Discoveries & Stats

19 March 2008

Topamax may cause language disturbances

James Discoveries & Stats, Medications 113

A team of researchers led by Dr. Francesca Coppola from the University of Perugia (Universiti degli Studi di Perugia), Italy, recently investigated some side effects of the drug topiramate, sold as Topamax. Specifically, they were looking at patients taking the drug for migraine, as compared to patients taking other medications. They wanted to see if Topamax was more likely to cause "language disturbances".

By language disturbances we mean things like not being able to think of the right word, mixing words up, difficulty coming up with the words you want to use. This is actually a symptom of migraine, so we shouldn’t be surprised to see language problems in migraineurs.

But the research did show a clear difference. Patients on other drugs had no language problems, but over a quarter of those on topiramate did.

The good news is that the symptoms were mild, and usually disappeared after a month without any change in dosage. In other words, it’s something to be aware of, but probably nothing to worry about.

Topamax has helped many migraineurs, but it is a powerful drug and should not be among the first you try. Read more about Topamax and migraine here.

14 March 2008

Why Migraine Auras are the way the are

James Discoveries & Stats 4

One of the most fascinating things about migraine is the symptom known as aura. More specifically, visual disturbances that sometimes are a part of a migraine attack. Some people have had visual disturbances and no headache at all, though most tend to have the headache and not the visual aura.

About 15% of migraineurs have some kind of aura. They see zig zags, or have a partial lack of vision, or see flashing lights, for example. But why does this happen?

We do know that as a migraine attack progresses, there is a spreading change in the brain – an area where there is a suppression of activity, surrounded by an area with hyperactivity. It’s likely that, as this change spreads over the visual cortex, the instability of the neuron-firing causes the visual hallucinations. Because the effect is spreading, the hallucinations usually change, and eventually disappear. For the migrainuer they may be in one eye, they may be partial or quite detailed, and they can be different as the minutes pass.

But why the weird shapes?

In 1926, psychologist Heinrich Klüver studied the hallucinations that came from patients taking mescaline, a psychedelic alkaloid. He found that there were four patterns that people tended to see, called form constants. The four were tunnels, spirals, cobwebs and lattices (ie checker boards and triangles). These four geometric patterns tend to appear with certain drugs or conditions such as epilepsy and migraine.

So where do these patterns come from? Are you just imagining shapes? Is it something in your body that you’re seeing?

Professor of Mathematics at the University of Utah Paul Bressloff did extensive calculations which seemed to point back to the visual cortex. It looks like the things you see actually reflect how the visual cortex works – how it’s set up. When the neuron-firing gets destabilized for whatever reason, predictable patterns are seen by your brain. It’s like seeing part of a map of your visual cortex. A summary of Bressloff’s findings are here (if you want to go in-depth, read one of his papers, available here in pdf format).

Visual auras in migraine are usually not too serious, but they can become incapacitating for some people. Migraine medication can help to minimize the symptoms if need be.

Thanks to Mind Hacks for pointing to Bressloff’s research.

12 March 2008

Rationing drugs due to insurance concerns

James Discoveries & Stats, Medications, Tips 2

Let’s face it. Stocking up on drugs is not an idea that makes your insurance company happy. But the challenge of having the right drugs on hand at the right time is adding to worldwide migraine pain.

This is actually a study from June 2007, but it’s worth looking at. Dr. Robert A. Nicholson, assistant professor at Saint Louis University School of Medicine and School of Public Health headed up a study of 233 migraine sufferers who took triptan drugs. Here’s what he found…

42% of patients said that their insurance plan restricted the number of triptan doses covered each month. 37% said they had a prescription for triptan drugs, but hadn’t filled it because of the cost.

Of those with no limitations, 79% took a triptan at first sign of a migraine attack (as most doctors recommend). Of those with prescriptions, only 49% took a triptan at the first sign of an attack. Of those who took a triptan right away, 51% said that migraine had a severe negative impact on their lives. But of those who hesitated to take the drug, 79% said that migraine had a severe negative impact on their lives. In fact, one in three of these people ended up in the emergency room at least once in the previous 12 months.

In summary – if someone’s insurance company is limiting their triptans per month, or if cost is keeping people from using them, they have more severe attacks and more frequent visits to the hospital. Not only does this seem bad for health, it doesn’t seem very cost effective for the insurance company.

The good news is that triptans, when used right away, are working.

One more interesting note. Dr Nicholson notes that many people delay in taking migraine medication because they want to be sure it’s really a migraine. Don’t worry, he says. Statistics show that your first guess is almost always right.

What can we do about this? Look for another insurance company? Find other alternative treatments (for when your pills run out)? What’s your strategy?

23 February 2008

Tonabersat – a new kind of migraine drug

James Discoveries & Stats, Medications, News 1

Back in early 2006 I wrote about a new class of migraine drugs that was in the testing phases. It’s called a gap junction blocker, and the drug being tested is called tonabersat. It’s time for an update!

A major phase of the clinical trials have been completed for tonabersat. The results were encouraging, and reason enough to continue to testing.

At the end of a three month treatment, patients had a 50% better improvement than those on a placebo. Patients also were able to significantly cut down on the amount of abortives that they were taking (ie painkillers). In the third month of the study, they took on average 60% less of these other medications.

This is really still in the early testing stages, meaning that there’s still a lot of work to be done to find the best dosages and so forth. So there’s reason to be optimistic that there will be more significant improvement in future trials.

The research is being continued at the Danish Headache Center under founder Dr. Jes Olesen. For more, visit the Minister Pharmaceuticals page on Tonabersat.

18 February 2008

Simple surgery for chronic headache

James Discoveries & Stats 5

Photo courtesy of allspice1

A simple surgery is being researched that may bring significant relief to those suffering from chronic headaches. The small trial showed an increase in "quality of life" of 250% over 12 months.

The study involved 42 women and 13 men with chronic migraine. What was done? Certain superficial blood vessels on the scalp were cauterized (sealed off). That’s it. The side effects of the surgery? Temporary numbness. It sounds like it would be rather worth it.

Dr Elliot Shevel of South Africa, Professor Carlo Cianchetti of Italy and Dr Egilius Spierings of the United States are working together to do further studies on this technique.

Shevel, founder and chairman of the South African Headache Society, is also a maxillo-facial and oral surgeon. He explains how he discovered the treatment: "During the first operation I was doing on a patient’s jaw she had a pounding headache and the carotid artery on the temple was pulsing. When I blocked off the artery to the temple with my finger, the pain went away. When I took my finger off, it came back. I knew that I could cut the artery with no side effects and offered to cauterise it."

Now both South African and Italian governments have thrown in their support for future research. Though the surgery may not help everyone with chronic headache, it could be a major breakthrough for those with symptoms that are very difficult to treat.

via Surgery cures lucky headache victims