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18 May 2018

Big News: First CGRP Inhibitor for migraine Approved in US – Aimovig

Yesterday, the FDA approved the first of a new class of migraine drugs – CGRP monoclonal antibodies. We’ve been talking about these drugs – and this one in particular, for many years. And it should be available in the USA in a couple of weeks.

Aimovig The drug is being sold as Aimovig, but we’ve known it by its earlier names, AMG 334 and erenumab.

Aimovig, and it has been approved as a migraine preventative. This is what the FDA had to say about it yesterday:

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.
[FDA Press Release]

For a somewhat lighthearted basic explanation from 2012, check out The Secret of CGRP.

Aimovig dosage

Aimovig Injector Aimovig is currently a 70mg injection taken each month. Some patients may take a double dose, which would mean two injections of 70mg taken the same day. The injection, done with a pen-like “autoinjector”, is taken in the abdomen, upper arm, or thigh. It’s designed to be injected by the patients, but there are some things to watch for, so talk to your doctor. The injection takes about 15 seconds.

Aimovig Side Effects and Other Concerns

Some of the headlines are claiming that this is a wonderful new side-effect-free medication, which is not strictly true. The side effects do seem to be minimal, which is certainly the general advantage. However, a few patients were irritated by the injection itself. Some also experienced constipation. There are also cautions because of the unknowns of taking Aimovig during pregnancy, and researchers are concerned that there may be an increased risk of preeclampsia.

But for most people, the side effects should be minimal or non-existent.

Advantages of Aimovig

Aimovig seems to be helpful for patients with episodic and chronic migraine, although you will need to discuss with your doctor if your attacks are frequent enough to warrant this type of medication.

As mentioned before, you may experience fewer (or no) side effects with this medication compared to what you have tried before. If you have not used a preventative medication before, your doctor will probably try some other drugs or treatments first before Aimovig.

Aimovig may not prevent all your attacks. If they cut your attacks by a third or a half, that will be a significant improvement.

However, using Aimovig with other treatments could mean a much more significant improvement. And remember, this is only the first of this type of drug to hit the market – other CGRP drugs could work better for you. And there are a whole new class of drugs coming after that.

Another interesting note – this drug is currently being investigated as a possible treatment for hot flashes during menopause.

We will look forward to hearing about your experiences with Aimovig. Once you’ve tried it, come back and comment!

8 February 2018

Are You CoQ10 Deficient?

James Uncategorized 0

Although CoQ10 has been a well known migraine treatment for many years, for whatever reason we haven’t spent a lot of time talking about it here. But a recent article at the New York Headache blog helps us with a summary of information about this treatment.

21st Century CoQ10 — Another brand recommended by Consumer Labs.

CoQ10, or coenzyme Q10, is an antioxidant found in every cell of your body, and also in some foods. It is sometimes listed as a supplement as Q10, vitamin Q10, ubiquinone, or ubidecarenone.

CoQ10 is often taken to fight symptoms of heart conditions. Many people also take it to fight migraine.

The recent article at the NY Headache blog points out that studies have shown CoQ10 benefits for migraine patients, whether children, adolescents, or adults. (Read the article here: Migraines can be prevented with CoQ10 supplementation) The doses given in the trials were 1-3mg for children and adolescents, and 100mg 3x daily for adults.

Dr. Mauskop (author of the post) makes the logical assumption that you’re more likely to benefit from CoQ10 treatment if your levels are actually low. There is a lab test for this, which is often covered by insurance plans. But the post gives the following advice:

It is important to ask your doctor what the actual blood level was because the laboratories will report as normal values between 0.37 and 2.2 (Labcorp) or 0.44 and 1.64 (Quest Diagnostics), studies have shown that the level should be at least 0.7.

Consumer Labs recommends Swanson Ultra as a good budget brand of this supplement (follow the link to “other sellers” and you’ll see that Swanson sells this and it’s shipped by Amazon). The high-absorption recommendation is only slightly more – Doctor’s Best High Absorption CoQ10.

(Note: the “high absorption” version may allow you to get better results with a lower dosage. However, it contains black pepper extract, which may cause issues with some medications, such as propranolol. Talk to your doctor, especially if you’re taking a prescription medication.)

CoQ10 has been helpful for the prevention of migraine for many years. Hopefully with better testing we can match it to the patients who will benefit the most. It’s an inexpensive option that could make a big difference.

27 November 2017

Researchers Looking for Predictors of Botox Success in Migraine

James Uncategorized 1

Excuse the complicated title to this article, but this is what it means in plain language. Botox, or onabotulinumtoxinA, has been very helpful for patients with chronic migraine. But it certainly helps some people more than others. Researchers want to know why, and they also want to know if there is an easy way to predict which patients will respond best to Botox.

Blood Tests and Botox Today, patients need to go through all the treatments before they know if they will work. But what if you could go for a simple blood test which would tell you ahead of time that your treatment had a – say – 87% chance of success? Or maybe a 16% chance of success? That would save everyone a lot of time and money.

A study published earlier this month in the journal Headache found that certain markers may predict Botox success.

