preventative

7 July 2022

Did You Quit Your CGRP Preventative Too Soon?

Typically, it seems to be a good idea to try any new treatment for three months. But a new study from Italy is suggesting that some patients may be quitting certain treatments too soon.

In this case, we’re talking about CGRP inhibitors that are used as migraine preventatives.

The study was presented at last month’s annual American Headache Society meeting. The study followed patients who were taking anti-CGRP medication for 48 weeks (about 11 months). The overwhelming majority of patients did indeed respond to the medication within 12 weeks. But depending on the medication, between 7.6% and 15.5% responded in weeks 13-48, the median time of response for the “late responders” being 20 weeks, or about 4.5 months.

Studies like this, though preliminary, raise some interesting issues. Dr. Deborah Friedman (from the University of Texas Southwestern Medical Center), quoted in an article in Neurology Today, gives her response to some of the online chatter that’s been happening:

There are colleagues of mine who said anybody who would keep somebody on a medication that didn’t work longer than three months, it’s unethical. Well, I keep my patients on it for four to six months and that’s what we did with Botox, because I’ve seen people respond late.
Dr. Deborah Friedman

Unethical? Why unethical?

Think about it. Even if there are a few people who may respond late, your chances of responding to the medication do significantly drop after 12 weeks. So if every patient is now put on a trial of 20 weeks or more (some are suggesting 6 months to a year), the drug company selling the product certainly benefits. The insurance company may not be so sure. And most of the people taking the medication for those extra weeks will never benefit from it, and so are only dealing with any side effects with no benefit at all. That’s the cold number crunching.

But the fact remains that some patients may be missing out because they’re only trying the medication for 12 weeks.

All right then, is there a way we could identify those patients – the ones that will benefit eventually – thus improving the odds?

The study has perhaps started to point the way. The researchers did note some tendencies among the late responders:

More likely to have a higher average body mass index
Slightly less likely to have one-sided pain with allodynia (more on this below)

Of course, this works both ways. If you have one-sided pain with allodynia, you may be a little more likely to benefit from an anti-CGRP preventative. Because basically the late responders were simply a little more like the non-responders.

This is a long way from a way to identify which patients will respond late. But what the study does tell us is that we should be looking closer to find out how we can identify those patients – it shows us that there may be a way, eventually.

Right now, it’s probably best to have a good relationship with a specialist you trust, and let them help you decide if it’s worth it to try your medication (or other treatment) for longer. They know you best, and know your medical history.

To delve further into this topic, check out the article at Neurology Today by Thomas R. Collins: Late Migraine Responses Seen for Anti-CGRP Therapy

Also the National Headache Foundation has put out a video on the optimistic side, explaining this study:

27 August 2015

5-HTP for Migraine and Tension-Type Headache

James Treatments 0

With all the new treatments becoming available for migraine, it’s easy to forget about some of the older treatments that have helped some people avoid attacks.

Back in the 1960s, researchers began to realize the important connection between migraine and a certain neurotransmitter – serotonin. As the decades went by, there was an increasing interest in the relationship between serotonin and migraine, and finding ways use this knowledge to treat attacks.

Today we know more about the complexity of migraine and migraine attacks. But serotonin remains an important, and at times controversial, component. Low levels of serotonin not only relate to migraine, but other comorbid diseases and disorders, including depression, sleep problems, and other types of chronic pain.
5-HTP
One complimentary treatment has been especially studied as a migraine preventative – 5-hydroxytryptophan, or 5-HTP.

The body uses 5-HTP naturally in the creation of serotonin. As a supplement, 5-HTP is made from the seeds of griffonia simplicifolia, a climbing shrub native to central and west Africa. 5-HTP supplements have been used to treat a variety of conditions, including depression, fibromyalgia, insomnia, obesity, and sleep disorders.

The use of 5-HTP for migraine and other types of headache remains controversial, because not all clinical trials showed a significant benefit. Also, it seems that very little serotonin increase can be seen in the brain itself.

However, several trials did show that 5-HTP benefited patients, with a lessened need for other medication, lower pain levels, shorter attacks, and fewer attacks. It may be that the increase in serotonin the the body as a whole does benefit patients with migraine in particular.

Taking 5-HTP for Migraine or Headache

Like many supplements, it is best to use 5-HTP as a complimentary preventative treatment. And as with any preventative, it is helpful to try it for at least three months, using a headache diary to measure its effectiveness.

Clinical trials have generally used 400-600mg of 5-HTP daily for adults (20mg per 10lbs/4.5kg of body weight for children).

You should take extra caution with 5-HTP if you have diabetes or high blood pressure. Do NOT take 5-HTP with antidepressants. If you are taking triptans, or other supplements, talk to your doctor.

5-HTP can be purchased at drugstore.com and amazon.com or amazon.co.uk, where you can find both 100mg and 200mg tablets or capsules.

Resources:

Serotonin and Headache American Headache Society
5-HTP University of Michigan
The Vitamin Cure for Migraine Drs. Hickey and Saul

3 June 2010

1% Thursday: Take a Break

James Medications, Tips 2

This tip is not for everyone, and certainly not for everyone at every time. I’m not talking about taking a break from life or from your job, but taking a break from your preventative medication.

Let me be clear: you most certainly need to discuss this with your doctor. Don’t make assumptions, and don’t stop taking a daily medication without her approval.

Sometimes we are so anxious (with reason) to find a treatment that works, we zip along from one medication and one treatment to another, without stopping. Sometimes you need to do this – after all, you’re probably taking an abortive of some kind even if you’re not taking a preventative, and that can be even worse for your body.

On the other hand, there may be a time when you need to stop for two or three months, and remember what it’s like without the daily preventative. Drugs can affect you in ways you don’t even realize, and it can happen gradually. When you get off the drug for a few weeks, you may realize how significant the side effects were.

This could be wise advice for any treatment – but drugs seem to be the most significant when it comes to those side effects.

So if you’ve been going through a period of trying one preventative after another, talk to your doctor about taking a break of 1, 2 or 3 months. Take the time to remember what it’s like without. It may clear your head and allow you to evaluate future treatments in a more objective way.

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!