Month: October 2005

Meds & Supplements, Treatment

Possibilities for a Better Headache Preventive

Kerrie Smyres

Our options for headache preventives suck. Yeah, some work for some people and it is a matter of trial and error based on each person’s needs, but there aren’t any consistently effective drugs available. All in My Head author Paula Kamen shares this disconcerting information:

“…I heard a variety of doctors clearly make an assertion again about the inadequacy of the currently available preventives. ‘Interestingly, a majority of commonly used [preventives] have little evidence of efficacy. In contrast, almost all options have well documented adverse effects, often leading to a discontinuation of preventive therapy,’ read a summary in the program book leading to the presentation of Dr. David W. Dodick, the well-respected director of the Headache Program at the Mayo Clinic branch in Scottsdale, Arizona. This time the assertion was backed up by the citation of many studies, including a major federally sponsored one for 1999 done at Duke University.” (Page 285)

If current understandings and expectations of a new compound, called tonabersat, play out, we may get a preventive of our very own. Tonabersat is the first in a class of compounds called “gap junction blockers.” (“Gap junction blockers” refers to the overall class or type of compound, just like “antidepressants” refers to a group of different drugs.) Targeting a different type of brain action than other drugs that are used as preventives, gap junction blockers are thought to be a breakthrough for headache prevention.

Depending on how you look at it, there’s either a lot of promise or a lot of hype for tonabersat. Some of the soundbites include:

  • “Tonabersat is an extremely interesting compound with a novel and very specific mechanism of action which means it is likely to be effective in prophylaxis of migraine.” (According to a past president of the International Headache Society who is working with the clinical trials)
  • “Given the clear demonstration of clinical activity with tonabersat in previous migraine studies, we anticipate it showing real benefit.” (Said the CEO of Minster Pharmaceuticals, the company that bought the rights to tonabersat and will develop the drug)
  • Tonabersat “represent[s] the first major advance in the treatment of migraine since the introduction of Imigran [Imitrex in the US].” (From GlaxoSmithKline, who identified the initial compound and is expected to market the drug if it is approved)

I am wearily intrigued. A good headache preventive would be invaluable, but there are so many obstacles left that I can’t get excited yet. Trials are in the early stages. Results aren’t expected for a couple years and FDA approval won’t come until long after that. The drug may turn out to not be effective or may have unbearable side effects. Or it could work great and makes us all happy. Or be somewhere in between.

To learn more about the study, see the press release or the blurb in the Cambridge Evening News. For more about tonabersat, see Minster Phamaceuticals‘ product overview and company profile.

Meds & Supplements, Patient Education, Treatment

Melatonin, Sleep & Migraine

Kerrie Smyres

Whether or not melatonin is an effective to fight insomnia is still under debate. A recent study indicates that when you take the medicine affects how it works in the body. Researchers report that it was most effective when taken in sync with an individual patient’s sleep cycle.

They warn that people shouldn’t self-medicate with melatonin. The lead researcher says, “This is all very complicated. If you give melatonin at the right time of day it can be effective. But if you give it at the wrong time it can make sleep problems worse.”

Melatonin may or may not be an effective migraine treatment. A small study published last year shows that taking the supplement 30 minutes before bedtime can help reduce migraines. But headaches can also be a side effect of melatonin. I took it for a while, but stopped because it increased my headaches and made me drowsy. I was told that in my previous headache specialist’s practice, some patients didn’t have side effects at first, but developed them after a few months.

Obviously there’s no conclusive evidence or prescribing guidelines here. If you’re interested, you should definitely talk to your doctor about it. Supplements don’t have to meet ingredient requirements, so one kind can vary dramatically from another. It may also interact with other common headache meds.

An article in UC Berkeley’s Wellness Letter issues these warnings about the supplement:

  • Having your levels measured won’t tell you anything, since levels vary from person to person and from hour to hour.
  • Chronic use of melatonin supplements may suppress the body’s own  production of the hormone.
  • Nobody knows what might happen if you have high natural levels and take a supplement on top of that.
  • Melatonin can interact with other hormones, which is why, in part, pregnant women and children should never take it.
  • Such drugs as aspirin, beta blockers, and tranquilizers can affect melatonin levels.
Meds & Supplements, News & Research

Heavy Reliance on Confusing Prescription Drug Stickers

Kerrie Smyres

How many different warning labels do your prescription meds have? Except for laughing at the ridiculous graphics or the dire predictions, I don’t pay much attention to them. But labels aren’t a laughing matter for many people in the US according to a study covered in today’s New York Times.

With tiny print and obscure language on other written warnings distributed with meds, many people rely on the stickers for instruction. Yet the stickers’ messages aren’t standardized or very informative. So they are hard to understand, inconsistent and, most important, open to interpretation. The graphic included in the story shows some of these misunderstandings.

Hardest hit are patients with a 6th grade or lower reading level. Considering that 50% of adults in the US can’t read an 8th grade level book, package inserts are useless for too many people. In fact, 46% of American adults can’t understand the label of their prescription meds.

