Why I’m fighting Migraine
Sometimes people ask me why I built this site, and why I’m out to fight migraine and various types of chronic headache.
Here are two big reasons why:
My kids (and a doll)
My kids (and a doll)
My kids (and a doll)
Namenda Migraine Treatment
It’s time to take a look at what’s new with Namenda migraine treatment. Namenda is actually just one brand name for memantine. It’s also sold as Axura, Akatinol, Ebixa and Memox.
Namenda is commonly used for Alzheimer patients, but is being tested for a number of other neurological disorders.
Technically known as a moderate affinity NMDA-receptor antagonist. In Alzheimer patients, excessive glutamate inhibits the normal sending of messages in the body. This drug blocks the effects of the excessive glutamate.
Namenda is being investigated for migraine, chronic tension-type headache, and various kinds of pain.
In one sense the news so far hasn’t been overwhelming. However, memantine may bring improvement to patients that are having difficulty finding other medications that work for them (Bigal, Rapoport, Sheftell, Tepper, Tepper 2008).
In Namenda treatment for migraine, small studies have shown some improvement in migraine patients who have significant disability and a significant number of attacks each month. The dosage is usually 10-20mg per day. Some studies saw over a 50% reduction in attacks (Krusz, Cammarata, 2005).
Namenda migraine treatment shows promise, but it’s still lacking the large, double blind trials that can really show us how well it works (and who it works best for).
I should also mention that there is some indication that Namenda may help with chronic tension-type headache. The results haven’t been as promising as with Namenda migraine treatments, but patients have seen a reduction in pain intensity, and some have seen a reduction in attacks (Lindelof, Bendtesn 2009)
Again, these are very small studies. But researchers are hopeful that memantine will be a good addition to migraine treatment, especially migraine that has been harder to treat in certain people. Since tension-type headache and cognitive problems often go along with migraine, there may be certain patients that see significant improvement with Namenda.
An interesting side note on the study of memantine is new light on the differences between men and women when it comes to migraine. Read more about Namenda, Migraine and cortical spreading depression
New Migraine Topamax study: Adolescents
The latest migraine Topamax study was published in Pediatrics this month. It was a study of migraine patients age 12-17.
The children and teen crowd have had far fewer migraine studies done. Last year we talked about Topamax for children; this study focused on the older subset – adolescents. Here’s what they found:
As you can see, there was a significant difference. In more practical terms, those taking Topamax went from 4.3 attacks per month to 1.3, and had fewer days with migraine. (Note, however, that even those on a placebo saw a significant reduction in attacks, so the numbers aren’t quite as good as they look) The numbers on the bottom of the chart show percentages.
The researchers said that topiramate was well tolerated. However, the fact of the matter is that almost 3/4 of the patients experienced side effects. The common ones were upper respiratory tract infection, itchy or tingling skin, and dizziness.
There should be some concern that, in the rush to make Topamax an "approved" migraine drug around the world, we start thinking it’s the best thing to try. The fact remains that topiramate is a powerful drug which commonly has side effects. It is hoped that Topamax will not be the first thing your doctor recommends.
This is especially important in children. As was pointed out in the Italian review in 2008, we should be especially concerned about the impact these side effects will have on children and teens. Other common side effects in children are weight loss, anorexia, trouble concentrating, and tiredness.
Topamax may prove to help adolescents with migraine. However, the side effects may prompt many to look at other options.
The Latest on Tezampanel, a new Migraine Drug
Trials for the new migraine drug, Tezampanel (NGX424), are moving quickly ahead. So it’s time to catch up on what this drug is, and who it might help.
Tezampanel is based on an emerging understanding of the role of glutamate (an amino acid) in pain. Targeting glutamate receptors (either through antagonists like Tezampanel or through modulators like ADX10059) is a new concept that may help not only those with migraine, but also muscle spasticity, fibromyalgia, arthritis, diabetic neuropathy, epilepsy, and neuropathic pain in general. It may also suppress symptoms of opioid medication withdrawal.
