5 Headache and Migraine News Highlights from the past 3 Months (June 2019 edition)
Don’t miss out on the latest! Here are the five most popular posts from the past three months – most popular post first. Thanks for reading! 🙂
“First FDA-approved drug that reduces the frequency of attacks of episodic cluster headache”
Earlier this month in the USA, the FDA approved Emgality (galcanezumab) for use with episodic cluster headache. This is a big step for CGRP inhibitors, which have shown promise for treating both migraine and cluster (for example, see this article about Ajovy).
As the official Emgality site states:
For adults with episodic cluster headache: Emgality can help reduce the number of weekly cluster headache attacks that occur during a cycle
Emgality.com
As mentioned before, CGRP inhibitors have shown promise for episodic cluster headache treatment, but the treatment of drugs like Emgality is far from a magic cure.
While most of the articles about the recent FDA approval point to the 8.7 fewer attacks per week during a cluster cycle, there is more to the story.
Patients experienced 8.7 fewer attacks, with only 5.2 fewer attacks with placebo. Significant enough to show that Emgality seems to be doing something, but by no means a silver bullet.
But that was in the middle of the trial, which was an 8 week trial. After two months, the difference between Emgality and placebo was even less – a difference which some say “is no longer statistically significant” (see Galcanezumab Offers Help for Cluster Headache and Migraine).
It is good news that cluster patients have something else to try – and we hope that Emgality will help some. But much more needs to be done to help cluster headaches. Sadly, this is only a small step toward better treatment.
Does Migraine Increase Pregnancy Risks?
A study out of Denmark, published last month in the journal Headache, is raising serious concerns about the link between migraine and certain pregnancy risks. How can mothers with migraine give their babies the best possible opportunities for good health?
In the study, researchers used population registries and identified 22,841 women with migraine who became pregnant, compared with 228,324 pregnancies where there was no migraine. They then identified several areas of increased risk for the women with migraine, including:
- pregnancy associated hypertension disorders
- miscarriage
- low birth weight
- preterm birth
- birth defects
There was also a higher risk of several complications after birth, such as febrile seizures.
The most concerning issue was that the increased risk seemed to be there whether or not migraine was treated – suggesting to the researchers that it was migraine disease itself that increased the risks in pregnancy, not the treatment or lack of treatment.
Although there are some weaknesses with this study, it does seem to confirm other studies that also indicate risks in pregnancy due to migraine. It’s difficult to tell exactly how medications come into play, but the researchers seem to think that medications are not explaining the risk.
At first, this may sound like information that you can’t use. After all – if there’s no improvement with treatment or without treatment, who cares? But several things need to be kept in mind.
- This study only found some associations with migraine, and further study will be needed to confirm. This is not to say that treatment is will not help you and your baby during pregnancy.
- Anytime there is an indication of increased risk, what can you do? You can decrease your risk in other areas. If there is a risk of hypertension, there are ways to lower your risk.
- Just because there is an increased risk does not mean it’s a high risk. This is very important to remember – the risk from migraine is still low.
- Pay attention to your own symptoms and talk to your doctor about them. A registry based study like this one relies a lot on minimal information collected after the fact. There are a lot of issues that may cause headaches, migraine, and changes in your symptoms. It’s not “just normal” in pregnancy.
For a summary of migraine changes during pregnancy, you may find this infographic helpful: Migraine During and After Pregnancy
Also, for a discussion of dealing with migraine and headache during pregnancy, and assessing medication risks, read The Myth-Busting Guide to Migraines and Pregnancy
And may your baby be healthy – and may you be healthier than ever – in the months ahead!
To read the whole study, or the abstract, see Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine
Botox Side Effects: Long Term
A new study casts some light on Botox (onabotulinumtoxinA) treatment and how side effects change over time. If you’re using Botox to treat chronic migraine, or if you’re considering it, take the time to look at this study.