The labels can be problematic for readers at every level. The study found that the “‘FOR EXTERNAL USE ONLY’ sticker stumped 25 percent of even those who could read every word, and misled 90 percent of the adults in the lowest literacy group.”

These stickers aren’t standardized and haven’t been seen as important forms of patient education. Clearly that’s a mistake that needs to be reconsidered.

Meds & Supplements, News & Research, Society, Treatment

More News Than You Want to Read

Kerrie Smyres

I’ve attempted to gather the news I’ve missed, but articles are surely missing. If you know of something, please post a comment with a link to it if you have it.

Under each heading the articles are vaguely ordered by relevance.

Research
Acupuncture May Ease Impact of Headaches
Adding acupuncture to standard medical treatment may improve the quality of life for people who suffer from frequent headaches, according to a new study.

Botox May Ease Facial Pain: Benefits Lasted for 60 Days in Small Study
A shot of Botox may ease a type of facial pain called trigeminal neuralgia, doctors report.

Pain Affects Black Women More Intensely
The far-reaching effects of chronic pain may be worse for black women than they are for white women.
(via Kevin, MD)

Websites Bolster Chronically Ill
Using interactive websites can help people with long-term conditions that include depression, heart disease and HIV/Aids, a study has found.
(via Medical Humanities)

Drugs
Eli Lilly Expands Cymbalta Liver Warning: FDA
Eli Lilly and Co. has expanded its warning about possible liver-related problems with its depression drug, Cymbalta, and cautioned doctors against its use in chronic liver disease patients, U.S. health regulators said on Monday.

EU Body Gives Old Pain Drugs Clean Bill of Health
Europe’s drug watchdog said on Monday it had no new safety concerns over older pain medicines like ibuprofen and naproxen, following an extensive review of side effect issues.

Another Way to Cut Drug Costs: Split Pills
Smart shoppers can’t resist a two-for-one sale. But should you purchase prescription drugs the same way you buy pizza or canned corn? For years, people who take daily medications have saved money by asking their doctors to prescribe pills with double the dose they need, which they then cut in half with a knife.
(via Kaiser Network)

Pain Meds Scarce in Black Neighborhoods: Study Finds Medicines Understocked
Pharmacies in black neighborhoods are much less likely to carry sufficient supplies of popular opioid painkillers than those in white neighborhoods, a new study has found, leading researchers to conclude that minorities are routinely undertreated for chronic pain.
(via Kevin, MD)

PhRMA Lawsuit Challenges D.C. Rx Drug Price Control Law
The Pharmaceutical Research and Manufacturers of America filed suit against the Washington, D.C., government last week alleging that a new price-control law on prescription drugs will cut supplies, hinder development and cause a “limitless parade of lawsuits.”

Drug Panels ‘Have Financial Links’
Doctors around the world are being advised to prescribe specific drugs by experts with close financial links to the pharmaceutical industry, it has been claimed.
(via Kevin, MD)

Healthcare Costs
Is Complementary Medicine Cost Effective? BMJ
The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.
(via Kevin, MD)

Treated for Illness, Then Lost in Labyrinth of Bills
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.
(via Kevin, MD)

Dying to Pay, New Bankruptcy Laws Hurt Seriously Ill
New bankruptcy rules that went into effect on Monday, don’t just affect those who’ve run up their credit cards due to poor spending habits.

They also affect people who have little choice about their cash flow, people who’d give anything ‘not’ to be in the situation they’re in.
(via Kevin, MD)

Insurance
Workers May Be in For Health Plan Sticker Shock
USA Today on Friday examined the shift toward higher employee contributions to health care costs as employers try to curb their health care spending. According to USA Today, employers are utilizing various methods, including coinsurance, restrictions on prescriptions, high-deductible plans and wellness incentives.
(via Kaiser Network; quote from USA Today Examines Rising Health Insurance Premiums, Out-of-Pocket Costs for Employees)

Wall Street Journal Examines UnitedHealth Group’s Move to Consumer-Driven Insurance Plans
The Wall Street Journal on Monday examined Minnesota-based UnitedHealth Group’s move to “so-called consumer-driven health care” in the face of “steadily eroding business” as a traditional health insurer. Consumer-driven plans are based on the idea that people will consider health care spending more carefully if they have to pay a larger proportion of the cost themselves.

High Deductible, High Risk: ‘Consumer-Directed’ Plans a Health Gamble
Elizabeth Fowler can be called an educated health care consumer: An expert on health care policy, she used to be the chief health and entitlements counsel for the Senate Finance Committee. But she was pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan — a type of insurance designed to protect consumers from catastrophic medical costs while prompting them to shop wisely for routine care.
(via Kaiser Network)

Policy
Canadians Still Waiting: 18-week Delay for Medical Care Reduced by a Day
Large increases in health-related spending have only marginally reduced the waiting times for medical services in this country from record-high levels in 2004, a new report says.
(via Kevin, MD)