Medications

4 December 2008

Doxycycline for daily headache?

James Discoveries & Stats, Medications 17

So how would you feel about taking an antibiotic for your headache? If you’d be uncomfortable with that, you’re not alone, and I’m proud of you. 🙂

But that’s no reason to ignore the small study that was done by Dr. Todd D. Rozen of the Michigan Headache and Neurological Institute. In the study he used Doxycycline to treat new daily persistent headache. Before we get to the results, a quick overview of Doxycycline itself.

Doxycycline is the generic ingredient in a whole host of brand name antibiotics, such as Adoxa, Doryx, Monodox, Periostat, and Vibramycin. These types of antibiotics work by interrupting the life cycle of the bacteria. It’s used for a number of different bacterial infections.

New daily persistent headache (NDPH) is one of the most treatment-resistant types of headache. In fact, the patients in this trial had already tried (unsuccessfully) 5 different preventive treatments. Interestingly, many patients get NDPH after an infection. And one theory is that a certain type of inflammation is behind NDPH.

That inflammation chain-reaction can also be stopped by Doxycycline, making it a candidate for treatment.

Only 4 patients were in the trial, but 2 became 100% pain free, 1 had an 80% improvement in daily pain intensity, and the last person had a slight improvement in pain intensity and a more than 50% decrease in severe pain episodes. On average, patients improved after 3 months (2 daily dosages of Doxycycline, 100mg). There was only one notable side effect – one patient got a severe sunburn (you have to be careful about your time in the sun when you’re on Doxycycline). These are very good results for something so difficult to treat!

So the results are pretty positive, and it probably wasn’t because of the antibiotic properties of Doxycycline at all. If these findings are confirmed by larger studies, it may show that our understanding of NDPH is on target. And it may open the door to better treatments.

Doxycycline itself may or may not be a good treatment. Obviously, we need to be cautious about taking antibiotics. Also, many medications, supplements and foods can decrease its effectiveness, so it needs to be taken properly under the care of a doctor.

This study was brought to my attention by the Headache News Blog.

22 November 2008

Caution: Giving Medications to Children

James Medications 1

Everyone should know that they need to be especially cautious when giving medication to children. But what special precautions should we take?

Caution when giving medication to children

I appreciated the reminders from ParentCenter last month entitled Seven medicines you shouldn’t give your child. There are some excellent reminders there.

Though the authors don’t give hard and fast rules (there are always exceptions), they advise against giving things like aspirin, over-the-counter cough and cold medicines (for children under 6), and anti-nausea medications.

The article also reminds us to check with a doctor before giving herbal remedies (some parents assume that these are safer than medications, which is not always the case).

There are a couple other common problems when it comes to headache and migraine in particular. First, giving too much acetaminophen/paracetamol is a common problem, because often times medications contain these ingredients and parent unknowingly give a double dose.

Second, giving "adult" medications. Some well-meaning parents see their children suffering something they’re well familiar with, and they’re tempted to try their meds for their kids. But many headache or migraine meds have not been properly tested for children, and can be dangerous. Some may be used for children at a different dose, but it’s important to do this under the care of a doctor.

There are more and more treatments specifically used for children with headache and/or migraine. For example, biofeedback and relaxation techniques have helped many children and teens. Some anti-nausea medication may be helpful, and even a preventative for migraine such as an anticonvulsant.

There are options out there – just remember to proceed with an extra measure of caution when trying to help a child.

13 November 2008

Migraine patients more sensitive to Topamax?

James Medications, News 56

Topamax – things "tasting funny"
a common side effect for migraineurs

Topamax (topiramate) has been a help to many patients with migraine and epilepsy. Unfortunately, many migraine patients also experience Topamax side effects, and these side effects make them more likely to stop topiramate treatment.

Researchers at the University of California in the United States and the University Medical Center in the Netherlands decided to ask the question – why so many problems? Are migraineurs actually more likely to have side effects from Topamax?