Why target Glutamate?
Glutamate is a key neurotransmitter. It’s called an excitatory neurotransmitter, and is the one most commonly found in your body.
Glutamate has a number of functions in your body, which may include to ability to learn and memorize, and the transmission of pain signals.
During certain stages of the pain chain-reaction, glutamate gets very busy sending signals. In certain people with chronic pain especially, there may be too much glutamate, inducing more pain than should be necessary.
Researchers are actually getting very excited about levels of glutamate, because this may be the key to understanding the mysterious chronic pain in many people. Could it be that some people’s chronic pain could be "seen" by the levels of glutamate? Better yet, could the pain chain reaction be stopped or slowed by controlling glutamate?
Glutamate does have a role in migraine. It’s present in the trigeminal nerve (where migraine pain often radiates from). It plays a role in cortical spreading depression (a brain "storm" that is a major part of a migraine attack), and seems to be key in causing central sensitization, where certain neurons in the spinal cord become sensitized, possibly causing increasing chronic pain. (more about what happens during a migraine attack)
Enter Tezampanel
Tezampanel (also called NGX424) is a drug being developed by TorreyPines Therapeutics, based on research done at Johns Hopkins University. It’s unlike any other drug in what it does. In scientific terms, Tezampanel is an ionotropic glutamate receptor antagonist that targets the AMPA and kainate sub-type receptors. Glutamate receptors receive glutamate and become activated – this drug is designed to interrupt the process.
There are actually two drugs here being tested, but we’ll get to the second in a moment. Tezampanel itself is injected, and was compared with injections of Imitrex (sumatriptan). It was found to work as well as Imitrex. Symptoms that Tezampanel seems to help with:
- pain (and excessive pain sensitivity)
- nausea
- sensitivity to light and sound
- allodynia (sensitive/painful areas on the skin)
Tezampanel and NGX426
Another related drug in an earlier stage of testing is NGX426. This is a "prodrug" of Tezampanel, which means that it causes Tezampanel to be formed in the body.
NGX426 is an oral drug, not an injection. Last month (February 2009) a Phase I trial was completed, and so far so good (read the results of the this early trial). NGX426 seems to have promise for relieving pain in migraine.
Side effects?
When a new drug comes out, there is always hope that many patients suffering from the side effects of something else may be able to make the switch. How is Tezampanel looking regarding side effects?
So far the side effects seem to be fairly minimal. Common ones seem to be:
- pain at the injection site (of course this wouldn’t happen if you took NGX426 orally)
- dry mouth
- some other side effects in very few people may include dizziness and sleepiness
The next step
Tezampanel is heading into the last stages of testing. NGX426 is farther behind, just heading into Phase II (of III). TorreyPines Therapeutics is just putting together the funding it needs to carry out the next step.
Summary
Drugs coming out that are totally different than what has come before are especially interesting. Not only may they help people who haven’t been helped, they may also lead to new treatments and breakthroughs. When it comes to chronic pain, Tezampanel is one to watch.
From what we’ve seen so far, this drug may work well for some people who have been unable to take other types of migraine drugs due to side effects or other medical conditions. It may also hold hope for those who have chronic pain conditions, including chronic migraine.
TorreyPines has more on Tezampanel and NGX426 here
Heads up from Ellen Schnakenberg
Creating a good environment (blog carnival)…
Some excellent entries this month over at the Headache and Migraine Disease Blog Carnival at Somebody Heal Me!
The topic this month was Creating a Migraine-Friendly Environment (of course, this means a Migraineur-Friendly Environment – I’m not going to be friendly to migraine!). I think you’ll learn something from all four on-topic posts:
- jasmine’s cove
- Coping with a Migraine: My Three Step Approach
- Creating a Migraine-Friendly Home Environment
- Make Your Home Friendly During a Migraine
My entry was off topic this time. You can see all the entries, plus information about entering next month’s carnival, right here.Headah