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Ibuprofen & Life-Threatening Potassium Loss

Ibuprofen and prescription NSAIDS (non-steroidal anti-inflammatory) are among my most effective meds, so this article caught my attention: Research finds ibuprofen linked to life-threatening potassium deficiency.

[Patients] were diagnosed with hypokalaemia, a dangerously low level of potassium in the blood that can lead to abnormal heart rhythms, the breakdown of muscle fibres, fatigue, muscle weakness, spasms, and paralysis.

Although hypokalaemia from ibuprofen isn’t a huge risk, I was surprised that one man was taking less than 4,800 mg per day. That’s still way too much to take regularly — 1,200 mg (or six regular-dose Advil or generic ibuprofen) is the maximum recommended daily dose for short-term use — but it is easy to creep to excessively high doses when you’ve got a killer headache or migraine.

An issue of far greater concern to people with migraine or headache is rebound or medication-overuse headaches. According to the National Headache Foundation’s rebound information sheet,

When used on a daily or near daily basis, [over-the-counter painkillers] can perpetuate the headache process. They may decrease the intensity of the pain for a few hours; however, they appear to feed into the pain system in such a way that chronic headaches may result. [emphasis added]

I must repeat: frequent use of over-the-counter painkillers like acetaminophen (Tylenol) and NSAIDs (Advil & Aleve) can turn occasional headaches or migraines into chronic ones.

If you’re having frequent headaches, see your doctor. Of course, few medical professionals know much about headache and migraine, so weaning yourself off may be the better option. Before you do, read Teri Robert’s excellent article, Medication overuse headache — when the remedy backfires and visit some forums to learn about other’s experiences. Migrainepage, My Migraine Connection, and WebMD are my favorites.

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Warnings Proposed for OTC Painkillers

A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. A painkiller shouldn’t be considered harmless just because it’s sold over-the-counter. Get my drift?

Now the FDA wants to spread the message by adding “prominently highlighted” warning labels to all OTC painkillers. Consumers will be warned that drugs containing acetaminophen can cause liver failure and those with aspirin or nonsteroidal anti-inflammatories (NSAIDs) can cause gastrointestinal bleeding.

The NY Times article points out an issue of particular interest to folks with chronic pain — and one that won’t make it to OTC drug labels:

“A recent study of liver failure in which Dr. Lee participated found that the percentage of cases related to acetaminophen overdoses had grown. Many were caused when patients with chronic pain took prescription narcotics bundled with acetaminophen. The new proposal does not address that combination.”

The brand names of the different types of OTC painkillers are many, but here are some of the most well-known. Other brand names can be found by clicking on the drug type.

For more about the proposed changes, see the FDA’s press release.

You can learn about the risks of OTC meds in the NY Times article, Medline’s pain relief section and in these previous posts:

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News, News, News

There is never enough time for me to post about all that I want to write about. And there’s been a ton of headache news lately. Here are some highlights.

Detailed Results of Trexima Studies (the drug isn’t named in the study, but it looks like Trexima to me)

  • Neck pain and discomfort decreased significantly at two hours for the compound versus placebo in study 1 (35 and 44 percent) and study 2 (28 and 54 percent).
  • Sinus pain and pressure decreased significantly at two hours for the compound versus placebo in study 1 (19 and 33 percent) and study 2 (23 and 38 percent).(1)
  • More patients were pain free at two hours in both studies (52 and 51 percent) compared to placebo (17 and 15 percent) and sustained pain-free response was maintained for significantly more patients (45 and 40 percent), without the use of a rescue medication, to 24 hours, compared to placebo (12 and 14 percent).
  • The compound was effective in rapidly eliminating migraine pain, as measured by pain-free rates at 30 minutes, one hour, two hours and four hours.
  • Incidence of migraine associated symptoms (nausea, phonophobia (sensitivity to sound) and photophobia (sensitivity to light)) was lower with the compound than with placebo.
  • The compound was generally well-tolerated. In both studies, only nausea (3 and 4 percent) and dizziness (1 and 2 percent) were reported in at least 2 percent of patients who took the compound versus placebo (1 and 2 percent for nausea, 0 and < 1 percent for dizziness).

