chronic daily headache

16 March 2010

Zanaflex for Migraine? and Chronic Daily Headache?

In the last few years, it seems that Zanaflex for migraine is becoming increasingly popular with specialists. The name of the drug is tizanidine hydrochloride, with brand names such as Zanaflex and Sirdalud. It’s considered a "muscle relaxant", and it acts on the central nervous system to relax certain muscles in your body.

Interestingly, Zanaflex is used not only for migraine but also for some comorbid or related conditions. For example, Tizanidine is often prescribed for fibromyalgia. It’s also sometimes used to treat sleep disorders. It may be prescribed to treat muscle spasms from stroke.

Why might Zanaflex help Migraine or CDH Patients?

Some specialists believe that Zanaflex helps with migraine because it helps some people sleep better. Certainly, sleep problems do seem to trigger migraine attacks in some people. Also, it could be that muscle tension could trigger a migraine attack.

However, as with most medications used for migraine, there are many possibilities why it may work – but due to the complexity of the human body we’re still exploring the reasons why.

However, it is clear that it is helping many migraine patients cut down on their attacks.

For Chronic Daily Headache (CDH), Zanaflex is one of the few drugs that has been tested as a preventative. It has also been considered as a treatment for tension-type headache. Also, using it with a NSAID (ie ibuprofen) has been considered to treat rebound headache, when the "problem" medication is discontinued.

Important things to ask (or tell) your doctor

When it comes to Zanaflex or Sirdalud, here are a few things you should check with your doctor:

Food makes a difference. Talk to your doctor about whether or not to take your tizanidine with food. What you’re eating does not seem to be as important as when.
Talk about any side effects you experience, such as weakness/tiredness, dry mouth, or dizziness. Sometimes changing the dose will help. Some other side effects include fever, stomach pain, gastrointestinal issues, back pain, nausea and depression or anxiety.
Tell your doctor if you have concerns about low blood pressure. This drug may lower blood pressure.
Tell your doctor right away if more serious (though rare) side effects occur, such as mood changes, vision changes, black stool, rash, severe dizziness, difficulty breathing or irregular heart beat.
Tell your doctor if you have liver, heart, kidney or eye disease.
As with anything, you should tell your doctor about all drugs and supplements you’re taking. There are particular concerns about taking Zanaflex along with fluvoxamine (Luvox – an antidepressant) or ciprofloxacin (Cipro – an antibiotic). There are concerned about other CYP1A2 inhibitors as well. A document from the FDA says specifically,"cocomitant use of tizanidine with other CYP1A2 inhibitors, such as zileuton, other fluroquinolones, antiarrythmics (amiodarone, mexilatine, propafenone, and verapamil), cimetidine, famotidine, oral contraceptives, acyclovir and ticlopidine should ordinarily be avoided. If their use is clinically necessary, they should be used with caution." (read the full report in pdf format: Updated Safety Information: Contraindications to the use of Tizanidine
As a preventative, you may take this drug for a long period of time. Talk to your doctor before stopping the medication.

For more information…

More on DHE: Home Therapy for Chronic Daily Headache?

James Discoveries & Stats, Medications 4

I appreciated Ellen’s blog post on Home therapy for intractable Migraine. She mentions an interesting study, and brings up, once again, DHE migraine treatment!

DHE, or dihydroergotamine, has been a topic of conversation here more than once. See especially DHE Migraine Treatment: Why some people still use it and Levadex â€“ inhaled migraine drug on the way. DHE has been used for migraine and cluster headache, and it remains a helpful treatment for many patients.

In her post, Ellen mentions a study in the USA reported on in Headache (from the American Headache Society) in January. The researchers wanted to find out how patients would react to a home based intravenous dihydroergotamine treatment.

This type of treatment is usually done in the hospital or clinic, which can make things a lot more difficult for many patients.

There are advantages and disadvantages to having treatment like this at home. But perhaps too often doctors default to the hospital visit, instead of considering some patients that may benefit more from home treatment.

The patients in the study saw good results. All had chronic daily headache (CDH), and in the end only one was still diagnosed with CDH. There were no serious adverse effects at all.

Though this was a very small study (only 31 patients), it may lead to more openness by doctors and specialists to new options in treatments – not only for DHE, but other treatments as well.

Thanks, Ellen!

For more, read Outpatient Home-Based Continuous Intravenous Dihydroergotamine Therapy for Intractable Migraine

18 February 2008

Simple surgery for chronic headache

James Discoveries & Stats 5

Photo courtesy of allspice1

A simple surgery is being researched that may bring significant relief to those suffering from chronic headaches. The small trial showed an increase in "quality of life" of 250% over 12 months.

The study involved 42 women and 13 men with chronic migraine. What was done? Certain superficial blood vessels on the scalp were cauterized (sealed off). That’s it. The side effects of the surgery? Temporary numbness. It sounds like it would be rather worth it.

Dr Elliot Shevel of South Africa, Professor Carlo Cianchetti of Italy and Dr Egilius Spierings of the United States are working together to do further studies on this technique.

Shevel, founder and chairman of the South African Headache Society, is also a maxillo-facial and oral surgeon. He explains how he discovered the treatment: "During the first operation I was doing on a patient’s jaw she had a pounding headache and the carotid artery on the temple was pulsing. When I blocked off the artery to the temple with my finger, the pain went away. When I took my finger off, it came back. I knew that I could cut the artery with no side effects and offered to cauterise it."

Now both South African and Italian governments have thrown in their support for future research. Though the surgery may not help everyone with chronic headache, it could be a major breakthrough for those with symptoms that are very difficult to treat.

via Surgery cures lucky headache victims

8 April 2005

Botox and CDH

James Discoveries & Stats, Medications 1

A new study published in the Headache journal is suggesting a still wider use for Botox. The makers of Botox, Allergan Inc, sponsored a study using Botox in patients with Chronic Daily Headache and migraine. The controlled study involved 355 patients, about 85% women. Each patient had at least one migraine attack during the trial period, so all of them had migraine with chronic daily headache as well. Patients had a Botox treatment every 90 days for 9 months. The patients that got Botox (rather than a placebo) did seem to get fewer headaches. However, Dr David W. Dodick from the Mayo Clinic College of Medicine (who was involved in the project) warns that results are difficult to interpret. More studies are needed.

There is very little treatment actually designed for those with chronic daily headache. Research in this area as a whole is needed, although the causes no doubt vary from person to person.