Medications

5 February 2010

More on DHE: Home Therapy for Chronic Daily Headache?

James Discoveries & Stats, Medications 4

I appreciated Ellen’s blog post on Home therapy for intractable Migraine. She mentions an interesting study, and brings up, once again, DHE migraine treatment!

DHE, or dihydroergotamine, has been a topic of conversation here more than once. See especially DHE Migraine Treatment: Why some people still use it and Levadex â€“ inhaled migraine drug on the way. DHE has been used for migraine and cluster headache, and it remains a helpful treatment for many patients.

In her post, Ellen mentions a study in the USA reported on in Headache (from the American Headache Society) in January. The researchers wanted to find out how patients would react to a home based intravenous dihydroergotamine treatment.

This type of treatment is usually done in the hospital or clinic, which can make things a lot more difficult for many patients.

There are advantages and disadvantages to having treatment like this at home. But perhaps too often doctors default to the hospital visit, instead of considering some patients that may benefit more from home treatment.

The patients in the study saw good results. All had chronic daily headache (CDH), and in the end only one was still diagnosed with CDH. There were no serious adverse effects at all.

Though this was a very small study (only 31 patients), it may lead to more openness by doctors and specialists to new options in treatments – not only for DHE, but other treatments as well.

Thanks, Ellen!

For more, read Outpatient Home-Based Continuous Intravenous Dihydroergotamine Therapy for Intractable Migraine

26 January 2010

Visual Snow and Persistent Migraine Aura – tests and treatments

James Information, Medications 132

In the last post we introduced two concepts – visual snow (VS) and persistent migraine aura (PMA). The first is a specific symptom which can have a number of causes; the second a diagnosis which can include the first.

First, persistent migraine aura (PMA) is diagnosed when other causes are ruled out. But as we’ve said there are a number of things that can cause visual snow (VS).

Doctors will take a careful drug history for patients with VS, because one cause is hallucinogenic drugs. The drug may only have been taken once, and time may have passed since it was taken, but it can have permanent effects.

Optic neuritis, an inflammation of the optic nerve, can also be a cause. Optic neuritis usually develops from an autoimmune disorder. Read more about optic neuritis here.

There are many other things that can be involved – even vitamin deficiencies.

Dr. Klaus Podoll, Dr. Markus Dahlem and Sofia Greene list common tests that are done for persistent aura symptoms here. These include:

Ophthalmologic examination
Neurological examination
Psychiatric examination
Thorough headache history and family history
Thorough drug history (including illegal drugs, especially hallucinogens: LSD, Ecstasy, mushrooms, other?)
CAT or MRI of head (the MRI is important to rule out what is called a migrainous infarction)

Other examinations may follow, including an EEG, evoked potentials (a testing of the functioning of the nervous system), blood work, and a lumbar puncture.

Obviously, if anything shows up on these tests, you’ll be following that up.

Assuming these treatments are out of the way, there are some treatments that have been tried, with some success. There is no tried-and-true established treatment, but some options include:

valproic acid
acetazolamide
lamotrigine (particularly for VS not classified as PMA)
topiramate (Topamax)

Sometimes injections of furosemide (frusemide) are used, if other treatments fail. Clonazepam is also used for patients who have symptoms from hallucinogenic drugs.

Do you have experience with ongoing migraine aura, or visual snow? Have you found anything that has helped? How did the symptoms start?

19 January 2010

Levadex – inhaled migraine drug on the way

James Medications, News 5

Levadex is something new, and it isn’t. It’s a new formulation of dihydroergotamine mesylate (DHE), known by many as DHE 45 (an injection) or Migranal (a nasal spray where the drug is accompanied by caffiene). DHE was introduced in the 40s, so it’s been around in various versions for a long time.

This new version known as Levadex is an inhaled version, brought to you by MAP Pharmaceuticals. Levadex will use the Tempo inhaler, designed especially for asthma and migraine patients.