Confusion Over Safety Of NSAIDs For Pain Relief Leads Patients To Suffer In Silence
Almost two thirds of people surveyed (64%) said they were confused about what to take for pain relief because of conflicting information on drug safety that has emerged following the withdrawal of Vioxx (rofecoxib), a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) . Around 4 out of 5 (78%) said they didn’t know enough about the risks and benefits of medicines, whether prescribed or bought over-the-counter. Almost half (47%) said they weren’t using any painkiller medication at all for a number of reasons. Some were concerned about side effects, often after reading worrying news stories about painkillers, some had been advised to stop medication by their PCP and some thought they could manage without them.

Triple Therapy Synergy for Frequent Severe Migraine (registration may be required to read this)
The combination of behavioral migraine management, preventive medication, and optimal acute therapy appears to provide a superior reduction in migraine activity measures, functioning, and quality of life compared with any one alone, according to a study presented at the American Headache Society meeting here.

For these patients, “effective migraine management may require three components: a tailored acute therapy, preventive medication and behavioral migraine management to get the optimal results,” said Kenneth Holroyd, Ph.D., a professor of health psychology at Ohio University in Athens, Ohio, in an oral presentation.

Overweight Kids More Likely to Get Headaches
Children with headaches are 36 percent more likely to be overweight, results of the new research suggest.

“The numbers tell us that being overweight may contribute to kids having more headaches, most often migraines,” said Andrew D. Hershey, M.D., Ph.D., director of the Headache Center and a pediatric neurologist at Cincinnati Children’s Hospital Medical Center. “There likely are a number of causes, including poorer general health, body stress, lack of exercise and nutrition. It may not be that being overweight directly causes migraine, but that the reasons for being overweight cause these children to have worsening headaches.”

Magnetic Device Short-Circuits Migraine Headaches, Suggests Early Research
A hairdryer-sized magnetic device held briefly to the back of the head may short-circuit migraines before the pain starts, suggests preliminary research being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

People With Near-Daily Migraine Headaches Get Relief From Anti-Seizure Drug
An anti-seizure medication “quiets the brain,” providing relief to people with near-daily migraine headaches, suggest results of a randomized, multi-center study being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

FDA OKs the Pain Drug Opana
The drug, called Opana, is an opioid pain reliever taken by mouth. It will come in an extended-release form, called Opana ER, and an immediate-release version, simply called Opana.

The drugs contain oxymorphone hydrochloride, which was previously only available by injection. Endo Pharmaceuticals plans to relaunch the drug’s injected version for hospital use under the new trade name.

If you know of an article that I missed, please add it to the comments. Thanks!

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NSAIDs and Heart Attack Risk

In a study of 5,000 people who’d had heart attacks and 20,000 who hadn’t, the was no evident increase of heart attack risk for people who took moderate amounts of Advil (ibuprofen), Aleve (naproxen), or Cataflam or Voltaren (diclofenac) for a year or more.

This article looked like good news at first glance, but so many people with headache who use OTC NSAIDs like Advil and Aleve exceed the limits of “moderate amounts” that I’m not sure the results apply.

The morals of the story? Just because a drug is sold OTC, it isn’t harmless. If you take lots of OTC painkillers, you likely either have undiagnosed migraine or tension-type headache or rebound headaches from taking too many meds.

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Tylenol & Ibuprofen Linked to Women’s High Blood Pressure

Women who take more than 400 milligrams of ibuprofen (or other NSAIDs) or 500 milligrams of acetaminophen per day have an increased risk of high blood pressure than those who do not take the meds, found a study that will be published in the September issue of the journal Hypertension.

Taking more than 400 milligrams of NSAIDs per day increased the risk of high blood pressure by 78% in women 51 to 77 years old and by 60% in women between the ages of 34 and 53. Daily use of more than 500 milligrams of acetaminophen raised the risk of high blood pressure by 93% in women in the older age group and by 99% in younger women.

This study clarified that it is the painkillers and not the headaches that women are trying to treat that cause high blood pressure.

Learn more by reading the WebMD article, Common Pain Drugs Up High Blood Pressure Risk, or the journal article abstract, Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women.