Meds & Supplements, Society, Treatment

Insurance Coverage of Triptans

Insurance is an ongoing nightmare for practically everyone. If you need more triptans (a common type of migraine abortive) a month than your plan allows, you’re in for a real hassle. Without insurance they are, of course, mighty pricey.

Kathy, a reader, is faced with a new bureaucratic hurdle that I’ve never seen before. Her story follows. She’d appreciate any advice you can give.

I just had to share this with someone that could understand, and maybe you have some suggestions as to whether anything can be done. I was just informed by my insurance company that I can now only get 4 Maxalt tablets at a time. I can get 8 per month (down from the 9 per month it used to be) but I have to go in to the pharmacy TWICE per month. Maxalt is the least troublesome of the triptans for me and enables me to keep working with a migraine. My migraines usually last 3 days (requiring 6 Maxalt) and CAN last 5 – 6
days. It is so infuriating that an insurance company can do this.

Their explanation was that studies have shown that most people (?) only refill their prescription of 9 tablets once every 3 months. 38% of the prescriptions are never refilled. So they decided that 3 pills is a 30 day supply. Have you ever heard of anyone being successful in fighting something like this? Any ideas on what to do?

Even if you don’t have suggestions for Kathy, eave a comment with your story — whether good or bad — about getting the meds you need. I and other readers will certainly benefit from your experience.

Treatment

Myofascial Release: A Massage Technique for Tissue Relaxation

Myofascial release is one of the new therapies I’m trying now. The three sessions I’ve had have been mentally and physically relaxing. A severe migraine dropped to a mild headache after Saturday’s session. The relief only lasted an hour, but what a wonderful hour it was. I went into today’s session with a severe migraine and left with a mild one. Nearly three hours later, the pain is hovering between mild and moderate.

Never heard of myofascial release? Neither had I until a reader mentioned it to me. It’s a massage technique that uses friction and sustained pressure to release fascia. Fascia is a connective tissue that envelopes or binds internal body structures to support, separate and protect them.

Normal fascia is relaxed and stretches and moves easily. Injury, tight muscles, hunched shoulders and slouching contribute to tightening fascia. Effects are cumulative, so repetitive motions or bad posture stiffen fascia more and more over time. The therapy seeks to release the fascia, returning it to a relaxed state.

It may seem strange to target connective tissue to treat headaches. Is there anyone who has headaches or migraines, but completely relaxed muscles? Tight muscles indicate that fascia is tight, too. (That’s my take on it at least.)

Whether my constantly tight neck, jaw and shoulders is a result of my migraines or a trigger of them (or both), they are still sore. The therapy won’t cure my headache disorder, but it may reduce the intensity of my headaches. At the very least, it soothes the pain in my shoulders and neck.

As with nearly every alternative or complementary therapy, myofascial release is often called quackery. Whatever. It feels good and helps me unwind more than other types of massage ever have.

Physical therapist John F. Barnes, a practitioner and educator of the technique, has an in-depth explanation of myofascial therapy and fascia. (I know nothing about him as a practitioner or his clinics, but the explanation fits with what I’ve learned from my massage therapist.)

News & Research

Why Women Have More Migraines Than Men

Three times as many women have migraine as do men. That translates to 18% to 25% of women worldwide. A new study shows that this discrepancy might be because women’s brains are faster to activate the cascading waves of activity thought to cause migraine pain and other migraine symptoms.

The strength of the stimulus required to trigger these waves of activity, called cortical spreading depression (CSD), was two to three times higher for men than for women. This excitability indicates that women’s propensity toward migraine is linked to more than just menstrual cycle.

I have the mental ability of a three-year-old today. See A Woman’s Brain Wired for More Migraines? from CBS/WebMD and Why Women Get More Migraines Than Men, a UCLA press release, for details.

Meds & Supplements, News & Research, Treatment

Cluster Headache Drug Verapamil May Cause Heart Problems

People who take verapamil for cluster headaches may be at greater risk of irregular heartbeats than those who don’t, according to a study published in the August issue of the journal Neurology. Researchers recommend that those who take the drug should have frequent EKGs to watch for possible heart problems.

