Medications

17 June 2013

Miracle Medication helps 3 in 10 Migraine Sufferers!

James Discoveries & Stats, Medications 8

Yes, there is an amazing medication that helps – 3 in 10 migraineurs! Ok, that doesn’t sound like much. Actually, it isn’t.

It is great for those 3, of course! But for the rest, no so great.

So what is this medication? Actually, it’s not just one medication – it’s most of the common ones you’ve heard of. No, I’m not saying that all medications only help 3 in 10, but that a single medication will probably only help 3 in 10.

This is based on research done at the Minnesota Evidence-based Practice Center. Researchers wanted to pool results from 5,244 clinical trials of migraine medications.

They examined 59 drugs in 14 different drug classes. This would include medications like:

Topamax
Depakote
Inderol
Toprol-xl

…and many more.

The researchers concluded that, generally speaking, individual drugs helped – at least, better than a placebo – about 200-400 people out of 1000.

Of course, whether they helped or not, many medications aren’t continued because of side effects. Some of the worst offenders include topiramate (Topamax), other antiepileptics used off label, and antidepressants.

Some drugs did much better when it came to side effects vs. benefit. These included angiotensin inhibitors (such as lisinopril (ie Zestril)) and beta-blockers (such as metoprolol or propranolol).

Other than the lack of a miracle drug, there were a couple of other things that did not impress the researchers. One was that many trials were of poor quality. Another was that there is a lack in research into the long term effects of these drugs, particularly when it comes to quality of life.

Again, this report is not suggesting that only 3 in 10 migraineurs can be helped with medication. Considering all the various drugs and treatments and combinations, that number is much higher. There is good treatment available!

But once again we’re reminded that migraine is very individual – what helps one person won’t help another.

We’re also reminded that much of the excellent migraine-fighting medication available today is still very new. We don’t have good studies, and we don’t know what the risks are when it comes to taking these meds long term.

A neurologist reflects on these findings: Effective Migraine Prevention per 215 Trials
Also see: Is your migraine preventive treatment balanced between drugs’ benefits and harms?

14 June 2013

The Top 12 Mistakes People Make With Nasal Sprays

James Medications, Tips 2

Medication isn’t cheap. So when you’re using a nasal spray, make sure you’re making the most of it by using it properly!

Here are the top 12 nasal spray mistakes that people make. Learn from their mistakes!

Photo courtesy of Kristina

They don’t blow their nose first: Don’t rush! Gently blow your nose before using a nasal spray. You don’t want the medication to get stuck, or just come out again.
They tilt their head too much: Sometimes it’s recommended that you tilt your head slightly forward or back, but leaning way over can make your medication less effective. And remember, keep your head up for a while after you’ve taken the medication.
They point the spray the wrong way: The nozzle should not point toward the centre of your nose. Point it up, and slightly out (away from the centre of the nose).
They keep both nostrils open: Close the other nostril with your other hand. You don’t want the spray just to go out the other side.
They hold their breath: Breath in gently as you spray.
They snort: Breath in gently, like you’re smelling a flower. Don’t “snort” the medicine. The spray could end up in the wrong place.
They don’t clean the nozzle: Obviously, this isn’t needed for a one-time use medication (for example a one-dose migraine spray). But if you’re using the spray over and over, follow instructions on how to clean the nozzle. Otherwise tiny bugs will soon have large families, and they’ll vacation in your nose.
They blow their nose afterwards: Yes, some people really do. Don’t! Give the medication a little time before you blow your nose again.
They prime – or don’t prime: Some nasal sprays should be primed first – that is, you give it a little spray into the air first. Other medications you should not prime. If it’s a one-dose medication, you’ll lose your only dose!
They use it past the expiry date: Not only may the medication be less effective, it may be contaminated over time.
They share their nasal spray: Never, ever share a nasal spray with someone else.
They don’t read through the instructions: Read the instructions in the package carefully before using. It will answer many questions, such as – should I shake it first? Should I prime it? How do I clean it (if needed)? How much is safe to use, and for how long?

Nasal sprays can be much more effective than other medication “delivery systems”. But they do need to be used properly so that the right dose can get where it needs to go when it needs to be there.

24 May 2013

Can Pregnant Migraineurs Take Drugs?

James Medications, News 1

Can a migraine patient take drugs while she’s pregnant? Common wisdom says “No – just suffer”. Well, that ain’t good enough.

First, take a look at this chart:

See that nasty orangy-reddish colour? That represents 1/3 of all pregnant women. Their migraine attacks just keep going all through pregnancy – and may get worse.

