sumatriptan

17 May 2013

Ginger and Sumatriptan: More Information

James Discoveries & Stats, Medications, Treatments 2

I’ve been getting a lot of questions regarding the ginger and sumatriptan study, so we’re going to take the time to talk about a few more details.

Obviously one study is not enough to change treatment practices around the world. However, the researchers were motivated to study ginger because it had already shown great promise as a migraine treatment.

Previous Ginger Studies

First of all, ginger has been regularly used for many related conditions – vertigo, motion sickness, and pain conditions being the most well known. Also, previous studies have shown very little problem with side effects.

Ginger is currently being studied to alleviate dental pain and inflammation. And one study suggested that it works about as well as ibuprofen for menstrual pain.

Products containing ginger, such as Gelstat Migraine, have already helped many people fight migraine symptoms. Gelstat Migraine has been studied in clinical trials, and the results were promising.

An older 1990 report showed that patients taking ginger during and after their attack were able to reduce frequency and severity of migraine.

Ginger Dosage in the Trial

In this trial, patients were given 5 capsules of either 50mg of sumatriptan or 250mg of ginger (these ginger capsules are 350mg). Everyone was to take one capsule when a headache was coming on. They didn’t know which they had (this was a double-blinded randomized controlled clinical trial).

This is actually a very low dose of ginger. As you’ll see below, others have recommended a higher dose, even up to a gram or two a day as a preventative. Ginger supplements are commonly 500mg and higher per capsule.

More on the study results

The patients had been generally diagnosed with migraine many years before, and they typically had several attacks per month.

Ginger and sumatriptan results were similar, with sumatriptan generally performing slightly better for actual headache pain.

250mg of ginger was used in this study, as mentioned above. Previously 500mg had also been recommended, repeated every 4 hours up to 1.5 to 2g per day for 3-4 days. Another report found that a woman found relief using similar amounts of ginger powder (1.5-2g) as a daily supplement.

The bottom line

The researchers of this study concluded that ginger should be preferred to sumatriptan because of the lack of significant side effects. The only reported issue with ginger was indigestion (4% had some issues here – interesting considering that many people take ginger for digestion!). But some patients taking sumatriptan experienced dizziness, vertigo, heartburn, and/or sleepiness (20% with one or more issue). In the end, patients were slightly more satisfied with ginger as a migraine abortive.

Researchers are now calling for more study into what dosage is most effective.

This was also a short term study. Longer term studies will help demonstrate if ginger can continue to fight migraine over the long term in individual patients.

For more on the study read the original post here.

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

5 April 2013

Warning: Generics and “Brand Names” are NOT (always) the same…

James Information, Medications, News, Tips 5

Yes, there are differences between brand name migraine drugs and generic migraine drugs. And those differences might make all the difference.

We talked about this back in 2009. Dr. Alexander Mauskop from the New York Headache Center had written about a study that had been done on Topamax and its generic counterparts.

Last week he wrote a little more about his patients’ experiences with brand name and generic medications.

This is not necessarily about brand name manufacturers wanting to make you pay for their products (although I’m sure they do want that – can you blame them?). The fact of the matter is, due to differing manufacturing processes, differing ingredients, and differing policies from country to country, brand name meds can be slightly different from the generics. And slightly may be all that is needed between “it works” and “it doesn’t work”.

Dr. Mauskop shares some wise advice in his post, which you can read here:

I have also seen this with sumatriptan â€“ my patients tell me that some generics do not work very well or at all. Out of about 10 generics of sumatriptan, I would guess that two are of poor quality. Once you find a generic that works for you, try to stick with the same generic manufacturer. The name of the manufacturer is printed on the bottle the pharmacy gives you. If one pharmacy does not have your generic, try another one.

He goes on to share a note from a patient dealing with pharmacies and changing availability of medications.

Of course, this involves pharmacies, drug companies, and insurance companies (oh, patients too!). One change anywhere along the line, and something that worked well for you can disappear.

If you run into trouble, share these posts with those you’re talking to, so they’re aware of the issue. Again, many times it may make no difference, but sometimes it will.

