did. A significant difference, but not dramatic.
Next, there’s really a lot we don’t know about this study. A press release came out in anticipation of the full report, which we can look forward to around the end of April. The information we have so far really does raise a lot of questions.
Finally, we have no idea how to interpret these results. Does this mean we should try to lose abdominal fat until we’re 55, then try to gain it? Or do people with migraine normally have more fat around the waistline because of the biological functions of migraine?
Researchers are trying to target risk factors of migraine. This may make the study valuable in the long run. But for now, stay active and don’t get too obsessed about your waist.
Namenda Migraine Treatment
It’s time to take a look at what’s new with Namenda migraine treatment. Namenda is actually just one brand name for memantine. It’s also sold as Axura, Akatinol, Ebixa and Memox.
Namenda is commonly used for Alzheimer patients, but is being tested for a number of other neurological disorders.
Technically known as a moderate affinity NMDA-receptor antagonist. In Alzheimer patients, excessive glutamate inhibits the normal sending of messages in the body. This drug blocks the effects of the excessive glutamate.
Namenda is being investigated for migraine, chronic tension-type headache, and various kinds of pain.
In one sense the news so far hasn’t been overwhelming. However, memantine may bring improvement to patients that are having difficulty finding other medications that work for them (Bigal, Rapoport, Sheftell, Tepper, Tepper 2008).
In Namenda treatment for migraine, small studies have shown some improvement in migraine patients who have significant disability and a significant number of attacks each month. The dosage is usually 10-20mg per day. Some studies saw over a 50% reduction in attacks (Krusz, Cammarata, 2005).
Namenda migraine treatment shows promise, but it’s still lacking the large, double blind trials that can really show us how well it works (and who it works best for).
I should also mention that there is some indication that Namenda may help with chronic tension-type headache. The results haven’t been as promising as with Namenda migraine treatments, but patients have seen a reduction in pain intensity, and some have seen a reduction in attacks (Lindelof, Bendtesn 2009)
Again, these are very small studies. But researchers are hopeful that memantine will be a good addition to migraine treatment, especially migraine that has been harder to treat in certain people. Since tension-type headache and cognitive problems often go along with migraine, there may be certain patients that see significant improvement with Namenda.
An interesting side note on the study of memantine is new light on the differences between men and women when it comes to migraine. Read more about Namenda, Migraine and cortical spreading depression