The study of 108 people with cluster headache specifically looked at high doses of verapamil. 21% showed an irregular heartbeat while taking high dose verapamil. 37% of participants had slower than normal heart rates while on the drug. Most cases were not considered serious.

The study abstract and the press release from the American Academy of Neurology (below) provide details.

Drug for Cluster Headaches May Cause Heart Problems

ST. PAUL, Minn. – A drug increasingly used to prevent cluster headaches can cause heart problems, according to a study published in the August 14, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology. Those taking the drug verapamil for cluster headaches should be closely monitored with frequent electrocardiograms (EKGs) for potential development of irregular heartbeats.

Cluster headache is a rare, severe form of headache that is more common in men. The attacks usually occur in cyclical patterns, with frequent attacks over weeks or months generally followed by a period of remission when the headaches stop.

“The benefit of taking verapamil to alleviate the devastating pain of cluster headaches has to be balanced against the risk of causing a heart abnormality that could progress into a more serious problem,” said study author Peter Goadsby, MD, PhD, DSc, of the National Hospital for Neurology and Neurosurgery in Queen Square, London, UK, and the University of California, San Francisco and a member of the American Academy of Neurology.

The study involved 108 people with an average age of 44. The participants started taking verapamil and then had an EKG and an increase in the dosage of the drug every two weeks until the headaches were stopped or they started having side effects.

A total of 21 patients, or 19 percent, had problems with the electrical activity of the heart, or irregular heartbeats, while taking the drug. Most of the cases were not considered serious; however, one person required a permanent pacemaker due to the problem. A total of 37 percent of the participants had slower than normal heart rates while on the drug, but the condition was severe enough to warrant stopping the use of the drug in only four cases.

Goadsby noted that 217 people taking the drug were initially supposed to take part in the study, but 42 percent of them did not have the EKGs done to monitor their heart activity. “Many of them said either they or their local services were reluctant to undertake such frequent tests, or they were not aware of the need for the heart monitoring,” he said. “Since this drug is relatively new for use in cluster headaches, it’s possible that some health care providers are not aware of the problems that can come with its use.”

emphasis added

Coping, Treatment

Caffeine Withdrawal Headaches

Caffeine can be a wonderful headache and migraine abortive. Use it too much and the withdrawal headache can be an unspeakable hell. Good thing I was in need of a post topic for today when the caffeine headache fairy visited me last night.

As with all of my abortives, I use caffeine no more than twice a week. Less than once a month I indulge when I need energy or really want coffee and the only decaf available is chemically processed. I stretch these rules when I’m traveling or have something big going on. Like when my niece was here last week.

I’ve been testing my caffeine boundaries in the last couple months anyway. I noticed in May that it didn’t seem to be working as well as it used to (and neither was Advil, my other abortive of choice). Before I realized I had a headache disorder, I drank caffeine when I felt a headache coming on, thinking that I was staying on top of caffeine withdrawal. Hart maintains — and I’ve come to agree — that the caffeine aborted migraines, not treated caffeine withdrawal headaches.

So I haven’t been as strict with my rules in the last couple months. Then when my niece was here, I was even more lax with my caffeine intake. After she left, the old guidelines didn’t kick in. And last night I had a horrendous caffeine withdrawal headache.

I assumed it was a migraine, even though it felt different than migraines that have been plaguing my sleep for the last year. I tried to sleep it off, but felt worse each time I woke up — not characteristic of my migraines at all. At 12:45 this afternoon, I finally acknowledged that I had a caffeine headache and dragged myself out of bed to medicate.

90 minutes later, I’ve finished my cup of tea. It took the edge off, but the dramatic soothing that caffeine brings to a withdrawal headache was absent. Maybe it was a migraine all along. In any case, I have a post written and now I can go back to being like the man who has been hiccuping for 45 years: