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Unexpected Migraine Treatments

Even when you feel like you’ve tried everything, there’s almost certainly more out there. This is something I’ve been posting about and e-mailing people a lot lately. Without knowing everything they’ve tried, it’s hard to point someone in the right direction.

Top 10 Unexpected Migraine Treatments, a HealthTalk webcast scheduled for Wednesday, April 18 will get to right to the point. Guessts will be Brian D. Loftus, MD and John Claude Krusz, MD PhD.

In the meantime, here are some other resources:

A fairly comprehensive list of available preventive and abortive medications, including some of the newer ones, like Lyrica and Cymbalta. (These websites describe the drugs, but don’t talk specifically about headache. They are both prescribed off-label (read comments at this link) as Topamax was for a long time.)

The National Headache Foundation‘s podcasts: The Condition of Migraine, Symptoms and Triggers, Migraine Treatments, Latest Migraine News and Information. It’s good stuff, particularly the one on migraine treatments (not surprising, huh?).

The American Council for Headache Education has a collection of articles on treatment (the second heading on the page). They cover a wide range of topics, but some of the articles are old. If something catches your eye, I recommend doing some further research on the topic. I’m happy to answer questions when I can.

The World Headache Alliance also covers various treatments. Most topics are supported by recent research. Non-Pharmacological Therapies. The Treatments section covers a huge variety of topics. They include studies that contradict each other, which is good to get both sides. Check out the news section, too.

Sorry for such a link-heavy post!

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Rebound Headaches a Risk With Trexima

“Do you need a naproxen dose every time you need a triptan dose?” Headache specialist Christina Peterson weighed in on the Trexima discussion with that brilliant question.

As bad as it is to make money by ill-informing consumers, that’s nothing compared to the possibility of worsening patients’ headaches.

Dr. Peterson pointed out that “many [headache specialists] recommend combining them–as an initial dose at headache onset. The potential danger could lie in a second or further subsequent dose.” This danger comes from medication overuse headache (commonly referred to as rebound headache or MOH).

This is as it sounds: Taking too many painkillers (and some other drugs) can lead to more frequent headaches. These more frequent headaches lead to taking more painkillers. And the cycle goes on.

So, while taking naproxen with the first dose of Imitrex during a migraine can be helpful, taking it with further doses can lead to more harm in the long run. As Dr. Peterson says, it’s unlikely that insurance companies are going to be willing to pay for a prescription for Trexima and one for plain old Imitrex in the same month.

Here’s her full comment:

No. That question, which desperately needs to be answered, has not been answered. That head-to-head study has not been done. Why? Nobody stands to gain financially from the answer. Nobody except, of course, you and me–the consumers.

True–there is not likely to be any advantage of Trexima over taking an Imitrex plus an equivalent dose of naproxen sodium. There is no voodoo in the combination.

Could there be harm, though? This is why the FDA is taking so long to look at Trexima. I don’t think the concept of sumatriptan (or any other triptan) plus naproxen sodium is inherently dangerous. Many of us recommend combining them–as an initial dose at headache onset. The potential danger could lie in a second or further subsequent dose. Do you need a naproxen dose every time you need a triptan dose?

I have concerns that in the hands of doctors and patients who do not understand the intricacies of medication overuse headache–i.e., most–this combination product could result in an increased risk of excessive dosing in the frequent headache sufferer, possibly resulting in an increased number of headaches.

And I think we all know how slim the likelihood is that an insurance carrier will reimburse both a prescription of Trexima and plain Imitrex in a given month.