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Migraine Remains After Migranal-Induced Nausea

A killer migraine knocked me down yesterday. I gave myself over to Migranal, the abortive that my headache specialist recommended last week. It reduced my head pain, but magnified the nausea tenfold. This is a common side effect. I just didn’t expect it to happen to me.

The migraine worsened in the night and was unbearable by 6 a.m. Advil, my old standby that has been useless in the last month, reduced the pain a bit. Attending my morning yoga class was an impossibility, so I turned off the alarm and slept until 10:30.

I still feel awful and am more nauseated than usual. I’ll be spending the rest of the day on the couch.

Researching Migranal for this post, I found some studies have shown it decreases nausea. Migranal is the nasal spray of dihydroergotamine (DHE). Maybe the side effect is more of an issue with the injectable form of DHE. Anyone know?

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A Visit to My Headache Specialist: Migranal, Seroquel, Biofeedback & Headache Management

Another visit to my headache specialist, another round of medications and therapies. This is the first time I don’t have any anticipatory excitement that one (or some) will help. It’s not that I don’t think there’s a chance, I’m just too tired to get caught up in what ifs.

The prescriptions I left with are for Migranal, an abortive, and Seroquel, a preventive. I’ve never tried Migranal as on-the-spot abortive. I did use it when a three-week intensive treatment of injectable DHE caused muscle pain. (DHE and Migranal are essentially the same drug, just in different delivery forms.) That three-week treatment was cut short after I failed to respond even the tiniest bit.

Seroquel has been on my mind since reading this success story. I know what works for one person doesn’t always work for another, but I needed to ask. Since I’ve tried multiple meds in all the classes of drugs used for headache with no success, my doctor and I decided it was worth a shot. It can be sedating, but I have to wonder if being sedated with less headache would be better than the exhaustion that accompanies a migraine. (I need to read the full side effect profile before I fill the prescription.)

Biofeedback and headache management therapy are the other two treatments I’m going to try. That’s right, I have never tried biofeedback. I feel like an impostor writing a headache blog without trying it. I’ll be able to shed my shame soon.

Even though I don’t really know what it is, headache management is what I’m most excited about. Apparently I will learn tricks to help when I have a bad headache, like massage and neck exercises.

As I write this, my head is bad so my outlook is bleak. Whenever I have a low migraine, low pain, high energy stretch, like I did last week, I return to “normal” with a thud. Having had a total of three good weeks in the last two months, I now believe I’ll have more migraine-light days in the future. But I quickly grow impatient for the next time to arrive.

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Migraine Treatment News

Here’s the roundup of migraine treatments. Other news posts I’m working on are about presentations at the International Headache Society’s conference (including cluster headache news), depression and chronic pain.

Migraine Patients Who Take Triptans Report Greater Satisfaction Than Patients Taking Barbiturates or Opioids
Survey: Migraine Patients Taking Potentially Addictive Barbiturate or Opioid
Medications Not Approved By FDA as Migraine Treatments

The survey found that patients taking triptans are significantly more likely than those taking barbiturates or opioids to report that their medication works well at relieving migraine symptoms, with sixty percent of triptan patients reporting that it describes their medication “extremely” or “very” well to say it relieves their migraines symptoms completely compared with 42 percent of patients taking barbiturates and opioids.

Patients taking opioids and barbiturates for their migraines also reported a lower quality of life than patients taking triptans, according to the survey. Patients taking these drugs were twice as likely as patients on triptans to say that migraines “always” limited their ability to exercise or play sports (35% vs. 14%), engage in sexual activity (33% vs. 17%), drive a car (28% vs. 14%), spend time with family and friends (28% vs. 8%) or simply get out of the house (33% vs. 15%).

Though many patients are prescribed barbiturates and opioids for their migraines, the majority indicated that they prefer their migraine medication to be FDA approved for the disease, not addictive and have few side effects. Seven out of ten patients (72%) surveyed said it’s “extremely” or “very” important that their prescription medications not be addictive, and eight out of ten patients (79%) said it’s “extremely”
or “very” important that their prescription medication have only minor side effects. Sixty-five percent said it’s important that their migraine medication be approved by the FDA to treat the disease.

Frova for Menstrual Migraine
Endo’s Menstrual Migraine Treatment Better Than Placebo in Study

Endo Pharmaceuticals said that its Frova 2.5mg tablets reduced the frequency and severity of difficult-to-treat menstrual migraine in women when used as a six-day preventative regimen.

Predicting Botox ‘s Effectiveness
Cutaneous Allodynia Predicts Response to Botulinum Toxin Type A in Migraine Patients

Botulinum toxin type A has been reported to be effective in preventing migraine attacks in some patients but not in others.

[R]esearchers found that patients with cutaneous allodynia had experienced significant reductions (P <.01) in migraine frequency and number of headache days in response to botulinum toxin type A, whereas patients without cutaneous allodynia had no such improvement in symptoms.

[I]nvestigators concluded that cutaneous allodynia could be used to predict which migraine patients are likely to respond to prophylactic therapy with botulinum toxin.

DHE Relieves Skin Sensitivity (Allodynia)
Migraine With Skin Sensitivity Eased By Older Drug

Dihydroergotamine or DHE, an established drug for migraine, works well even when the attack is accompanied by super-sensitivity to touch or heat and cold, according to researchers.

