By

Why I’m Doing Better, Part 1: Climate & Medication

After my recent glowing posts, many people have inquired why I’m feeling better. I’d like to give you a clear, definitive answer, but migraine is never that simple. There are a number of factors, from climate and medication to exercise, meditation and forgiving myself for being sick. I’ll talk about the first two today and the others, which have probably had a greater impact on my health and suffering than medication, later this week.

Climate
Moving to Phoenix, away from the clouds and rain of Seattle and the ever-changing weather of Boston, has had the biggest influence on my migraine frequency, duration and severity. Storms and clouds have been rolling through Phoenix the last week and I’m on migraine day six. Though migraines aren’t always present when there’s weather, particularly if I’m on vacation, the correlation holds about 90% of the time. I wonder if the issue is barometric pressure changes, though Seattle’s barometric pressure is relatively steady, so parts of my hypothesis fail there.

Indomethacin
I began taking this nonsteroidal anti-inflammatory drug in June because the sand-in-my-eye symptom pointed to the slight possibility that I had an abnormal presentation of hemicrania continua. This rare headache disorder is completely responsive to indomethacin. Though my headache pain lessened, it did not cease, which means my diagnosis is still migraine. My doctor kept me on a daily dose of 225 mg of the medication, though he warned that it is not recommended for long-term use as it is hard on the stomach. I’m sticking with it for now because it is the only medication on which I’ve noticed a decrease in the frequency and severity of my migraines.

Discontinuing Wellbutrin and Lamictal
In 2005, I was prescribed Cymbalta, Wellbutrin and Lamictal for depression. I stayed on them far longer than I intended, especially considering that I was still majorly depressed while taking them. I finally went off of them this summer after determining that my dizziness, tremor, hot flashes, fatigue, cold hands and feet, mental fogginess, nausea, and increased pulse were not migraine symptoms, but medication side effects. I believe Wellbutrin was the culprit, but I wanted to stay off all three if I could. When my depression symptoms returned, I went back on Cymbalta. I’m happy to say that the depression is at bay and I’m not experiencing any other side effects.

Namenda
I’m in love with this medication, which is an Alzheimer’s treatment that is used off-label for migraine. I don’t know if it has had an effect on the migraine severity or duration, but it has cleared the mental blah that has plagued me as the migraines worsened. I credit Namenda with returning the mental wherewithal necessary for me to resume blogging and restoring my sense of intelligence. The feeling dumb aspect of migraine, which is not addressed frequently enough, has been one of my most limiting symptoms and has caused the greatest loss of my sense of identity and purpose. Did I mention that I love this drug?

By

Epilepsy Drug Trileptal Not an Effective Migraine Preventive

Anticonvulsant drug Trileptal (oxcarbazepine) is not an effective migraine preventive even though preliminary data indicated it might be. In the 15-week study, 85 patients received Trileptal and 85 received a placebo. There was no difference in the number of migraine attacks for the two groups.

Unlike other epilepsy drugs that are successful for migraine prevention, Trileptal does not regulate a neurotransmitter involved in the headaches.

“Since some antiepileptics are useful against migraine
headaches, it would be reasonable to assume that Trileptal would work, too. This is an example of what is necessary to prove the presence or absence of benefit,” Molofsky said.

The three epilepsy drugs that have been shown to prevent
migraines, topiramate, divalproex and gabapentin, do so through several mechanisms. One mechanism is the regulation of the neurotransmitter called GABA. However, oxcarbazepine appears not to affect GABA activity. It is possible that epilepsy drugs need to regulate GABA to prevent migraine, Silberstein noted.

The findings were published in today’s issue of the journal Neurology. Novartis, the maker of Trileptal, funded the study.

Article abstract: Oxcarbazepine in migraine headache: A double-blind, randomized, placebo-controlled study

By

Surprise, Surprise: Patients Have Trouble Understanding Drug Websites

Nearly half of Americans don’t understand the information on drug websites that are created specifically for the public. The FDA news bulletin summarizes:

Understanding content on the average drug website requires 12 years of education, meaning that only 55 percent of the U.S. population can fully understand the information provided on these sites, the analysis by healthcare marketing firm Campbell-Ewald Health found. More than three-quarters of the websites do not offer information in Spanish, and only half were designed using standard guidelines to improve the usability and accessibility of websites, the study showed.

There’s a “plain language” movement in the government, which seeks to make written material easy to read, understand and use. These drug sites aren’t prepared by government employees (at least I hope not!), but the concept should be the same. What’s the point in providing information to the public that they can’t understand?

My job when I worked for a government agency was to edit material so that it was not presented in a standoffish and unnecessarily complicated manner. It was nearly impossible.

My theory is that people use overly complex language and sentence construction so they appear smarter. If I say “utilize” instead of “use” or “at this juncture in time” instead of “at this time,” do I seem more intelligent? No, I seem obtuse and unfriendly (not to mention that I’m misusing the words).

Pet peeves aside, drug companies should have this same goal. They are trying to sell drugs to the public; they should reach out to their potential customers. Unless, of course, they don’t want patients to be able to understand side effects or clinical trial results.

I wonder how many patients are put off by the website and take the drug anyway.

Thanks to my dear friend L for sharing this article with me.

By

Using Targeted Meds for New Headache Patients

In what appears to be today’s theme, James Cottrill from Relieve Migraine Headache blogged about getting the most effective headache treatment sooner in your hunt for headache meds.

He cites a study on how doctors treat new headache patients. Some start with inexpensive, less effective and non-targeted meds. Others jump right in to specific headache treatment, like triptans for migraine. The results show that patients whose docs treat headache aggressively from the start have a better eventual outcome.

Read James’ post for details.