The most frustrating part of this story is that there are surely patients out there who have tried a triptan, and have given up on it, even though the very same triptan of a different brand might work.

So it may be worth your while to not only try different triptans (yes, one may work well when another doesn’t work at all), but try different brands of the the same triptan. And of course this goes for other medications too, like Topamax (topiramate) and whatever you may be trying.

Pharmacies and insurance companies need to understand that this isn’t just hype – in some cases the difference is very important. How can you in the industry better serve your patients?

21 January 2013

ZECUITY (formerly Zelrix Migraine Patch): Approved!

James Medications, News 0

ZECUITY, the drug formerly known as the Zelrix Migraine Patch, finally got its approval from the FDA on Thursday (the 17th of January 2013). It should be available in the United States toward the end of this year.

The medication at the core of ZECUITY is familiar to most migraineurs – sumatriptan (which has been sold under the brand names such as Imitrex and Imigran). But it’s much more than just another brand of the same thing.

Many migraineurs have found that common triptan drugs (such as this) don’t work for them. There are a number of reasons for this, but a common one is that the medication is not getting to where it needs to be at the right time. Drugs taken orally may sit in the stomach and not be delivered properly (due to gastric stasis, a common issue for migraineurs). Or they simply don’t get it into their system fast enough to fight the migraine chain-reaction (remember, this is not a preventative – it’s taken for a specific migraine attack (abortive)).

Oh, and let’s not forget the nausea associated with migraine. Who wants to take anything orally?!

This particular patch, which delivers the sumatriptan though your skin, contains a microprocessor. The patch is “activated”, and delivers the medication using a mild electrical pulse. This is known as iontophoretic delivery.

The microprocessor actually “customized” the delivery somewhat – monitoring how well it’s being absorbed and adjusting the delivery to match.

The advantages? The medication is delivered at just the right time, in just the right amount. Patients who were never helped by sumatriptan before may be helped now. And patients who suffered from side effects before may now be able to avoid them.

This delivery patch is being used already for other medications, such as anti-inflammatories. If it works well with sumatriptan (or should I say – if it sells well!), it will no doubt be used with other migraine medications.

Now for the question everyone is asking – does it hurt?

Generally speaking, the adhesive seems to be an issue for more people than the mild electric current. If you have allergies to adhesives, the ZECUITY adhesive may cause problems.

The delivery of the medication may include a slight tingling or warm sensation – but from what I’ve heard so far it seems to be painless for most people.

Get more details at the official ZECUITY website.

6 November 2012

Triptans (and more) for Children with Migraine

James Medications, Treatments 1

I think parents will appreciate a recent post from Dr. Alexander Mauskop regarding treatments for children. Here is a summary of his suggestions:

Try wafer medications (that melt under the tongue) or nasal sprays. Rizatriptan is approved in the USA for children, and Maxalt MLT is a “wafer” medication. Imirex NS (sumatriptan) is a nasal spray approved in Europe, and Zomig NS is another available in the USA.
Some common triptans used for children include rizatriptan (in the USA approved for children as young as 6), almotriptan, sumatriptan, and zolmitriptan.
Rizatriptan will be available in generic form around the end of 2012.
Child migraine attacks tend to pass quicker than adult attacks. This is another reason why faster acting medications are helpful (such as nasal sprays), but may also explain why some children tend to get over the attack quickly (in an hour or two) no matter what they take.
Triptans should not necessarily be the first choice for children with migraine. Other options include ibuprofen and paracetamol/acetaminophen, lifestyle changes (regular sleep/meals/exercise), biofeedback, magnesium, CoQ10, etc.

For more tips for treatment of children with migraine, read Triptans for pediatric patients

Another reminder or two – just because a triptan hasn’t been “approved” for children in your country does not mean that it won’t be effective. It just mean that the required studies haven’t been completed. However, always talk to your doctor before giving your child a triptan medication (or any medication, for that matter) for migraine!

Also, don’t be surprised if your doctor isn’t quick to recommend a pill. There are excellent, well proven non-drug treatments for children (some are mentioned above).

Read more about Pediatric Migraine Medication here.