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Botox Doesn’t Relieve Migraines & Tension-Type Headaches?

A review of all available data on treating migraines and tension-type headaches with Botox indicates it is no better than a placebo, according to a US News & World Report article. The findings are included in guidelines for using Botox published in today’s issue of the journal Neurology.

Botox Works on Muscle Disorders But Not Migraines

[B]otulinum toxin has become an effective treatment for numerous movement disorders associated with excessive muscle contraction.

The new guidelines approve its use for treating cervical dystonia, a condition of involuntary head tilt or neck movement; involuntary facial contractions, involuntary eye closure, focal limb dystonias (such as writer’s cramp), essential tremor and some spastic bladder disorders. The drug is injected directly into affected muscles.

[non-contiguous paragraphs]

The finding that botulinum toxin probably does not help relieve migraine or chronic tension headaches surprised the researchers.

“Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” pain guidelines author Dr. Markus Naumann, head of the Department of Neurology at Augsburg Hospital in Germany, said in a prepared statement. “It is no better than placebo injections for these types of headache.”

I haven’t even found the abstract yet. I’ll let you know as soon as I learn more about this surprising report. If you know anything about it, please leave a comment below.

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Debilitating Nausea Caused By High(ish) Magnesium Dose

white capsulesWoo hoo! I feel human again and it’s all because I stopped taking magnesium. Yep, magnesium, the wonder supplement that helps so many people with migraine and chronic daily headache. I don’t think magnesium itself is to blame, but that the dose was too high. Since I can’t even take a multivitamin without nausea, I was hyper-aware as I increased from my starting dose of 100 mg. Or so I thought.

At 333 mg per day, it was within the normal dose range for treating headaches of 200-500 mg per day. It was also within the recommended daily allowance of 350 mg. I’ve discovered that allowances and ranges are like speed limits: A guideline you’re not supposed to exceed, but that you don’t have to meet.

Practically every health care provider I’ve seen has recommended magnesium to me. I’ve taken it on and off over the last five years, although this is the first time I’ve taken it consistently for more than a few weeks. Because I’ve read so much about it and had it prescribed before, I thought I could adjust the dose myself just fine. I figured I’d be fine if I stayed at or under the RDA. I unwittingly fell for the myth that medications, vitamins and supplements sold over-the-counter are harmless.

The good and frustrating news: My overall head pain was less and I had fewer migraines during the time I was horribly nauseated. I’m guessing that means the magnesium helped some. I think once my system flushes the current round of magnesium, I’ll have my different vitamin and mineral levels tested. I’ll also make myself keep a diary of my symptoms and doses. I wouldn’t want to go through these last six weeks again. I felt horrible and was so scared of what might be wrong with me.

I haven’t had any blood tests, so I’m not positive the nausea was caused by excessive magnesium. But when debilitating nausea that began about the time I increased my dose goes away when I stop taking the pills, the evidence is strong enough for me.

What is your experience been with magnesium? Please leave a comment below or chime in on the online support group and forum.

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Trouble Thinking on Topamax? Study Finds “Language Disturbances”

Migraine preventive Topamax (topiramate) has long been associated with trouble thinking, hence the widely used nickname of Dopamax. A recent study indicates that some people have trouble with language while taking Topamax. Some “language disturbances,” as the authors call it, include:

  • Finding words
  • Substituting a word with another unrelated word
  • Taking forever to get a thought out
  • Meshing words
  • Naming objects

According the Reuters article, “Language disturbances generally occurred within the first month of treatment, were of mild severity, and did not require further adjustment of dosages or discontinuation of topiramate.” I’m not sure what that means. Did the language disturbances subside after a month? Does “mild severity” mean that participants chose to stay on the drug even with the side effects?

The abstract of the original article in the journal Headache, Language Disturbances as a Side Effect of Prophylactic Treatment of Migraine, doesn’t answer these questions, but does raise others:

Conclusion.—It can be hypothesized that a disorder such as migraine, which involves numerous cortical and subcortical circuits implicated in the transmission and behavioral and emotional processing of pain, represents a facilitated substrate for the occurrence of language disturbances due to topiramate. This could be the expression of a more generalized impairment of cognitive processing. These aspects should be investigated in prospective studies involving larger migraine patient samples.

My interpretation: The make up of a migraineur’s brain is such that Topamax’s language side effects can flourish. Language problems could be only one part of overall impaired thinking. I believe this means that Topamax impairs thinking, but most migrainuers will attest that our minds are fuzzy even without Topamax. That’s the research I want to see.

Do these findings fit with your experience of Topamax? Take The Daily Headache’s Topamax & migraine survey.

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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

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Link Between Antiepileptic Drugs and Suicidal Thoughts or Behaviors Distilled

FDA’s warning about suicidal thoughts and behaviors in people taking anti-seizure meds distilled: “For every 1,000 patients, about two more drug-treated patients experienced suicidal thoughts than placebo-takers, FDA concluded,” according to New York Times article FDA Warns of Risks From Epilepsy Drugs. Other article highlights include:

Very rarely were suicidal thoughts or behavior reported. Still, the FDA found drug-treated patients did face about twice the risk: 0.43 percent of drug-treated patients experienced suicidal thoughts or behavior, compared with 0.22 percent of placebo-takers.

The FDA found drug-treated patients were at increased risk no matter their diagnosis, but that the risk was highest for epilepsy sufferers.

If you’re worried about a medication you’re on, don’t stop taking it without talking to your doctor. Stopping anticonvulsants abruptly can cause seizures or other neurological effects.

See Antiepileptic Drugs Linked to Increased Risk of Suicidal Behaviors and Thoughts for the full FDA warning. The 11 medications mentioned:

  • Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
  • Felbamate (marketed as Felbatol)
  • Gabapentin (marketed as Neurontin)
  • Lamotrigine (marketed as Lamictal)
  • Levetiracetam (marketed as Keppra)
  • Oxcarbazepine (marketed as Trileptal)
  • Pregabalin (marketed as Lyrica)
  • Tiagabine (marketed as Gabitril)
  • Topiramate (marketed as Topamax)
  • Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
  • Zonisamide (marketed as Zonegran)