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.
[via Somebody Heal Me
“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:
- Medication overuse (rebound) headaches
- Failure to treat a co-existing medical condition such as depression or a sleep disorder
- Unrecognized medication-induced headaches, such as might occur from cholesterol drugs, proton-pump inhibitors for GERD, and anti-depressants
- 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
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
In studies of Lyrica’s effectiveness for fibromyalgia and shingles pain, participants have reported sleeping better while taking Lyrica.
On his RevolutionHealth blog, sleep specialist Steve Poceta wrote:
Lyrica has been shown to improve sleep in certain patients who have pain, such as fibromyalgia and shingles pain. However, it is also important to assess the effect of a drug on the sleep of normal sleepers, because the sleep of patient groups is by definition already abnormal.
Dr. Poceta also describes the stages of sleep and how different drugs target different areas. Although I had trouble summarizing his points, the explanation isn’t hard to read or understand. I recommend reading it.
For anecdotal evidence, a reader told me that since starting Lyrica in January, her migraines have gone from 3 or 4 times a week to about once a month. Her insurance won’t cover it, even after having her doctor appeal the first decision.
She spends $100 a month on the drug, although she just found a pharmacy that carries it for $72. Proof that shopping around is valuable!
Preventive medications can significantly improve the quality of life for people with migraine, but their quality of life is still below that of people without migraine. The study tested quality of life for patients taking nadolol (Corgard) and topiramate (Topamax). The article, Impact of Preventive Therapy with Nadolol and Topiramate on the Quality of Life of Migraine Patients, appears in the August issue of Cephalalgia.
[R]esearchers studied 76 consecutive migraine patients at least 16 years of age, evaluating them at the beginning of the study and again after 16 weeks of treatment with nadolol at 40 milligrams per day or topiramate at 100 milligrams per day. The study was completed by 61 of the patients.
The results of the Hospital Anxiety and Depression Scale revealed a mild anxiety state and a moderate depressive state at the beginning of the study, which both remained unchanged after therapy.
The migraine-related quality of life questionnaire score indicated statistically significant improvements with treatment.