Medications

10 April 2012

Botox and Magnesium for Cluster Headache?

Yesterday Dr. Alexander Mauskop reported on a man who has been taking Botox and magnesium for cluster headaches for three years. He’s found it very helpful, although the treatment is not alone. Here’s what he’s taking:

verapamil
intravenous magnesium (every 3 weeks to one month)
Botox injections (every 2-4 months, usually between 2-3)
To take for an attack, he usually uses rizatriptan (Maxalt) tablets or zolmitriptan (Zomig) nasal spray. If he needs more he takes sumatriptan (Imitrex) injections

Dr. Mauskop says he has found that about 40% of cluster patients are magnesium deficient, and respond to the magnesium injections. The Botox also seems to be helpful, but there are few long term cases. The interesting thing about this case is that the man has taken Botox over the course of 3 years.

All of these medications are also used for migraine, though verapamil is one of the less common ones.

For more, read Dr. Mauskop’s post: Botox for chronic cluster headaches

30 March 2012

Watch for it – Ketamine for Migraine and More

James Discoveries & Stats, Medications, Treatments 6

Using ketamine for pain is not a new idea. But I think we’re going to see it get an increasing amount of attention in the months ahead.

A few weeks ago, NPR featured a news story on the use of ketamine for depression. Ketamine, originally developed as a human anaesthetic, has since been used for various applications in medicine.

Ketamine for depression, migraine, and more?

It’s also used as an illegal drug, gaining fame as "K", "Vitamin K" or "Special K".

In recent years there has been sporadic interest in using ketamine for pain. It’s a difficult drug to study, because it tends to be rather obvious that you’ve taken it.

But it has been suggested as a treatment for cluster headache, familial hemiplegic migraine, chronic daily headache, and migraine, as well as other types of pain.

Ketamine is a neurological drug, classed as a NMDA (N-methyl-D-aspartate) receptor antagonist. It is believed to work in a number of different ways in the brain – relating to calcium channels, serotonin, and glutamate – terms that will be familiar with migraine researchers in particular. In fact, ketamine has been especially useful in the treatment of headache or migraine that just won’t go away and isn’t responding to other kinds of treatment (refractory). It’s given as an IV or intranasal treatment. Of course, this means it’s way down on the list of treatments that will be given – it’s rare and even when it’s tried it’s often not successful.

However, with the growing interest in ketamine for depression, the game changes. You can bet that there will be increased interest in ketamine for chronic pain conditions, which often come hand in hand with depression.

Although increased interest doesn’t mean this should be the drug of choice for most people, it does mean that more research will be done. It may be a treatment that will help a few patients whose pain is seemingly unstoppable.

For more on the background of ketamine, read Ketamine and MDARs in the treatment of neuropathic pain from Dr. Jan M. Keppel Hesselink. For a review of the studies on ketamine for other types of pain aside from headache, read Ketamine in Chronic Pain Management: An Evidence-Based Review

6 March 2012

Coming Migraine Treatment: Lasmiditan

James Medications, News 1

Lasmiditan is a new drug that is being investigated for the treatment of migraine attacks. It’s in a new class of drugs known as ditans, which are serotonin receptor agonists that selectively bind to the 5-HT1F receptor.

Lasmiditan has been the subject of numerous studies already. The advantage of Lasmiditan is that it doesn’t seem to constrict blood vessels, and there have been no reports of cardiovascular effects or chest symptoms. This is very important because of the increased risk that migrainuers already have for heart issues and stroke. Those in particular who can’t take triptan drugs may find relief with Lasmiditan.

Like the very popular triptan class of drugs, Lasmiditan would be taken for a specific migraine attack.

Recent trials showed significant improvement in migraine patients over a placebo. Over 60% of headaches were reduced to nothing or almost nothing within 2 hours. Sensitivity to light and sound were also significantly reduced. Interestingly, nausea was also reduced, but this took more time.

The company that is testing Lasmiditan, CoLucid, is planning trials throughout 2012, 2013 and 2014, hoping to have a product ready for 2014. Already, a recent survey in the USA suggested that 10% or neurologists would prescribe Lasmiditan. As you might imagine, the financial experts are keeping an eye on statistics like these, in the highly competitive world of migraine medication.

This is what CoLucid has to say about the drug:

Lasmiditan is a first-in-class Neurally Acting Anti-Migraine Agent (NAAMA) designed to deliver efficacy in migraine without the vasoconstrictor activity associated with previous generations of migraine therapies. Lasmiditan is a member of a novel chemical class called "ditans" and, unlike triptans, penetrates the central nervous system (CNS) and selectively targets 5-HT1F receptors expressed in the trigeminal pathway. Lasmiditan does not interact with vasoconstrictor 5-HT1B/1D receptors activated by triptans.

9 January 2012

New Clues about Medication Overuse Headache and Opioids

James Medications 7

In the video below, researcher Dr. Julie Wieseler discusses new research into the opioid medications.

Opioids include medications such as codeine and meperidine (Demerol). They’re common when it comes to migraine treatment, but they’re also highly suspect when it comes to Medication Overuse Headache (MOH). Meaning – taking them for migraine symptoms can temporarily help, but make symptoms worse later on. (Actually, most medications can do this – but opioids seem to be among the more likely)

Researchers have noticed that taking opioid medications can make symptoms of cutaneous allodynia worse – but why?

The investigation began to see why exactly this migraine treatment was causing more symptoms in the long run. Their results, discussed in the video below, may help researchers find better treatments, or use opioids more safely, or find ways to prioritize treatments that are less likely to cause MOH.

Find out more about this new research here: Why Opioids Enhance Migraine Pain: The Puzzle Points to Glia

15 December 2011

Triptans and Heart Disease – A Dangerous Mix!

James Discoveries & Stats, Medications 4

Triptan medications such as Imitrex, Frova, and Relpax are still an important part of migraine treatment. But for people with a risk of heart disease, they can be dangerous.

At the annual meeting of the American Neurological Association in September, a surprising and disturbing study got a lot of notice. It was all about the prescription of triptan medications.

The study included 120,000 migraine patients. Now, triptans are not recommended for those with certain types of heart disease. Did doctors follow this recommendation?

The surprising result was that 1 in 5 patients with heart disease was prescribed a triptan medication!

That’s right, 1 in 5. Why? Did the doctor not know about the patient’s medical history? Was the doctor not aware of the dangers triptans pose to these patients?

Triptans can narrow blood vessels by 10-20%, and those of you with experience with heart disease know just how dangerous that can be.

Not only should your doctor know your medical history, she should also know your risk of heart disease. If you know you have multiple risk factors, even if you’ve never had problems with heart disease, you should think twice about taking triptan medications.

Dr. Arthur Elkind, president of the National Headache Foundation board of directors, particularly notes that you should be aware of elevated lipid levels, hypertension, a history of smoking, history of angina pectoris, and heart attack.

Though triptans are considered generally safe for most migraineurs, there is a lack of care being taken for patients who are at risk.