The researchers compared patients with epilepsy and patients with migraine who were taking topiramate alone as a treatment. The data showed that migraineurs were indeed more likely to stop taking the drug because of adverse reactions.

Epilepsy patients were more likely to suffer behaviour reactions and headache. Migraine patients were more likely to find that things "taste different", or have cognitive problems (such as language problems). Migraineurs were also more likely to drop out of topiramate treatment because of adverse reactions.

Technical data for the study can be found here: Are Migraineurs at Increased Risk of Adverse Drug Responses?

9 October 2008

Being tested: Inhaler for migraine

James Medications, News 2

The last thing a migraine patient needs is to be poked with more needles. But research is slowly making more options available. One of the methods that is actively being tested is an inhalation system.

Alexza Pharmaceuticals is working on a system they call Staccato. The device is the size of a small cell phone. Inside is a surface that has been sprayed with the needed drug. When they patient breathes into the device, a reaction is triggered and the drug is vaporized, entering the lungs. It’s quickly absorbed – and that speed is what migraine patients need.

There are some drugs already in use (such as ZOMIG nasal spray) that are inhaled. One problem with the traditional systems, according to Alexza, is that it’s hard to get the exact right dosage. As a result, other ingredients are added to get the right rate of flow. Staccato should avoid this problem, and also get the drug into your system faster than the traditional inhalation techniques.

Much of the focus of the project has been on drugs related to mental health. However, there is interest in drugs that can be used for migraine as well. Two of the drugs now being tested fit into this category: prochlorperazine and loxapine.

Prochlorperazine has actually been used in emergency rooms for migraine for a number of years. It’s especially valued for fighting nausea. For mental health it’s used as an antipsychotic. Its brand names include Phenotil, Compazine, Buccastem and Stemetil.

Less used for migraine is loxapine, sold as Loxitane and Loxapac. Also an antipsychotic, it’s prescribed for schizophrenia. There is hope that it may be useful for some migraineurs as well.

Alexza is optimistic that both of these drugs may be able to replace triptan drugs in patients that can’t take them or don’t find them useful.

Both these drugs are in phase 2 of trial with Staccato and are soon to head into the last phase.

We’ll keep a watch on these new technologies. Anything needle-free is great for migraine – especially if it gets the medication into your system faster.

Other needle-free options being tested

22 September 2008

Demerol for Migraine in the Emergency room

James Discoveries & Stats, Medications, Tips 84

If you end up in the emergency room here in North America, and you’re diagnosed with migraine, there’s a very good chance you’ll end up with an injection. That injection is usually something called Demerol, or meperidine hydrochloride. But is that the best way to go?

Of course, Demerol for migraine is nothing new. Basically, it’s prescribed for the pain (usually headache pain). Meperidine is a powerful, fast-acting opiod (narcotic) drug.

Though Demerol may help with the pain, there are problems. It doesn’t tend to last as long as some drugs, there are issues with toxicity, and concerns about dependence. Is Demerol really the best drug to take in an emergency situation?

Though it’s being used less and less in many countries around the world, it’s still prescribed for migraine in the emergency room. A study over the summer set out to find out what other options might be better.

This was a meta-study – a review of information on the use of drugs for migraine in emergency (11 clinical trials were studied in all). The study found that many of the alternative drugs already used were more effective (or similarly effective) than Demerol at killing the headache pain itself (for example, a DHE (dihydroergotamine mesylate or Migranal) injection). (overview here)

Surely there are many options for dealing with advanced migraine symptoms, far beyond DHE and Meperidine. I hope more studies are done to find the best, fastest treatment for someone who so urgently needs it.

There may not be much we can do in the meantime. However, if you have ended up in emergency before, it would be a good idea to take a note of what worked for you (I remember being in emergency and going through a lot before finding real help!). You could make the information part of an emergency card or medicine log that you carry around and can pull out at the hospital (after all, you don’t want to try to explain it in the middle of an attack!). Remember, what worked well for someone else may not work well for you – these studies are simply looking for what is generally most effective.