This study comes out of the USA and was published this month in Drug Safety: The Official Journal of the International Society of Pharmacovigilance. It compiles about two years of information from what was called the COMPEL study – The Chronic migraine OnabotulinuMtoxinA Prolonged Efficacy open-Label Study. Although “long term” was only about 2 years, the study does provide valuable insights into the side effects of Botox.
Before we get to the specific side effects, it’s worth noting that the study does confirm the general safety of Botox treatment. Although many patients withdrew from the study for various reasons (such as simply not staying in contact or not following the study protocols), only 3.5% withdrew specifically because of “adverse events” or side effects.
Only a small percentage of those were “serious adverse events”, and the researchers believe that only 1 patient (716 started the study) had a serious adverse event actually related to the Botox treatment – and that was a rash. Of course, there are always patients who respond poorly to medication (or even to food!), so this is a pretty good record.
But Botox is not completely free and clear, because there were reported side effects. First, let’s look at the common ones. Then stay tuned for a very important clarification.
Here are the most common side effects. None of these were common – in other words, you’d be unlikely to find even one patient in 10 with the most common side effect.
- Neck pain
- Eyelid ptosis (droopy eyelid)
- General stiffness or weakness
- Pain at injection site
- Headache and/or migraine symptoms
- Facial paresis (muscle weakness)
- Skin tightness
Now if you’ve experienced any of these side effects, there may be some good news for you. The side effects did tend to lessen with repeated treatments.
In this study, treatments were given every 12 weeks. The neck pain was the worst after the first cycle – it decreased significantly after that. Headache and migraine symptoms were the worst during the first two cycles (migraine symptoms actually increased during the second cycle), and then significantly decreased. Droopy eyelid decreased significantly in the second cycle, and then almost disappeared.
Generally speaking, side effects decreased after the third cycle. By the fourth treatment, side effects were drastically decreased.
Now if treatment isn’t helping at all, you’re not likely to stick with it for four treatments. Remember, at every 12 weeks, that’s about 11 months. However, if you find that Botox is helping after you’ve tried it two or three times, you might be encouraged to know that the side effects should be far less at treatment 4 (or even 3) and beyond.
Also remember, there are ways to be safer with Botox treatment. See How to be Safe with Botox (10 tips).
It will be interesting to see even longer term studies in the future. But at this point, this study confirms what other studies have shown us. Side effects are minimal, and tend to be even fewer as the months pass.
To read the abstract, or the whole study, visit Long-Term Safety and Tolerability of OnabotulinumtoxinA Treatment in Patients with Chronic Migraine: Results of the COMPEL Study.
5 Headache and Migraine News Highlights from the past 3 Months (May 2019 edition)
Once again a very eclectic list makes up the articles that were most popular to guests here at Headache and Migraine News. Both symptoms and treatments are highlighted this month. Here are the links, with a little introduction to get you started. The most popular article of the month is first.
- Eyes Dry and Sensitive to Light? Could be more than Migraine… You probably already know that photophobia, or sensitivity to light, is a common migraine symptom. You may also know that migraine patients may be sensitive to light even when they’re not in the middle of a migraine attack...
- sTMS Mini – Now approved to Fight Migraine in Teens & Adults (with video) The migraine-fighting device now called the sTMS mini has received expanded approval from the FDA. It is now approved as a preventative and abortive device for ages 12 and up…
- New Approaches to “Aggressive” Migraine Treatment Migraine symptoms are sometimes “endured” for months or years without serious focus on treatment. Many people are being told that migraine is “normal” and that they just have to “put up with it”…
- Eye Drops for Migraine revisited – a low-cost treatment? A few years ago we talked about a possible “$5” treatment for migraine – Timolol eye drops. Since then the price may have increased slightly, but researchers are still interested in the possibility that such an inexpensive treatment may work well for many migraine patients…
- Fighting Stress as an Adolescent Although you should never accept the “it’s just stress” diagnosis of migraine or headache, it’s clear that there is a link between the two. Minimizing the negative effects of stress can certainly have a positive effect on your life…