Archive for May, 2010

May 28 2010

Genetics and Triptans

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A recent study suggests that there may be a genetic reason for why some patients respond well to triptan type drugs, and others don’t.

We can expect to see more and more studies on migraine and genetics.  We know that there is a strong genetic component to migraine, but in most cases we still aren’t ready to diagnose and treat based on genetic factors.  With so many different types of medications and treatments out there (more combinations than you will try in a lifetime), we want a way to predict which patients will respond to which treatments.

A study out of Italy this month found a strong correlation between “STin2 VNTR polymorphism of serotonin transporter gene” and inconsistent response to triptan medications (such as Relpax, Zomig, and Imitrex).  Focusing on biology related to serotonin is a natural way to start, since we know there is a connection between serotonin levels and migraine.

There was one more factor – patients who were not taking preventatives were also less likely to consistently respond well to triptans.

We can consider this another early study on the road to accurately predicting which medication you’ll respond to.  The more we can predict, the more time, money, and suffering we’ll save.  These seemingly "fringe" studies are not fringe at all – they could be the key to a transformation in the treatment of migraine.

Read more about the study here: The serotonin transporter gene polymorphism STin2 VNTR confers an increased risk of inconsistent response to triptans in migraine patients.

From the Headache and Migraine News Blog

Genetics and Triptans

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May 27 2010

1% Thursday: Moderate.

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Too much of a good thing is still too much.  One danger for everyone, but especially for these dealing with chronic headache or migraine, is the danger of being immoderate in something – doing too much, eating too much, and so on.

This week, keep an eye out for signs that you might be going overboard with something.

Here are two ways this can be a danger.  First, ongoing problems – like constantly overeating, consuming too much salt, eating too much junk food.  Believe it or not, even drinking too much water can put extra strain on your body.  Then there’s the more obvious issues like smoking or drinking too much alcohol, which can make your symptoms worse both in the short term and over the long haul.

Another common migraine trigger is simply a quick change in your body – staying up all night, skipping breakfast one day, suddenly starting strenuous exercise.  Migraineurs tend to be especially sensitive to these kinds of changes.  Sometimes we even jump into a new treatment too fast – making matters worse.

Sometimes patients can even crave something that makes things worse, such as craving chocolate or citrus fruits before an attack.  Before you do a lot of anything, stop yourself and take it slow.

Take a quick inventory – are there ongoing habits that need to be changed?  Or are you prone to jump into something with both feet that’s causing undue stress on your body?  Just noticing and taking things a bit slower may make that 1% difference for you.

What is 1% Thursday?

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!

From the Headache and Migraine News Blog

1% Thursday: Moderate.

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May 26 2010

Highlights from the last 3 Months (May 2010 edition)

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Here are some of the most popular posts with our visitors from the past 3 months.  The most popular posts come first.  The posts in bold have been winners more than once:

From the Headache and Migraine News Blog

Highlights from the last 3 Months (May 2010 edition)

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May 25 2010

A New way to take Toradol

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Toradol is actually a brand name, but I mentioned it in the title because people are more familiar with that name.  It’s also sold as Acular, Glicima, Supradol, Apo-Ketorolac, Ketanov and Ketorol.

The actual name of the drug is ketorolac tromethamine, or simply ketorolac.  Most commonly it’s given as an oral tablet or injection.

Sprix

But there’s a new way to take ketorolac, and it has a new name – Sprix.  Sprix comes from ROXRO PHARMA, Inc.

What makes Sprix special?  It’s a nasal spray.  Nasal sprays may be an easier alternative particularly for those who are tired of taking injections.

Ketorolac is non-narcotic, a non-steroidal anti-inflammatory drug (NSAID).  It’s often used for fever and moderate to severe pain relief.  Obviously as an anti-inflammatory it’s helpful for reducing swelling and inflammation.

It’s not usually recommended for chronic conditions, however is an option for short term pain relief (usually up to 5 days).

Sprix is not yet available, but was just approved on the 17th of May (2010) by the FDA in the United States, so it should be available soon and will probably be a well accepted alternative to other forms of ketorolac.