In the United States, Levadex took a big step forward when the FDA decided not to ask for another phase III study. MAP Pharmaceuticals will go right ahead with their study of long term safety.

This part of the study is expected to be completed this year (2010).

So far Levadex looks promising for some patients, dealing not only with pain but other common symptoms – nausea, and sensitivity to light and sound. It’s believed that in a few years Levadex will be a major player in the migraine market. Then again, our understanding of migraine is changing and increasing at such a rapid rate, it’s hard to say what will be going on in a few years.

via FDA Clears the Way for MAP Pharmaceuticals

14 December 2009

Migralex finally launched – new abortive

James Medications 2

Dr. Mauskop’s Migralex, a new abortive, was finally announced by Dr. Alexander Mauskop, director and founder of the New York Headache Clinic.

Dr. Mauskop has been working on this one for a long time. He was also involved in the testing of an excellent preventative medication that we’ve talked about here before, Migrelief.

This abortive contains two very simple ingredients, both of which you’re most likely familiar with.

First, aspirin. Aspirin of course is one of the world’s favourite abortive drugs. Aspirin alone for migraine hasn’t been studied as much as you might think, though it does seem to help some. However, aspirin in combination is commonly used for migraine and other headaches – take for example Excedrin Migraine. With combinations, finding the right balance is always a challenge.

The other ingredient is magnesium. We’ve often talked about magnesium as a preventative. But it also seems to have a benefit as an abortive. Sometimes patients with migraine in the emergecy room are given a shot of magnesium, for example.

Once again, it’s the combination and balance that are key here. How much to use, what types work well together, how to coat the tablet – all that. Dr. Mauskop was also looking for a medication that could be used by a wide number of people with a minimum of side effects.

It might surprise you to discover that Migralex is not being promoted for migraine. But if you take a look at the name, you can see the direction it’s headed. The truth is that more studies are being done in hopes of official approval in the USA.

In the meantime, Migralex is being offered for "Tension-type Headaches, Stress Headaches, Sinus Headaches, Alcohol Headaches, Sex related Headaches, Menstrual Headaches, and Exertion Headaches" …and more.

These, you’ll notice, are not a list of all official headache classifications – the point is Migralex should help a lot of people with a variety of headache pain, not to mention some other symptoms as well.

Adults can take two tablets every six hours with a full glass of water.

I’m glad to see this option now available from someone who has done a lot of research in this area. I hope it will continue to show good results, and that it will soon be more widely available.

Meanwhile, you can read more about the birth of Dr. Mauskop’s Migralex here, and there are a couple of special offers available when you order Migralex at amazon.com.

Has Migralex been the thing to finally break the pain cycle for you? Tell us your experience by leaving a comment.

Here’s a brief overview of Migralex:

19 November 2009

1% Thursday: What are you taking your medication with?

James Medications, Resources, Tips 0

This week – double check what you’re taking your medication with.

What am I talking about? Well, most of us are familiar with the fact that some medication should be taken with food, some on an empty stomach, and so on. Sometimes this impacts how the drugs work in your body. Other times it’s just a matter of what’s more comfortable for you.

But there are other issues that you may or may not hear from your doctor. Taking certain medications along with supplements, for example, could be a problem. You may find both work better if they’re taken at different times. Or you may need to cut out a supplement while taking a certain medication.

There is increasing concern about taking medications with juice – not just grapefruit juice, the most famous, but other juices such as apple and orange. Various chemical interactions could mean you end up with more or less medicine than you bargained for – both a serious problem. Try sticking to water.

Even taking some supplements together can be a problem. For example, many people take calcium with magnesium, not realizing that you need to take magnesium for migraine without calcium (read more here).

So – quick tips:

Try taking your medication with water, not juice
Make sure your doctor is aware of all the medications and supplements you’re taking
Check a reliable source for yourself to investigate possible interactions. Good online sources include Medline Plus (English and Spanish, includes herbs) and MedBroadcast, and others. I prefer to have a published work on hand, and like The Pill Book.

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!