Menu

Medications

The Battle of the Nasal Sprays

Occasional but Terrible Migraine Attack? You might want to try Sprix.

, , 0

New research is confirming the benefits of a medication that can fight episodic migraine. It might be just the thing to try if you haven’t had success with the medications your doctor has prescribed up to this point.

Many migraine patients are familiar with Toradol, or ketorolac tromethamine. Ketorolac is actually one of the top recommended drugs to give a migraine patient in emergency. It’s low on side effects and high on effectiveness.

Today, ketorolac is available as a nasal spray – perfect for those trying to avoid injections but who still want something that’s fast-acting. The nasal spray is commonly sold under the brand name Sprix.

The Battle of the Nasal SpraysBut how does this medication compare to migraine-specific medications, such as the ever-popular sumatriptan?

A study in the journal Headache this past February attempted to answer the question, pitting ketorolac nasal spray against sumatriptan nasal spray.

In a double-blind study of 72 randomized participants were treated for 152 migraine attacks.

The results? Ketorolac was every bit as good as sumatriptan – in fact, in some ways it had the edge. The pain relief seemed to last longer, and ketorolac was better at fighting nausea. It also helped fight photophobia, that painful sensitivity to light that many migraine patients experience.

More good news – none of the patients, taking either of the two medications, withdrew from the study due to side effects.

These things make a nasal spray such as Sprix very attractive for those with episodic migraine.

However, ketorolac is not recommended for chronic migraine. It is intended for very occasional use. There are cardiovascular and gostrointestinal risks if the medication is taken frequently, or if it’s taken constantly for more than a few days (read more here). For migraine patients who already may be at increased risk in these areas, frequent use of ketorolac should be avoided.

But those with episodic, or more occasional, migraine still face another hurdle. This medication can be very expensive. However, Dr. Alexander Mauskop from the New York Headache Clinic has an excellent suggestion to save money. He writes:

The main problem with intranasal ketorolac is its cost. On GoodRx.com the price of 5 vials of Sprix (with a coupon) is about $1,000. Each vial is good for one day of use; it contains 8 sprays (15 mg each) and the usual dose is one spray into each nostril, repeated every 6 hours as needed. However, there is a way around the cost of this medication. Ten 30 mg vials of generic ketorolac for injections cost $15. You just need to buy a nasal spray bottle, empty the contents of the vial into it and use it as needed.

Check with your doctor and your insurance company to confirm which option is best for you.

To read the ketorolac vs. sumatriptan study results, visit A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine

Yes, Drugs Can Be “3D Printed” Now.

, 0

Last year the FDA approved the first “3D printed” drug, a formulation of levetiracetam. Levetiracetam has been used both for as a migraine preventative and for certain types of epilepsy.

At first glance, a 3D printer may seem a lot like the automated process that we’ve used to manufacture drugs for a long time. But the 3D printing process allows for a lot more precision and customization.

Imagine that, instead of simply blending and compressing a bunch of ingredients into a tablet, you could actually “print” the ingredients into precise layers. The process allows not only precision of ingredients and position in the tablet, it also allows for a porous fast acting medication.

In the case of levetiracetam, even a high dose of 1000mg (a dosage that has been used for migraine), the tablets disintigrate rapidly – that is, within seconds. That makes the medication a lot easier to take, and may allow for abortive medication to be absorbed more quickly (a key goal in migraine treatment).

What if you could more precisely control your dose? What if you don’t need 1000mg, but only 950mg? What if your doctor could “ptint” exactly what you needed, helping you avoid unwanted side effects?

3-D Printed DrugsAnd imagine this scenario, described by Katharine Sanderson in The Pharmaceutical Journal:

Imagine a paediatrician talking to a four-year-old child who is having trouble adjusting to taking daily doses of steroids after being diagnosed with Duchenne muscular dystrophy the previous month. “What’s your favourite animal?” she asks. “A zebra,” quietly replies the child, who we will call Sam. The paediatrician smiles as she makes a note on her office computer. “But not a black and white one, a blue and green one,” adds Sam, with a little more confidence. Later, the toddler watches with wide eyes as the uniquely coloured, zebra-like tablets appear from a three-dimensional (3D) printer in the hospital pharmacy.

Although better medications coming from 3D printers are a likely scenario, the mass customization that could revolutionize the industry may be harder to achieve. Drug companies seem to be moving more to centralized, big-factory manufacturing, which would be the opposite of a 3D printer in your local pharmacy.

But if there were a cost-effective way to make it happen, the advantages not only to children but to all ages would seem obvious. The same drugs could become accessible and actually helpful to a whole new group of patients. But it could be that the same old drugs don’t make the money that new drugs could make.

So we may have to be content, for the time being, with companies using 3D printers to make better drugs – but only to mass-produce in their factories.

More information:

Nose Powder for Migraine? Why Would I Want That?

, 0

A new delivery system for migraine medication was just approved in the USA, and it’s been largely flying under the radar. Maybe that’s because people aren’t sure why they would need – or want – to shoot powder up their nose.

Actually, you’re going to want to take a closer look at this medication, so let me take a moment to explain.

Choosing a Medication

Some people have been helped, others not so much, by triptan class medications. But for abortive medications, triptans remain one of the best options in general for migraine.

But some people can take a triptan and find it doesn’t work – then take a different triptan and find that it does work. Perhaps more surprising, they can take a medication in one way with no success, but then take the exact same medication another way and find that it works.