First, CGRP levels. We’ve heard a lot about CGRP (calcitonin gene-related peptide) lately, because of the new migraine medications that are coming out. CGRP levels an important part of the trigeminovascular system, and seem to play a role in communicating pain messages in the body. Levels were higher in patients who responded well to Botox treatment. (This is not the first time this has been observed – see Botox and CGRP – and the Future of Migraine Treatment

Second, PTX3 levels. High PTX3 (pentraxin 3) levels have been linked to inflammatory and vascular issues. Patients with higher PTX3 levels were also more likely to respond to onabotulinumtoxinA treatment.

Though this is likely one of many studies that need to be done, this kind of information will not only help us predict who is most likely to benefit from Botox treatment, but should also help us understand both disease and treatment better, so that we can make better options available in the future.

Read the study abstract here: CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine

20 November 2017

CBD Oil for Migraine

James Uncategorized 0

Thanks to those of you who have been submitting questions to Headache and Migraine News – keep them coming!

Today I have a question from Stacey in the United States. She had heard about someone who had tried many things for her migraine disease, but finally found almost complete relief using CBD oil.

There is a lot of talk about CBD oil for migraine, but here’s one example from Ireland – Migraine sufferer finds relief in cannabis-derived oil

Hemp plant If you do a search online, you’ll find a whole lot of information about CBD oil – some of it good, some of it bad. Just looking at the title of this article, which describes CBD oil as “cannabis-derived”, you can imagine there is a lot of politics an money going into various points of view on this issue. Emotions run high on every side.

CBD oil is generally take under your tongue (drops or spray) for conditions like migraine, or in a capsule. Some people use it as a preventative, some as an abortive.

I’m not going to repeat all the information here, but I will try to give you a few highlights to help you navigate information in your own research.

First, CBD oil does not necessarily have a “psychotropic” effect, because it doesn’t necessarily contain the psychotropic chemical, tetrahydrocannabinol (THC). There are actually various types of CBD oil with different percentages of THC and CBD (cannabidiol). CBD oil with very little or no THC may have an anti-migraine effect, as may oils with a mix of CBD and THC. But to answer a question you may be asking, no, you don’t need to “get high” for this to “work”.
But does it work? Many people are reporting that it does help them, with migraine and chronic pain conditions. There is enough information to make us hopeful about the future use of CBD oil. But there is very, very little information from clinical trials to give us solid evidence and to assure us of safety.
You’ll see contradictory, and what appears to be contradictory, information about legality. Legality depends not only on what country you’re in, but also on how the laws of that country are interpreted. So I’ll leave that one for now!
If you want to purchase CBD oil online, you are probably going to buy it from a travelling salesman in the wild west. And you won’t be able to look him in the eye to see how honest he is. In other words, there are a lot of slick, professional looking websites selling CBD oil. But some of that oil, contrary to what they tell you, has hardly any CBD in it. It may even contain harmful chemicals. So you will need to do a lot of research, and even then there may be a lot of experimentation to see what works for you.

So let me give a perspective as someone who has researched migraine treatments for many years. Although cannabis in general has been used throughout history, CBD oil is one of many, many treatments that are in the very early stages of clinical trial research. There are likely dozens of treatments and combinations that have good evidence behind them that you should probably try first.

That is not to say that CBD oil and other cannabis/marijuana/hemp related treatments are not good treatments. They are a valid area of study, but that study has just begun. So you need to be aware that there is risk associated with these treatments.

I’m not even saying you can’t find reputable companies to sell you good products – but that there are various risks naturally associated with something with little clinical trial evidence behind it and little or no regulation.

If you want to try CBD oil, talk to your doctor, and be aware of the risks. Do careful research before you give your money to someone.

Here is some information to get you started:

19 October 2017

More on Migraine, Flying, and Current Research

James Uncategorized 0

There is a lot of interesting research out there regarding headaches and airplane travel. The fact is, there are probably various causes and types of headache that are brought on during flight, and there isn’t always agreement on what the cause is.

Airplane travel Research has been going on at Aalborg University (Denmark) to better understand and better treat these headaches.

Last year, a study of 254 passengers found that 35% had headaches during travel. However, wanting to specifically study airplane headache, they evaluated each person and found that only 8.3% had actual airplane headache as defined by The International Classification of Headache Disorders, 3rd edition (beta version).

Still, that’s almost 1 in 10, with more than 1 in 3 suffering from some kind of headache!

Earlier this year, research was published in an attempt to find a cause for these headaches. An increasingly important testing method was used – testing saliva for certain chemicals.

In this case, participants were on a flight simulator. Regular saliva samples were taken. The patients with headache were found to have higher levels of cortisol and PGE2.

Now cortisol is a common indicator of stress. Were these people anxious about flying, even though it was just a simulation? Or is there another reason for the high levels?

PGE2, otherwise known as dinoprostone, may be at increased levels to fight inflammation. It could be that changes in cabin pressure may actually cause inflammation, leading to the release of PGE2.

PGE2 has been linked to migraine before, and it is leading to other possible migraine treatments. So there could be a connection here between airplane headache and migraine, leading to better treatments of both.

The next step of research is indeed to find treatments. It has been noted that triptans can help with airplane headache, so researcher Sebastian Bao Dinh Bui wants to test patients taking triptans – again using saliva samples.

Triptans may be something to try, along with nasal decongestants, vitamin C, and simply staying hydrated.

To find out more: Researchers aim to cure headache during flight