For more on Sprix, including the official press release, visit the Sprix website.

From the Headache and Migraine News Blog

A New way to take Toradol

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May 20 2010

1% Thursday: Deal with Clutter

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This week: Eliminate some clutter in the house.

When you have a headache, or migraine attack, or something similar, life can be overwhelming.  Big crowds, action movies, complex decisions – these are the kinds of things we generally want to avoid in the middle of an attack.

In the same way, clutter can be pretty difficult to deal with during an attack.

So this week’s challenge is – deal with some of that clutter.  Start with your bedroom and bathroom (places that you are likely to be in during an attack).  Clean up that clutter in that place you’re likely to see when you’re sick.

Don’t clean your entire house (unless you really want to!) – just start with that one place where the improvement will make the most difference.

So next time you’re sick in bed, you won’t be staring at that pile of papers you know you need to deal with, or that broken chair you were going to fix "soon", or those toys the kids left there, or the CDs that you’ve been meaning to put away.

You’d be surprised what a difference it can make – from a pile of "somethings" annoying you during an attack, to a neat area of peace.  You could eliminate the pile, or replace it with a bit of nice art, or some flowers.  And maybe your next attack will be just 1% more bearable.

What is 1% Thursday?

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!

From the Headache and Migraine News Blog

1% Thursday: Deal with Clutter

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May 17 2010

Nortriptyline for Chronic Pain

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Nortriptyline, part of the class of drugs known as tricyclic antidepressants, is often used as a preventative to fight chronic pain.

Obviously, as an antidepressant, it’s commonly used to treat symptoms of depression.  It works in the chemicals of the brain by inhibiting the reuptake of norepinephrine (noradrenalin) and serotonin.  It’s commonly sold under the brand names Aventyl, Pamelor, Norpress, Allegron, Sensoval, and Nortrilen.

But nortriptyline hydrochloride (commonly misspelled as nortriptilyne) has long been used for a variety of other conditions.  Some commonly go along with migraine, such as irritable bowel syndrome, fibromyalgia, and TMJ disorder.  But it is also used to treat chronic pain, particularly the pain of migraine and tension-type headache, but also cancer pain and arthritic pain.

Sometimes nortriptyline is given along with gabapentin (Neurontin) for certain types of pain.  Gabapentin is an anti-convulsant, also prescribed for migraine prevention.

Many drugs in this class are very common in migraine treatment.  If your doctor prescribes one, it doesn’t mean that she thinks you’re depressed – though they may be used for migraine with depression as well.

Usually your doctor will start you on a low dosage, and raise it slowly.  As is common with migraine treatment, you may need to try it for three months before you can really tell if it works for you.  Side effects may diminish over time as well.

Important notes:

This is not likely to be the first drug your doctor will try.  Although it the side effects are usually mild, there are still more concerns with this type of drug than with other treatments.

First, be sure you’re working with a doctor who knows your medical history.  Nortriptyline can interact with some drugs, and make some more powerful, which can be dangerous.  Particular caution needs to be taken if you’ve used a MAO inhibitor drug in the past.  Also, if you have any history of seizures or heart conditions, your doctor will probably want to look elsewhere for treatment.

Your doctor will also want to monitor you carefully for the first while, particularly if you have any history of depression.  Younger patients (ie teens and young adults) have been known to experience suicidal thoughts early on in the treatment.

However, as I’ve said, side effects are usually mild.  These include sleepiness, confusion, dry mouth, constipation (particularly in older adults), and visual problems (including increased sensitivity to light).

Patients that stop taking nortriptyline for migraine often do so because it makes them sleepy.  But do discuss the side effects carefully with your doctor – they may diminish or change over time.

That being said, nortriptyline has helped many patients with chronic migraine and tension-type headache.  Other good news is that there’s not a high risk of dependence as with some other drugs, and you may be able to take a lower dosage if you’re not being treated for depression as well.

