abortive medication

20 July 2020

Ubrelvy: Not the Silver Bullet, but Helping Many

James Discoveries & Stats, Medications 0

Ubrelvy, generic name ubrogepant, is a migraine drug that was approved in the USA late 2019. We’re just now beginning to see how it’s working for real people in the real world.

Ubrelvy is an abortive medication, taken to stop a specific migraine attack when it hits. And so far, it’s doing as well as expected – actually, maybe better – for patients that have been taking it in everyday life.

Last month, Dr. Chia-Chun Chiang from the Mayo Clinic presented some preliminary findings at the American Headache Society Annual Meeting. Patients were asked to report on their use of ubrogepant 1 month to 3 months after it was prescribed. Here are some of the results from 57 patients:

So most patients, 66%, were either somewhat satisfied or very satisfied with ubrogepant.

Next, researchers looked at the goal of being pain-free within two hours. Now, you can take another dose after two hours if needed, but ideally you should have significant relief by then. In total, 27% reported that they had general relief in all their migraine attacks when they took ubrogepant. 73% had relief at least one time when they took it, and 32% were free from headache at two hours during at least one attack.

So, for most people it worked some of the time. But for 27%, it provided consistent relief.

The numbers sound a little more impressive when you realize that most of the patients in this study (81%) had chronic migraine. Now, this shouldn’t be your only treatment if you have chronic migraine, because you shouldn’t be taking it that often. But it says something that it was working for many patients who have a very serious migraine condition, and who have probably tried a number of other medications.

So the bottom line is that, so far, this medication does seem to be helping a lot of people. We’ll look forward to seeing more “real world results” in the months ahead.

via: Study collects real-world data on newly approved migraine treatments

14 January 2020

Aspirin: Cliché or Real Treatment?

James Discoveries & Stats, Medications 0

There’s no doubt that aspirin has become a cliché – almost a symbol of all that is wrong with headache treatment.

You know, the doctor who just tells you to “Take two aspirin and call me in the morning”. He doesn’t take your symptoms seriously, he doesn’t differentiate between different types of migraine or headache. No recognition of the cutting-edge medications or complimentary treatments.

Aside from that, it can be dangerous to take over the counter “painkillers”, especially if you’re taking them every week, without an expert diagnosis and observation.

That being said, the evidence still points to aspirin as a helpful treatment for headache and migraine. It’s become so cliché that it ends up being overlooked. But a new study is reminding us again that aspirin may still be one of the best drug treatments for migraine.

This is actually a review of 13 randomized trials showing the use of aspirin in thousands of patients with migraine. The review came from Florida Atlantic University’s Schmidt College of Medicine. Here’s a summary of their findings:

Their findings, published in The American Journal of Medicine , suggest that high-dose aspirin, in doses from 900 to 1,300 milligrams given at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, some but not all randomized trials suggest the possibility that daily aspirin in doses from 81 to 325 milligrams may be an effective and safe treatment option for the prevention of recurrent migraine headaches.
Migraine Headaches? Consider Aspirin for Treatment and Prevention

You may remember that we wrote about aspirin as a preventative in 2012, when it came out as a winner against preventatives such as propranolol (Inderal) and topiramate (Topamax). Considering the side effect that may accompany preventatives such as these, aspirin is an attractive option.

Of course if we can find ways to treat migraine without a daily drug, that would be preferable. But the strongest evidence seems to be for aspirin as an abortive.

We talked about best options for NSAIDs (which would include aspirin and ibuprofen) here: NSAIDs – Which One Should I Take For Headache? The take-away for aspirin is that is is certainly one of the most effective, with a recommended dose of 1000mg. However, it can be hard on the stomach. So, if possible, take it with food, and certainly use a brand you trust – if possible, a version that is not time release, but that has a coating to protect your gut.

Aspirin is still a good abortive. But remember, if you’re reaching for it regularly, you have a more serious problem and you need to look at other options.

For more information on this recent study, see Migraine Headaches? Consider Aspirin for Treatment and Prevention.

