topiramate

17 January 2011

Children’s Headaches – Should I Consider a Preventative Medication?

It’s a challenge to diagnose headache disorders, especially in younger children. But it’s becoming clear that it’s important, and more and more research is being done to help fight pediatric headaches.

Headaches are surprisingly common in children.

The catch is that sometimes even the children don’t really know how bad they are. The matter is further complicated when it comes to issues like migraine, where the symptoms can be so varied. Many people with migraine simply "don’t feel well", and have very little actual head pain. In children, abdominal migraine is common, where nausea may be the main symptom and the pain may be in the stomach.

It takes time to work with your doctor and child to uncover the symptoms and find a good treatment. But it’s important to do so. Catching headache disorders early can help avoid later complications. And children with frequent headaches can have extra trouble at school that can leave them farther behind than they need to be.

A preventative medication is something that your doctor may recommend if the headaches are frequent. The good news is, many medications have been found to really help children with migraine.

Some of the common medications that have helped children include:

Propranolol: A beta-blocker. Some brand names include Inderal, Avlocardyl, Inderalici, InnoPran XL, and Sumial
Flunarizine: A calcium-channel blocker. Brand names include Adalat, Cardizem, Isoptin, Nimotop, and Sibelium.
Topiramate: An anticonvulsant drug. Brand name Topamax.
Sodium valproate: An anticonvulsant. Brand names include Depakote, Epilim, Orlept, and Epival.
Amitriptyline: A tricyclic antidepressant. Brand names include Vanatrip, Elavil, and Endep.

Here are some things you and your doctor will want to consider when thinking about preventative medications:

How disabling are the symptoms? How often is the child having attacks? How is this impacting their daily life?
Are there other symptoms or co-existing disorders that could potentially be treated with the same medication? (For example, nausea, epilepsy, etc)
What are common risks and side effects associated with this medication? How will your doctor help you watch for these things over time?
Will a preventative medication help the child cut down on abortive medications? If you are giving your child "painkillers" more than twice a week, it’s very important you look for other options.
Is there a trial period? Is there a time when we could try taking the child off the preventative in the future?
What other treatments can be used alongside of (or instead of) the preventative medication? For example, changes in diet, biofeedback, an exercise program, CoQ10 etc.

In certain cases, preventative medications have helped children effectively fight headache and migraine symptoms. But do your homework, and remember that this is something you need to take one step at a time. Don’t expect an instant cure-all. But do expect to find a combination of treatments that works well.

26 July 2010

Menstrual Migraine: Will Topamax Help?

James Discoveries & Stats, Medications 1

It can … but not as much as we hoped, according to researchers in the University of Turin, Italy.

In a study published online last week, researchers reported on 198 women that suffered from menstrually related migraine. After one or two months of observation, patients were given 50-200mg of topiramate per day for six months.

The good news is that the women had fewer migraine attacks. Of course, this was not a blind study – patients knew they were getting treatment, which means we need to be aware of a significant placebo effect. Still, the significant decrease in attacks is encouraging.

On the other hand, the attacks that did come were no less severe, and were not shorter than normal.

There was no difference with patients who had aura, or in patients that took oral contraceptives.

Topamax (topiramate) may help, it seems, but women will probably want to be on the lookout for other treatments, either in combination or instead of just Topamax.

More about this study: Perimenstrual migraines and their response to preventive therapy with topiramate.

Menstrual migraine – real pain, real solutions

26 January 2010

Visual Snow and Persistent Migraine Aura – tests and treatments

James Information, Medications 132

In the last post we introduced two concepts – visual snow (VS) and persistent migraine aura (PMA). The first is a specific symptom which can have a number of causes; the second a diagnosis which can include the first.

First, persistent migraine aura (PMA) is diagnosed when other causes are ruled out. But as we’ve said there are a number of things that can cause visual snow (VS).

Doctors will take a careful drug history for patients with VS, because one cause is hallucinogenic drugs. The drug may only have been taken once, and time may have passed since it was taken, but it can have permanent effects.

Optic neuritis, an inflammation of the optic nerve, can also be a cause. Optic neuritis usually develops from an autoimmune disorder. Read more about optic neuritis here.

