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FDA Approves Generic Version of Migraine Preventive Drug Topamax (Topiramate)

The FDA has approved production of topiramate, the generic version of migraine preventive drug Topamax. It will be available in multiple strengths from 17 different manufacturers.

This is great news for the many people who have found relief from migraines or headaches with Topamax. Except for the side effects, which many find intolerable, Topamax is often called as a “miracle drug.” I don’t believe in miracle drugs, but one that can help so many people is pretty impressive.

Ortho-McNeil Neurologic’s patents on Topamax began expiring last year.

Related posts:

[via Somebody Heal Me]

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Chronic Daily Headache Prevention: Why is it so Difficult?

puzzle“I’ve tried everything and nothing helps my chronic daily headaches.” How many times have you uttered something similar? A HealthTalk Q & A gives some common reasons why:

  1. Medication overuse (rebound) headaches
  2. Failure to treat a co-existing medical condition such as depression or a sleep disorder
  3. Unrecognized medication-induced headaches, such as might occur from cholesterol drugs, proton-pump inhibitors for GERD, and anti-depressants
  4. Failure to investigate the possibility of relatively rare causes of headaches such as abnormalities at the base of the skull and top of the spine (craniocervical junction), intracranial hypotension (low-pressure headache), sinus abnormalities, and food or environmental allergies

Sadly, none of these reasons explain my chronic daily headaches. How about you?

photo by Erik Araujo

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Examining Supplements for Chronic Daily Headache & Migraine Treatment

Dietary supplements feverfew, butterbur, magnesium, riboflavin, coenzyme Q10 and melatonin pop up frequently in the discussion of treatment for chronic daily headache and migraine. Do they work? According to headache specialist Stewart J. Tepper in the medical journal Consultant, “Although the data are relatively few, and sometimes weak, there is some evidence that so-called natural remedies may be effective at preventing or aborting migraine attacks.”

Even if the evidence is weak, many people with CDH and migraine are willing to try supplements because there’s a chance that it might work for them. That’s my approach too, unless there’s indication that the supplement might be harmful or there hasn’t been enough research to show the long-term effects of it.

The journal Headache published a detailed review of supplements in 2006.

“Natural” or Alternative Medications for Migraine Prevention, an article in the journal Headache in 2006, introduced the topic:

For preemptive prophylactic therapy, CAM [complementary and alternative medicine] is not only a viable option, but should be a major consideration. Patients often balk at the use of daily drugs due to the perception such treatment may frequently cause side-effects. So, why not a “natural” agent, mineral, vitamin, or bodily substance? The modern equivalent to the “wild, wild, west” (ie, the Internet) informs us that petasites…. [T]hese CAM therapies are not as strictly regulated by the Food and Drug Administration of the United States as are prescription therapies and devices; they are classified as dietary supplements and not drugs.

The article includes efficacy and safety details on the following supplements:

If the links take you to a sign-in page, you can get a login at BugMeNot.

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Test Results Negative, New Neurologist Loses Interest

The neurologist I had such high hopes for lost all her shimmer in my follow-up appointment. The good news is I have no aneurysms, tumors or lesions and all my blood tests, except for one, came back fine. The bad news is the test results made me completely uninteresting to a neurologist who is primarily interested in autoimmune disorders.

Prolactin, Wikipedia and Google
The one concern in my blood test was an elevated level of prolactin, a pituitary hormone. The neurologist thought one of my medications could be the cause, so she turned to Google to check. Nothing came up until she came across the Wikipedia page that said Reglan could increase prolactin. I trust Wikipedia for Joanie Loves Chaci trivia, not for medical information.

She did look for further confirmation. Google turned up a six-page article on prolactin and the results included something on Reglan. After looking through all six pages, the neurologist didn’t see a mention of Reglan. She said, “I can’t find it, but Google says it’s in here, so Reglan is probably the cause.”

I actually agree, especially because I think the endocrinologist checked my prolactin levels in March. The neurologist and I also agreed that I should stop taking the drug and get another blood test in a month. She also mentioned that the endocrinologist should look for adrenal problems.