27 May 2014

Do You Make this Medication Mistake?

James Medications, Tips 4

There are some fairly healthy people who have a migraine condition – and they try a medication – and it works well – and life goes on.

I’m happy for you.

But some of us have spent more time looking for treatments that work. But some of us spend more time than we should, because we make a classic mistake.

We don’t keep detailed records.

Most of us, if we have records at all, just have something like this:

I’ve tried

sumatriptan

propranalol

Depakene

Anti-depressant

Well, that’s a good start. But there are some problems with that list.

You tried sumatriptan. Brand name, or generic? Did you know that it could make a difference which you tried? Was it a nasal spray? Or a pill? Injection? Or did you try all three at different times?

Propranolol – that’s a generic name. And you spelled it wrong. 😉 Was it Inderal? Depakene – that’s a brand name for sodium valproate. Was it actually Depakene you took?

Which anti-depressant? Elavil? Paxil? Norpramin? In what form?

This is very important, because another form of sumatriptan may work when this one didn’t. One type of sodium valproate could help, while another doesn’t.

And what about other treatments? Have you been for physiotherapy? Have you seen the chiropractor? Have you taken a magnesium supplement?

Detailed records will help your doctor know what to try next. For example, you may have a better change trying a different form of what you’ve already taken, rather than trying something totally new.

So here are some suggestions of the information that you should have on hand to show a doctor or check yourself when the need arises.

Drug name
Manufacturer (especially if generic)
Dates used
Side effects (and how severe)
Benefits (if you have the dates, you may have this information in your headache diary)
Dosage(s)
Doctor who prescribed
Form (tablet, gel tab, injection, etc)
Preventative or abortive? (eg did you take this as a daily preventative, or when a migraine attack was starting?)

If possible, also include information such as what else you were taking at the same time. It might be handy to snap a picture or scan the actual package of the medication or supplement to catch whatever info you’ve missed.

For those who are more or less new to medications, this may seem a little obsessive. But the better your records, the better off you’ll be in the future. For example, what if a treatment stops working? What if one manufacturer makes slight changes to a medication? What if you develop another condition which means you can’t take this medication anymore? What if you change doctors, or your medical files are lost or damaged? What if you have a severe attack and need to go to emergency – do you really want to rely on your memory and a few scribbled notes?

Keeping track as you go along sure beats trying to remember and locate the files and call the right doctor years later.

Trust me. Been there.

How do you keep track of medications/supplements/treatments? Any suggestions to help the rest of us?

15 May 2013

Can you kill Migraine Pain with Ginger instead of Triptans?

James Medications, Treatments 15

It was only last month that we talked about taking ginger to fight the pain of headache and migraine, as well as other symptoms. Actually, ginger has long been a popular treatment for nausea, which is used regularly by doctors.

But a recent study in the journal Phytotherapy Research set out to investigate ginger specifically as a migraine abortive.

In a study of 100 patients, each patient received either sumatriptan (ie Imitrex) or ginger powder. They did not know which one they were getting.

This was an abortive treatment, taken for 5 migraine attacks. So what were the results?

After 2 hours: with either treatment, there was a significant decrease in “mean headaches severity”. Both treatments helped about the same amount.
Patient satisfaction: About the same for either treatment.
Side effects: Fewer in ginger, more in sumatriptan.

In the end, then, the treatments were very similar. It would be interesting to know more about individual symptoms. For example, did ginger help more with nausea? Inflammation?

But the main benefit of ginger seems to be the lack of side effects, although that doesn’t mean you can just take all the ginger you want without checking with your doctor (especially if you’re diabetic, have a heart condition, or are pregnant).

Ginger powder capsules may be worth a look (such as these standardized ginger capsules), especially for those who haven’t been helped by triptans, or those who are concerned about side effects and long term effects of triptans.

Study abstract: Comparison Between the Efficacy of Ginger and Sumatriptan in the Ablative Treatment of the Common Migraine