Many migraine sufferers get relief from the newer drugs known as triptans, but these are less effective when people also have heightened skin sensitivity. This condition, called cutaneous allodynia, makes even a light touch to the face or neck feel painful.

“Unlike triptans, DHE works in the presence of allodynia, any time in the migraine attack,” lead investigator Dr. Stephen D. Silberstein told Reuters Health.

Migraine Preventives
Migraines: Symptoms Disappear With The Right Prevention

According to Greek researchers, migraine sufferers can eliminate symptoms altogether if they take higher doses of anti-migraine medicine for a longer period of time than is now customary. Another team of researchers has found that certain psychopharmaceuticals could serve as a new therapy option for persistent chronic headaches.

“In treating migraines, optimizing the effect of already available agents is at least as important a task as developing new substances.”

I’m a little wary of this article, but wanted you to know about it. Take it with a grain of salt.

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CGRP Receptor Antagonist a Promising New Migraine Abortive Drug

Calcitonin gene-related peptide (CGRP) receptor antagonist MK-0974 holds promise as a migraine abortive, according to Phase II study results that will be presented at the American Headache Society‘s annual meeting this week.

The drug works by blocking CGRP, a brain chemical that is important for transmitting pain signals during a migraine. It does not appear to contrict blood vessels, as triptans do, so people who can’t use triptans may be able to use MK-0974 as an abortive. Researchers hope that it will have fewer side effects and safety concerns than triptans do.

The American Headache Society’s press release on the study follows.

New Migraine Drug Holds Promise for Headache Sufferers: First Class of Migraine Medication Since the Triptans

CHICAGO – An innovative drug appears to treat migraines in a majority of people, potentially ushering in a new era for the treatment of the painful and disabling headaches, suggests early research being presented at the 49th Annual Scientific Meeting of the American Headache Society.

The study is the first presentation of a drug called MK-0974, which belongs to a potential new class of drugs, known as calcitonin gene-related peptide (CGRP) receptor antagonists.

Fifteen years ago, the advent of triptan medication revolutionized migraine treatment by stopping the headaches and related symptoms, rather than just providing pain relief. However, triptans don’t work for about a third of the estimated 28 million people with migraines and because they constrict blood vessels, they cannot be used in patients who have had a heart attack or stroke and should be used with caution by those who are at risk.

“The real excitement is that this drug has a different mechanism of action from the triptans, and the hope is that it will have fewer side effects and safety concerns,” said Alan M. Rapoport, M.D., clinical professor of neurology at the David Geffen School of Medicine at UCLA, in Los Angeles, and a co-author of a study on the drug being presented at the Society’s meeting.

The new drug works by blocking CGRP, a brain chemical that is important for transmitting pain signals during a migraine attack. Unlike the triptans, research has shown that the new drug does not appear to constrict blood vessels.

“Because we know that the CGRP level is elevated during a migraine attack, and that if you give CGRP intravenously, you can cause a migraine-like headache, we’ve been studying what would happen if you block the CGRP,” said Tony Ho, M.D., senior director of clinical neuroscience at Merck & Co., Whitehouse Station, N.J. “Our hope is that this drug potentially can have a significant impact for migraine patients as an additional treatment choice.”

The new drug has not been approved by the Food and Drug Administration (FDA). Results from the Phase II study being presented at the Society meeting are an early step in the development process.

The randomized, double-blind, placebo-controlled study tested safety and effectiveness of MK-0974 and involved a total of 330 people who suffered one to six migraines a month. Study patients kept a diary to assess: pain relief two hours after taking the medication, pain freedom two hours after taking the medication, and freedom from pain 24 hours later.

More than two-thirds (68 percent) of those who took the 300 mg dose of the new drug had pain relief two hours after the dose, compared to 69.5 percent of those who took the FDA approved triptan called rizatriptan and 46 percent who took a placebo, or dummy pill. Nearly half (45.2 percent) of those who took the new drug were free of pain after two hours, compared to 33.4 percent who took rizatriptan [Maxalt] and 14.3 percent who took the placebo.

More than a third (39.6 percent) were free of pain 24 hours after taking the new drug, compared to 18.4 percent who took rizatriptan and 11 percent who took the placebo. Common side effects included nausea, dizziness and sleepiness.

“These early results are very promising,” said Dr. Ho. “There’s potential for the new drug to be superior to the triptans 24 hours after the medication is taken, but this needs to be confirmed in a larger trial.”

“There’s good reason to believe that at least some people would respond to this drug, even if they did not respond to the triptans,” said Dr. Rapoport, who also is the cofounder and director emeritus of The New England Center for Headache, in Stamford, Conn. “Also, additional data suggest that this drug gets into the blood stream fairly quickly and may stay in the blood stream longer than several of the triptans.”

In addition to Drs. Rapoport and Ho, other authors of the paper being presented at the meeting are: Lisa Mannix, M.D., Xiaoyin Fan, Ph.D., Chris Assaid, Ph.D., Christine Furtek, M.S. and Chris Jones, M.S.

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More on Serotonin Syndrome

In response to the FDA’s alert in July about the possibility of serotonin syndrome when people on antidepressants use triptans, HEADQuarters Migraine Management has released special bulletin on serotonin syndrome and medications. It’s a clear explanation of what migraineurs need to know about the illness.

I linked to the February/March issue of the HEADQuarters newsletter in my first post about serotonin syndrome. This contains some of the same information, but the special bulletin relates directly to the FDA’s announcement. It’s worth checking out.