Lupus, Autoimmune Disorders and Fibromyalgia
Having hoped an autoimmune disorder was the reason I’m tired to the bone, I asked if fibromyalgia might be the cause. “Maybe, but we’re only looking at things we can do something about,” was her response.

Cyproheptadine
Cyproheptadine is an old antihistamine that has been used to treat migraine. The neurologist said she used it when she first started practicing 25 years ago, then quickly moved on to other meds. Now she’s come full circle and finds it pretty effective.

Great, but I’m not taking a drug without knowing anything else about it. I asked “What are the…” before she cut me off with “…the side effects for cyproheptadine? Nothing. You may have a dry mouth in the morning, but that’s it.” I know better than to believe a drug has only one side effect.

Researching the drug when I got home, and not relying on Wikipedia or Google search results for an answer, I discovered dry mouth is one of the biggest side effects. So are headaches and dizziness, my two main symptoms.

And, get this — cyproheptadine can affect pituitary-adrenal response lab results. I’m going off Reglan because it might affect pituitary lab results. I’m also supposed to have my endocrinologist check for pituitary and adrenal problems. But I’m prescribed a drug that can affect these very lab results?

Sinus Blockage
My left front sinus cavity has three pockets of fluid. It isn’t floating around, but walled off in lumps. I forgot to ask about treatment for that; she forgot to mention it. I guess an ENT is next?

Dismissal
I could feel her interest in me waning as the appointment went on. I became another migraine patient — one who is hard-to-treat at that. She’s willing to try the two best drugs in her arsenal (Topamax if cyproheptadine doesn’t work). She would probably continue to treat me if those drugs don’t work. I just don’t think she has any interest in doing so.

I’ve been fortunate with doctors. Other than one poorly regarded headache specialist, I have never felt this dismissed. It is like I started dating someone I thought would be a great match and was dumped with no explanation.

What’s Next
I’m discouraged. I hoped the lupus test would be positive. Not that I want to have lupus, but having a place to start would be nice.

I see the endocrinologist in June and will wait until that appointment before taking cyproheptadine. The drug might work and I want to try it. Just not at the expense of already questionable lab results. Then it is time to go through the list of -ologists I haven’t seen and make some appointments. I’ll also add an ENT to my list of doctors to check my sinuses.

I increased my magnesium to 200 mg last night. That is the only thing I’ve noticed a difference with, so I’m going to run with it. As long as I don’t get nauseated, I’m happy to push the dose. Still, I’m tired of treating myself.

I will probably go to an inpatient headache clinic this fall. Chronic daily headache patients often have excellent results at first, then return to the same levels of pain a few months later. A few months would be better than none at all.

I’ll get through this. I’ll look for more possibilities. I even believe I may find something soon. That doesn’t prevent the disappointment.

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Type of Magnesium Affects Absorbtion Rate, Reaction

After I stopped taking magnesium, the severe nausea diminished over several days. And the after-eating headaches that had ceased, slowly increased over those few days. Then I learned from a reader that the dose may not have caused nausea, but the type of magnesium. There are many different kinds; turns out I was taking one of the most difficult to absorb.

I planned to let my my system “flush” it all before I started again, but didn’t want to lose the progress I had made. Especially after I learned it can take three months to get the full effect. So I tried again with a lower dose of an easier-to-absorb type. On my new dose of 150 mg of magnesium glycinate chelate, the nausea is manageable and the after-eating headaches have yet to return.

Although about magnesium before I started taking it the first time, I was apparently unable to absorb the information until I was too sick to move. I have since re-read The Magnesium Solution for Migraine Headaches, a highly informative book. In addition to explaining the connection between migraine (and cluster headache) and magnesium, it shares the history of and evidence for using supplements of the mineral. Guidelines for taking magnesium are also included. If you’re thinking about taking magnesium, consider reading this short book, which is only $5.95 new and about $2.50 used.

The National Institutes of Health also has an excellent (and free!) overview of magnesium, including dietary sources, absorbtion rates and drug interations.