Even when you feel like you’ve tried everything, there’s almost certainly more out there. This is something I’ve been posting about and e-mailing people a lot lately. Without knowing everything they’ve tried, it’s hard to point someone in the right direction.
Top 10 Unexpected Migraine Treatments, a HealthTalk webcast scheduled for Wednesday, April 18 will get to right to the point. Guessts will be Brian D. Loftus, MD and John Claude Krusz, MD PhD.
In the meantime, here are some other resources:
A fairly comprehensive list of available preventive and abortive medications, including some of the newer ones, like Lyrica and Cymbalta. (These websites describe the drugs, but don’t talk specifically about headache. They are both prescribed off-label (read comments at this link) as Topamax was for a long time.)
The National Headache Foundation‘s podcasts: The Condition of Migraine, Symptoms and Triggers, Migraine Treatments, Latest Migraine News and Information. It’s good stuff, particularly the one on migraine treatments (not surprising, huh?).
The American Council for Headache Education has a collection of articles on treatment (the second heading on the page). They cover a wide range of topics, but some of the articles are old. If something catches your eye, I recommend doing some further research on the topic. I’m happy to answer questions when I can.
The World Headache Alliance also covers various treatments. Most topics are supported by recent research. Non-Pharmacological Therapies. The Treatments section covers a huge variety of topics. They include studies that contradict each other, which is good to get both sides. Check out the news section, too.
Sorry for such a link-heavy post!
Harvard Medical School researchers have found brain changes in patients with migraine. For a more accessible article about the study, read The Migrainous Brain: What You See Is Not All You Get? by Peter Goadsby of the Institute of Neurology. I fear this more than living the rest of my life in pain. It doesn’t necessarily mean changes in brain function, but the possibility is unsettling.
Using two forms of magnetic resonance imaging the researchers studied 24 patients with migraine (12 who had migraine with aura and 12 without aura) and 15 age-matched healthy controls.
There were no differences in cortical thickness in motion-related areas between the participants with migraine who had aura (neurological disturbances such as illusions of flashing lights, zig-zag lines, or blind spots) and those who did not, but the area of cortical thickening in one area corresponded to the source of cortical spreading depression previously identified in a person who had migraine with aura.
As well as showing that there are some structural differences in the brains of people with migraine, the position of the changes could help to explain why some people with migraine have problems with visual processing even in between attacks.
In 2004, Teri Robert of About.com‘s Headache and Migraine section wrote about a study examining the risk of brain lesions in people with migraine. It’s different than the current study, but scary nonetheless.
In case you’re not scared enough: Taking Topamax on a long-term basis increases your risk of developing kidney stones, according to a recent study.
Researchers found that taking topiramate on a long-term basis, or for about one year, caused systemic metabolic acidosis — a buildup of excessive acid in the blood — as a result of the inability of the kidney to excrete acid. Topiramate use also increased the urine pH and lowered urine citrate, an important inhibitor of kidney-stone formation.
“These changes increase the propensity to form calcium phosphate stones,” Dr. Sakhaee said.
In the short-term study, urinary calcium and oxalate — a chemical compound that binds strongly with calcium and is found in most calcium stones — did not significantly change in people taking topiramate.
Kidney stones are solid deposits that form in the kidneys from substances excreted in the urine. When waste materials in urine do not dissolve completely, microscopic particles begin to form and, over time, grow into kidney stones.
Some sort of good news: Sumatriptan, the generic for Imitrex has been approved in Sweden. It will be available as soon as the European patent expires in 2007. Few of you actually live in Sweden, but it could indicate the likelihood of other European countries to follow their lead.
The graphic is from the motor cortex page of PBS‘s Probe the Brain section.
A 16-week clinical trial of 59 people who have CDH from transformed migraine (not chronic tension-type headaches) found that about 29% experienced at least 50% headache relief while taking Topamax. On average, participants in this group had 3.5 fewer bad days a month. Those who received a placebo had a 0.2 day increase in headache days. The amount of headache relief was determined by headahce and quality of life questionnaires, including MIDAS and HIT.
It often takes three months for a patient to determined if a particular drug is an effective preventive for them. Because Topamax has to be started at a small dose and slowly increased to a higher dose, it takes about a month to reach the full dose. In this study, researchers only included the level of patient response in their last four weeks of treatment.
The side effect data gathered from the trial is initially shocking. Of those who took Topamax, 75% had side effects. But, 52% people on the placebo also had side effects. The researchers concluded that there was no statistically significant difference between the two groups in the incidence of side effects.
Speaking of side effects, if you visit a headache forum, you’ll see a large number of posts on the evils of Topamax. Dubbed Dopamax by patients and medical practitioners alike, the mental fogginess, trouble concentration and a bad memory are the frequently side effects. Waiting out the initial three months of taking the drug leads to a decrease in the severity and/or amount of side effects.
As with the aspirin study results, this study was presented at the European Headache Federation‘s annual meeting.
If you take Topamax, you’ll get a $5 check to offset the cost of your prescription if you register your information with the company.
Also, in June the FDA approved new prescribing information for Topamax. The current version is on the Topamax site. From the document that the FDA also published, I’ve put together a document with only the pages about the findings for treating migraines.