There are many other things that can be involved – even vitamin deficiencies.

Dr. Klaus Podoll, Dr. Markus Dahlem and Sofia Greene list common tests that are done for persistent aura symptoms here. These include:

Ophthalmologic examination
Neurological examination
Psychiatric examination
Thorough headache history and family history
Thorough drug history (including illegal drugs, especially hallucinogens: LSD, Ecstasy, mushrooms, other?)
CAT or MRI of head (the MRI is important to rule out what is called a migrainous infarction)

Other examinations may follow, including an EEG, evoked potentials (a testing of the functioning of the nervous system), blood work, and a lumbar puncture.

Obviously, if anything shows up on these tests, you’ll be following that up.

Assuming these treatments are out of the way, there are some treatments that have been tried, with some success. There is no tried-and-true established treatment, but some options include:

valproic acid
acetazolamide
lamotrigine (particularly for VS not classified as PMA)
topiramate (Topamax)

Sometimes injections of furosemide (frusemide) are used, if other treatments fail. Clonazepam is also used for patients who have symptoms from hallucinogenic drugs.

Do you have experience with ongoing migraine aura, or visual snow? Have you found anything that has helped? How did the symptoms start?

28 July 2009

Generic Medications – The same but different?

James Discoveries & Stats, Medications, Tips 1

We’re often told that the generic medications are exactly the same, you’re just not paying for the "brand name". So, why support the big names? Why not save your money?

Well, it turns out it just might not be the case. Depending on what country you’re in, the law may allow for variations in the generic medication.

A surprising study just came out of the USA that should concern anyone buying drugs there, for example (read it here). The study was done with Topamax (topiramate) and its generic version. In this case, it was epilepsy patients. The study (published in last month’s Neurology) found that epilepsy patients on generic versions required more medication, had more injuries, and ended up in the hospital more often and for longer periods of time than those on the Topamax brand. The worst were patients who used various generic brands during the study period.

Why? It turns out that US law allows generic brands to have slightly less of the medication in them. That’s right. And there may be other minor differences, depending on the medication (and the country).

Now, migraineurs are less likely to have severe problems with topiramate, since they usually take lower dosages and are less likely to end up in the hospital. But this is something to be aware of for any medication you’re taking.

So are you stuck with the expensive version? It depends. In many cases, it really may not make a difference. In some cases, raising your dosage slightly may solve the problem, and still be cheaper. But in this case, you do need to stick to the same generic brand. Talk to your doctor.

It’s time to stop assuming that generics and the original are 100% equal. Be careful!

via Headache News Blog

16 March 2009

New Migraine Topamax study: Adolescents

James Discoveries & Stats, Medications 7

The latest migraine Topamax study was published in Pediatrics this month. It was a study of migraine patients age 12-17.

The children and teen crowd have had far fewer migraine studies done. Last year we talked about Topamax for children; this study focused on the older subset – adolescents. Here’s what they found:

As you can see, there was a significant difference. In more practical terms, those taking Topamax went from 4.3 attacks per month to 1.3, and had fewer days with migraine. (Note, however, that even those on a placebo saw a significant reduction in attacks, so the numbers aren’t quite as good as they look) The numbers on the bottom of the chart show percentages.

The researchers said that topiramate was well tolerated. However, the fact of the matter is that almost 3/4 of the patients experienced side effects. The common ones were upper respiratory tract infection, itchy or tingling skin, and dizziness.

There should be some concern that, in the rush to make Topamax an "approved" migraine drug around the world, we start thinking it’s the best thing to try. The fact remains that topiramate is a powerful drug which commonly has side effects. It is hoped that Topamax will not be the first thing your doctor recommends.

This is especially important in children. As was pointed out in the Italian review in 2008, we should be especially concerned about the impact these side effects will have on children and teens. Other common side effects in children are weight loss, anorexia, trouble concentrating, and tiredness.

Topamax may prove to help adolescents with migraine. However, the side effects may prompt many to look at other options.

Via: Topiramate safely prevents migraine in adolescents