I know, I’m full of good news today.

So – just suffer? No way. Surprise surprise, migraine attacks are not good for you – or the baby. Yes, your pain (and other symptoms such as vomiting) can affect the baby.

Now many people ignore the many excellent non-drug treatments that are available, as if they “don’t work”. Well, they do work – as do drugs – for some. And in some cases they’ll work better than drugs. Take for example massage and biofeedback and relaxation techniques and chiropractic treatment and foot massage and changes in diet and … the list goes on.

But it’s a myth that pregnant women cannot take drugs for migraine. Many doctors do regularly prescribe medications for migraine during pregnancy.

As you probably know, it’s a question of risk. For obvious reasons, few drugs have been carefully studied during pregnancy. But knowing that migraine attacks can do long term damage, the benefits may outweigh the risk – and the risk in some cases may be relatively small.

This month at the American Congress of Obstetricians and Gynecologists annual meeting in New Orleans, the news was that triptans were the go-to drugs, even during pregnancy, for more serious forms of migraine.

If you’d like to read the comments from some doctors, it may help you make an informed decision. The two articles below will get you started:

20 May 2013

5 Migraine Medications that may cause Weight Gain

James Medications 4

sodium valproate (Epival)
paroxetine (Paxil)
metoprolol (Toprol-XL)
divalproex sodium (Depakote)
amitriptyline (Elavil)

DO NOT stop taking medication without talking to your doctor.
DO talk to your doctor if you’re gaining weight – there are options available.

These are medications that are often used as migraine preventatives – and often help – but that are also notorious for contributing to weight gain in some people. Obviously there are other examples. (Note: I just included one brand name for the sake of space. These medications are included in various other brand names.)

I appreciated the recent post from Diana-Lee – Avoiding & Coping With Migraine Medication-Related Weight Gain and Kerrie’s thoughts in Migraine Preventives & Weight Gain, so I thought I’d add some specifics to the conversation.

Have you experienced weight gain with any of these medications? What about others – topiramate? Propranolol? What else?

17 May 2013

Ginger and Sumatriptan: More Information

James Discoveries & Stats, Medications, Treatments 2

I’ve been getting a lot of questions regarding the ginger and sumatriptan study, so we’re going to take the time to talk about a few more details.

Obviously one study is not enough to change treatment practices around the world. However, the researchers were motivated to study ginger because it had already shown great promise as a migraine treatment.

Previous Ginger Studies

First of all, ginger has been regularly used for many related conditions – vertigo, motion sickness, and pain conditions being the most well known. Also, previous studies have shown very little problem with side effects.

Ginger is currently being studied to alleviate dental pain and inflammation. And one study suggested that it works about as well as ibuprofen for menstrual pain.

Products containing ginger, such as Gelstat Migraine, have already helped many people fight migraine symptoms. Gelstat Migraine has been studied in clinical trials, and the results were promising.

An older 1990 report showed that patients taking ginger during and after their attack were able to reduce frequency and severity of migraine.

Ginger Dosage in the Trial

In this trial, patients were given 5 capsules of either 50mg of sumatriptan or 250mg of ginger (these ginger capsules are 350mg). Everyone was to take one capsule when a headache was coming on. They didn’t know which they had (this was a double-blinded randomized controlled clinical trial).

This is actually a very low dose of ginger. As you’ll see below, others have recommended a higher dose, even up to a gram or two a day as a preventative. Ginger supplements are commonly 500mg and higher per capsule.

More on the study results

The patients had been generally diagnosed with migraine many years before, and they typically had several attacks per month.

Ginger and sumatriptan results were similar, with sumatriptan generally performing slightly better for actual headache pain.

250mg of ginger was used in this study, as mentioned above. Previously 500mg had also been recommended, repeated every 4 hours up to 1.5 to 2g per day for 3-4 days. Another report found that a woman found relief using similar amounts of ginger powder (1.5-2g) as a daily supplement.

The bottom line

The researchers of this study concluded that ginger should be preferred to sumatriptan because of the lack of significant side effects. The only reported issue with ginger was indigestion (4% had some issues here – interesting considering that many people take ginger for digestion!). But some patients taking sumatriptan experienced dizziness, vertigo, heartburn, and/or sleepiness (20% with one or more issue). In the end, patients were slightly more satisfied with ginger as a migraine abortive.

Researchers are now calling for more study into what dosage is most effective.

This was also a short term study. Longer term studies will help demonstrate if ginger can continue to fight migraine over the long term in individual patients.

For more on the study read the original post here.