Key points to remember

If your doctor has prescribed nortriptyline, here are a few things to keep in mind:

  • This is a common treatment for migraine and chronic pain.
  • Be patient; give it three months before expecting a big change in your symptoms.
  • Be sure your specialist knows your medical history (particularly a history of heart problems or seizure), and knows about all the drugs and supplements you’re taking.
  • Talk to your doctor about the side effects you experience – even if they change over time.
  • Don’t change your dosage or stop taking the drug without talking to your doctor.
  • If it’s not effective, don’t give up – there are many other options!

More on nortriptyline from Drugs.com

From the Headache and Migraine News Blog

Nortriptyline for Chronic Pain

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May 14 2010

Enzyme Supplements and Migraine

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One hot set of supplements these days are the enzymes.  And yes, enzyme manufacturers do make claims about migraine.  But is this just another claim, or something that will help the rare person?

This is a bit of a different post, because enzyme supplements is really too big a topic to jump into with both feet.  It’s complex, and there are many different enzyme supplements out there.

So I’ll give you a brief introduction, then I’d like to hear from you.

Enzyme supplements – why?

Enzymes are proteins that control chemical reactions in the body.  They’re critical to your health – if you’re missing certain enzymes, serious diseases can result.

Enzymes are very important when it comes to digestion – and that’s where we start to find the link to migraine.  There is increasing evidence that migraine is impacted by the health of your gut.

And, indeed, enzymes are a common supplement to deal with not only digestive issues, but neurological ones as well.

Recently we talked about the casein-free/gluten-free diet for migraine.  This diet is sometimes used for people with autism, as well as other neurological conditions.

Now, if your body is having trouble with things like gluten, because of a lack of enzymes – could you add enzymes to your body with a supplement?

The answer is – maybe.

Here’s what I’ve learnt from my own reading thus far.  In actual experiences with real people, certain enzymes seem to help with certain issues.  (Such as pancreatitis, cystic fibrosis, or lactose intolerance).  However, when you’re dealing with something complex and indirect such as migraine, results are mixed.

Some people aren’t helped at all.  However, a fair number of people seem to find enzymes help as a compliment to other treatments.

But wait – are the enzymes really helping?

Wait – is this simply a case of mixing a useless supplement with an actually useful treatment, and just thinking it’s helping?  I think there may be more to it than this.  Why?

First, we’ve seen a lot of research relating migraine with gut issues.  This includes diet and general gut health.  Second, migraine is a condition that goes along with other conditions that are more directly helped by enzymes (for example, digestive problems).  Third, enzyme supplements do seem to help with pain and neurological conditions of various kinds.  Fourth, if your digestive system improves, it will help you in many indirect ways – improved absorption of nutrients, and improved absorption of medications and supplements.  Poor absorption is a common issue when it comes to migraine.

So if it’s so likely there’s a connection, why don’t we have 17 clear studies showing that this is a major migraine treatment?  Why have most of you never heard of it?

Could we just all go out and buy an all-in-one enzyme super-pill, and all feel better?

As you’ve guessed, it’s not that simple.  Products vary greatly, and your body is so different from the next person’s – in genetics, and in your eating habits, and your past, etc.  Your best bet may be a more customized enzyme product.  In fact, you may not react well to certain enzyme supplements.

And that makes this very hard to do a clinical study on.

Also, from what I’ve read so far I’m convinced that this works best as … well, a supplement.  It works best when you’re already eating a healthy diet, not a lot of processed foods, sugars, sweeteners, and additives.  This isn’t something easy you can go out and buy to solve all your problems.  On the other hand, a little supplement may make all the difference when diet alone hasn’t been killing all the migraine attacks.

I’ve spent a lot of time reading on the topic, but here’s where you come in.  I know some of you have experience, or have read specific research that I haven’t read yet.  Share with us your experiences.

More reading:  Obviously a very pro-enzyme site, Enzyme Stuff will give you lots to think about regarding how enzyme supplements may be useful.  It’s mostly focused giving enzymes to children but there’s lots of ideas here.