And so researchers often start with a tried and true triptan medication – sumatriptan (a familiar brand is Imitrex) – and try to find a better delivery method to get it to stop the pain, and to stop it as soon as possible.

So there are a lot of options for sumatriptan – tablets, injections, nasal sprays … even a skin patch.

Pros and Cons of Nasal Sprays

Nasal sprays have some advantages. No needle, and no swallowing, for one. But maybe the most key advantage is that they get the medication into your system fast. This is important because – well, you know you want to end the pain as soon as possible. It also tends to be the case that stopping an attack early is easier than stopping an attack later.

But nasal sprays aren’t perfect. Here’s the problem – first, they may be easy to use, but they aren’t foolproof. It is easy to – not spray it quite right (see The Top 12 Mistakes People Make With Nasal Sprays).

Even with an expert sprayer, liquid can leak out and you won’t get the full effect of the medication.

So – Why Powder?

Onzetra Xsail deviceFinally, after all that explanation, we get to spraying powder up the nose. Why would I want that?

The new medication is called Onzetra Xsail, from Avanir Pharmaceuticals. The medication was formerly known as AVP-825, based on the OptiNose delivery system (we talked about it here in 2014).

Here’s the advantage with powder – instead of leaking and spraying all over the place, it immediately sticks to the inside of your nose and gets absorbed (think throwing flour onto a wet sponge). That means less waste, less room for error, and an extremely fast-acting medication.

Xsail Onzetra for MigraineNow the developers of Onzetra Xsail have actually done something pretty clever as far as use goes. You don’t technically push a button to spray something up your nose. The problem with that is, you never know if you should exhale, inhale, hold your breath… Instead, you actually blow into the device. This automatically pushes the powder where it needs to go, and you’re done. 2-3 seconds.

This is the “Xsail Breath Powered Delivery Device” (now you get it, right? Xsail?), and it seems to be a great idea, and it seems to be working well for the patients who have tried it. It would be great to see similar innovations for other migraine medications.

Now that Onzetra Xsail has been approved, we begin the process of getting it out to patients, and of course there are other countries which will need to approve it. This could take a while, but the process is in motion.

For more information:

Is Your “Targeted” Migraine Painkiller Worth the $$$?

, 0

If you had a choice between a package 200mg ibuprofen tablets (generic), and a product known as Fast Acting Migraine Formula, which would you choose? Hey, if the package was professional and the claims were reasonable, many of us wouldn’t mind paying a little more for the targeted migraine medication, right?

Recently Reckitt Benckiser, a company based in England, raised eyebrows in Australia when it was discovered that a whole line of specialized painkillers were – the same thing.

Nurofen PainkillersThis was the Nurofen line, including Nurofen Period Pain, Nurofen Migraine Pain, Nurofen Tension Headache – all products that appeared to be specially formulated for a specific thing.

The active ingredient? Ibuprofen – 200mg – the same in every product.

But – don’t people look for something specifically for headache? Dr. Aomesh Bhatt, regulatory and medical affairs director for Nurofen, defended the marketing in that way. “Consumer research indicates that 9 in 10 people (88%) look for pain relief for a specific type of pain (eg headache, migraine, back pain) and 7 in 10 (71%) say pain-specific packs help them decide which product is best for their needs.” (see Nurofen maker Reckitt Benckiser defends Australia packaging)

We all want people to be able to find the medication they need. But did everyone realize that they were not really getting something specifically targeting for migraine pain?

To make the question more interesting, here’s another interesting fact. Not all these products were the same price. For example, ASDA Migraine Relief was half the price of Superdrug Migraine Relief – even though they both contained the equivalent of 200mg of ibuprofen.

The court in Australia was not amused, asking Nurofen to remove the products from the shelves. No changes were immediately planned for other countries.

All that to say, be cautious about what you’re spending extra money on. Just because it says “Migraine” on the box, doesn’t mean it’s any more special than the cheaper box next to it. Read the label and do your research, and save your money.

Read more: Painkiller rip-off: Pills for migraine, period pain, backache ‘are identical’

$5 Eye Drops to Stop Migraine Attacks?

, 1

Reports that a common type of eye drops may be able to stop migraine is getting attention. And researchers think there may be good reason why it could work for many more people.

Could it be that, with all the talk about specially formulated pills and new injection techniques, that we’ve been missing another obvious delivery method?

Timolol eye dropsSeveral years ago the story came out of a woman who had been suffering from monthly migraine attacks. At one point she was diagnosed with bilateral ocular hypertension, and started taking eye drops (a timolol maleate solution). She didn’t have another migraine attack – and was still migraine free after 18 years.

Since then there have been more reports. Some patients take the eye drops regularly, others just at the first sign of an attack.

Timolol is actually already well known as a migraine preventative (though not as eye drops). It’s a beta-blocker, a common type of medication for migraine.

But beta-blockers are preventatives. They’re not known for stopping attacks once they start. But what if an eye drop version could do just that? Could it be that the medication gets into the system faster, and is able to abort the attack?

The University of Missouri in Kansas City, USA wants to answer that question. They’re starting a trial which will test the use of timolol drops as an abortive migraine medication. If the trial is a success, it could change the way we use beta-blockers and other medications for migraine.

And a few dollars for bottle of common eye drops – that’s a whole lot better than what many of us have spent in the past.

Also see:

Load More

Back To Top
The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.