Medications

17 November 2014

Unique Migraine Nasal Spray: We’re still waiting

Back in 2008 we talked about some unique nasal sprays that were being tested for migraine treatment. One of these was AZ-001, a nasal spray using the drug prochlorperazine.

I’m not sure if that specific version is being actively developed by Alexza Pharmaceuticals or not, but the concept is still being researched. Dr. Venkata Yellepeddi from Roseman University of Health Sciences has developed a nasal spray based on prochlorperazine. Here’s what he had to say:

Prochloperazine is a dopamine receptor antagonist that is widely used as an anti-nausea medication. Comparative clinical studies have shown that prochloperazine provides better pain relief than other anti-migraine drugs such as sumatriptan, metoclopramide, and ketorolac. Currently, there are no marketed nasal spray formulations of prochlorperazine available for the treatment of migraine. Prochlorperazine is only available in tablet form, which has delayed onset of action.

Prochlorperazine is already used for migraine, and is especially useful for migraine with nausea. It’s also used for severe nausea from other causes, and in some cases as a antipsychotic. It’s sold under brand names such as Compazine, , and Buccastem among others.

Nasal sprays are useful for a number of reasons. For one thing, by bypassing the gut they are more useful for patients with nausea. A more precise amount of medication will get into your system, and will be available faster.

Dr. Yellepeddi has also created a nasal spray with no preservatives, which may cause problems in some patients. The formulation seems to be stable, but unfortunately testing is still in the early stages. We may have to wait several more years before this one is available.

For more, read the press release from the American Association of Pharmaceutical Scientists: First-in-class nasal spray demonstrates promise for migraine pain relief

14 November 2014

ZECUITY: New Migraine Treatment Coming Soon…

James Medications, News 2

An old and yet brand new migraine treatment is about to be released – the ZECUITY migraine iontophoretic transdermal system (TDS)!

ZECUITY has gone through a lot of changes. It was formerly called the Zelrix Migraine Patch, and it was developed by NuPaths. It was approved this past January. Earlier this year, NuPathe was acquired by Teva Pharmaceutical Industries, a company based in Israel.

Through all this change, ZECUITY has survived. Teva has talked about launching new migraine treatment on the market this year, although the rumour now is that it may not be available to consumers until 2015.

ZECUITY is new and old because the medication is sumatriptan, an early migraine medication. But the delivery method is all new, and for some patients that makes the difference between a drug that doesn’t work and a drug that does.

Dr. Deborah E. Tepper from the Cleveland Clinic describes it this way:

The sumatriptan patch consists of a single-use patch that comes in a foil packet. After tabs are pulled to expose a small well of sumatriptan and another well of salt solution, these areas are each rubbed to release the two compounds. The patch is placed on the upper arm or thigh, in an area where there are no tattoos or skin irritation. A tiny battery embedded in the patch is then turned on by pushing a button. A red light comes on, indicating the patch is activated.
[Source]

When the medicine has all been delivered into your system, the light goes off. Easy as that.

The beauty of this approach is that it bypasses the stomach and gets into your system a lot faster, which may make all the difference. It also means no needles, for those who have been using, or have tried to use, injections.

If the patch is successful, we will likely see more migraine meds coming out with a similar delivery system.

If you’re in the USA and would like to get news directly from the source when ZECUITY is available, you can sign up right here.

10 November 2014

Abdominal Migraine in Adults

James Discoveries & Stats, Information, Medications, Treatments 0

Abdominal pain – likely a nauseous feeling – recurring again and again. It can be very hard to get a diagnosis, but it could be abdominal migraine.

Abdominal migraine in adults is not often recognized, even though the medical community has been talking about it for almost a hundred years. Abdominal migraine is well recognized in children, all the more reason why it’s overlooked in adults. And to be fair, it probably is a rare condition.

As with most types of migraine, abdominal migraine brings on recurring symptoms. It usually lasts from a couple of hours to three days.

Unlike migraine headache, the pain in the abdomen isn’t one-sided. It could be very severe, or just a dull ache. During an attack, there is usually nausea and/or vomiting, or you may become pale and lose your appetite.

To be technically diagnosed with abdominal migraine, there should be no headache associated with the attack. In other words, instead of headache you have abdominal pain. However, it’s true that other types of migraine may include abdominal pain as well.

Other characteristics of migraine may be present, such as an aura before an attack.

Abdominal migraine usually starts in childhood and disappears in adulthood (or “changes” into other types of migraine). But there have been cases of abdominal pain from migraine appearing in adolescence and early adulthood for the first time.

Diagnosis of Abdominal Migraine in Adults

If the above description sounds like you, you’ve taken the first step. But your doctor will still want to run some tests and rule out other possibilities.