From the Headache and Migraine News Blog

Enzyme Supplements and Migraine

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May 13 2010

1% Thursday: Your Shopping Buddy

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This is related to last week’s post, in a way – finding ways to make life a little easier when you’re dealing with a chronic illness.  This is a way you can help out, and be helped out – find a shopping buddy.

A shopping buddy is someone who lives close by.  The idea is this – when you’re going to the store (ie the grocery store), call the other person and see if there’s anything they need.  That simple.

When my fridge is getting low on milk, or bread, or juice, and I have a bad day and I’m stuck in bed – all of a sudden I have a lot to catch up on.  Still not feeling well, I have a choice – catch up on work, that other errand I need to do, or finally get the milk before it runs out.

You’d be surprised how much a help it can be if you just call up your shopping buddy and say,"Hey, I’m just heading to the Green Grocery Market – can I grab you anything?"

And, of course, they can return the favour.

That way, you can feel like you’re helping someone else, and they can feel like they’re helping you.  And some days, it can take off a big load.

Make some ground rules, of course.  Don’t obligate someone to call you every time they shop (sometimes they’ll be in an extra hurry).  It helps to take note of some essentials – for example, what bread does your shopping buddy always buy?  What kind of milk?  If you learn some of the basics at the very beginning, you won’t need a long explanation every time.  Just hang on to that note of what brands your friend likes, and a one-minute phone call or text message is all you need.

You might be surprised how big a help this can be to both of you.

Note:  I got this idea from this excellent comment from Brenda at ButYouDontLookSick.com.

What is 1% Thursday?

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!

From the Headache and Migraine News Blog

1% Thursday: Your Shopping Buddy

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May 12 2010

Migraine and Depression: Shared Genetics

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We know that migraine and depression are comorbid – they often go together.  But why?  Does one cause the other?  Do they cause each other?  Or is there a shared factor causing both?

Depression and Migraine
Migraine and Depression – a common combination

Researchers in the Department of Neurology at the Leiden University Medical Centre in the Netherlands set out to see if there was a shared genetic factor.  They found 360 migraine patients, carefully diagnosed.  There were 209 that had migraine without aura, and 151 that had migraine with aura.

Then they measured heritability between migraine and depression in these patients.

Heritability is a complex measurement that tells us if genetic factors contribute to something.  Without going into more detail, the researchers found that there was a connection between depression and both types of migraine.

But they still had to make some adjustments – some migraine patients are on antidepressants, for example.

But even after adjustments, it was obvious that genetic factors do contribute, at least in part, to the connection between depression and migraine.  The connection is even stronger in migraine with aura.

This is further confirmation of the involvement of genetics in both migraine and depression, and the reality of a medical connection between the two (far beyond "You’re just depressed because of the pain" or "You just have migraine because you’re so pessimistic"!).

For more on the study, read Shared genetic factors in migraine and depression: evidence from a genetic isolate., published in January 2010.  For more on heritability, check out this brief description.

From the Headache and Migraine News Blog

Migraine and Depression: Shared Genetics

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May 11 2010

New Drug on the Horizon?

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You can swallow them and you can snort them, but soon you may be able to inhale them. MAP Pharmaceuticals recently announced that they are entering the last phases of clinical trials for a new inhaled medication for treating acute migraines. Levadex is a form of dihydroergotamine (DHE) that will be inhaled, much like asthma medications. Early indications are that Levadex has been useful not only for so-called "traditional" migraines, but for other migraine types such as patients with allodynia, menstrual migraine, migraine with nausea and vomiting, severe migraine or who treated late in their migraine cycle.

The final trials will determine if this medication has adverse affects on the cardiovascular and pulmonary system as well as comparing Levadex to intravenous forms of DHE. MAP Pharmaceuticals plans to file for final approval sometime in early 2011, so this new medication is still a bit far from appearing at the pharmacy. Then we'll see how the insurance companies decide to handle it, which is a different story all together.

Review the "usual" migraine treatments.

Are you a candidate for preventative migraine treatments?

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New Drug on the Horizon? originally appeared on About.com Headaches / Migraine on Tuesday, May 11th, 2010 at 14:23:46.

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