Be sure to tell your doctor how many attacks you’ve had, and what the symptoms were. She’ll want to rule out various other conditions, such as gallstones, irritable bowel syndrome, infections, and even abdominal epilepsy, which can be quite similar.

A common feature of abdominal migraine in adults seems to be a family history of migraine. If you know anyone in your family who may have had migraine, be sure to mention that. Also, your doctor will want to know if you had migraine symptoms when you were younger, or possibly cyclic vomiting syndrome.

Treatment of Adult Abdominal Migraine

Because it is so rarely diagnosed, there’s no standard treatment. However, there are some treatments which have been used successfully.

Triptans, a common migraine abortive, such as sumatriptan, may be tried. Pizotifen (pizotyline, Sandomigran, Sanomigran), a serotonin antagonist, has been used for abdominal migraine in adults. Other migraine treatments such as topiramate (Topamax), calcium channel blockers, beta blockers, and valproic acid (Depakote) may be tried, depending on the patient. Antihistamines have also been used.

For more information:

16 October 2014

Sumatriptan and Cluster Headaches

James Medications 2

Sumaptriptan has been used for cluster headache for many years, but it may not be used in the way you think.

Cluster headaches are not only known for the very severe pain which is the most well known symptom, but also for their predictable cycle. Lasting from a few minutes to a few hours, they come during a “cluster period” lasting weeks or months, most often followed by a remission of months or even years. Some patients, however, do not experience remission, but continue to have attacks up to eight times a day.

One of the most common abortive treatments is a sumatriptan injection. Cluster patients often have injection kits, so that they can inject themselves right when an attack hits. It is usually effective within a few minutes, and can be repeated once in the day if the pain continues or returns.

But here are a few other facts you might not have known about sumatriptan and cluster headaches:

A sumaptriptan injection does not always involve a needle. For example, Sumaval DosePro pushes the sumatriptan through the skin in a tenth of a second without a needle.
Sumatriptan works better for men than women. Women with cluster respond better to inhaled lidocaine.
Some cluster patients take a sumatriptan nasal spray, or even oral sumatriptan. These approaches work, but take longer, which limits their usefulness in a headache like cluster which doesn’t usually last long to start with.
Usually patients experience very few side effects, and they don’t last long. Typical temporary side effects include nausea, fatigue, and dizziness. However, if you get hives or experience chest pain or pressure, you should call your doctor immediately.
Because cluster is rare and studies are limited, there have been very few studies into various other triptans. Zolmitriptan is most commonly used next to sumatriptan, but it does not tend to be as effective. However, for some patients it may have fewer side effects.
Dosages vary depending on how you’re taking sumatriptan, from a small dose of 6mg for an injection to a large dose of 100mg when taken orally.

Have you used sumatriptan for cluster headache? How well did it work for you?

Also see: Cluster vs. Migraine (Infographic)

21 August 2014

Topamax not working? Here’s a Possible Alternative

James Discoveries & Stats, Medications, Treatments 4

Although Topamax (topiramate) has helped many patients, it is by no means the silver bullet to stop migraine. It’s popularity has also been hampered by the side effects that some patients experience.

Of course there are many good alternatives to Topamax, but researchers are looking for something similar that will work for patients that are good candidates for something like topiramate, but who do not respond well to topiramate itself.

A study published in July (2014) investigated a drug called zonisamide as an alternative to topiramate. In this case, patients with episodic migraine with aura were studied. These were not patients who had severe reactions to topiramate, but who simply had not seen more than a 50% reduction of migraine attacks.

Zonisamide (sold as Zonegran)is another antiseizure drug. Like Topamax, side effects are a common reason why patients do not continue with the treatment. In fact, in this study 12% dropped out because of side effects such as dizziness, nausea, insomnia, and drowsiness.

In the end, however, there were two positive results.

First, many of the patients had much better success with zonisamide. Over three months, every month things got better.

Second, side effects did actually seem to be less of a problem with zonisamide. In particular, paresthesia (a tingling or burning feeling of the skin), one of the most common side effects in topiramate, was almost non-existent.

This is only a preliminary study. It was open label (meaning the patients knew what they were taking), and patients directly switched to a steady dose of zonisamide (100mg/day taken in two doses). It will be interesting to see how patients respond to different doses.

One other interesting note – some patients dropped out because they improved very quickly and decided they didn’t need more treatment! That sounds great, although it’s too bad they didn’t understand the value of continuing the study so that the results can be measured.

Zonisamide has not been approved as a migraine medication, but this study shows that it is worth studying as an alternative preventative to Topamax. If you’ve tried it, leave a comment and let us know how it worked for you.

Sources:
Efficacy of Zonisamide in Migraineurs with Nonresponse to Topiramate
Zonegran (Drugs.com)