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Medical Marijuana in California

This has been all over the news since Saturday, but I missed it somehow. In case you did too, here’s the release: California Suspends Medical Marijuana IDs.

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Potential Problem with Pain Drug in Trial

In clinical trials of pregabalin, a new drug for treating pain and seizures, a participant abruptly stopped taking the medication and developed headaches, confusion, hallucinations and other neurological symptoms. An MRI, done three weeks after the symptoms began, showed an area of fluid buildup in her brain. This is the first case of such problems with the drug and does not indicate whether it is a rare or common response; it just tells the researchers and participants to watch out for similar cases.

How does this affect you? Anticonvulsants, like Neurontin, Topamax and Depakote, are frequently used to treat chronic pain. In particular, Neurontin is chemically similar to pregabalin. Epilepsy patients have long been warned that going cold turkey with any of these drugs could trigger seizures, but those risks didn’t seem to apply for people taking the meds for other reasons.

While many of us don’t follow our doctor’s instructions to the letter, it’s not a good idea to be a maverick on this one. Just as you have to taper off antidepressants, also frequently used for headaches, you need to decrease the amount of the anticonvulsant slowly. If you decide the drug isn’t working or you don’t like its side effects, get instructions from your doc on how to cut your dose.

Read the full article: Report Describes Potential Problem with New Drug for Seizures, Pain

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In a (Large) Nutshell

Some readers have asked me to share my story, so here it is. Be forewarned, it’s long!

I’m 28 and have had bad headaches for as long as I can remember. They became daily around the time I was in middle school. My doctors said it was just a headache, so I ignored the pain or treated it with Advil, Tylenol and caffeine.

I have no idea how many painkillers I took in a day, but by college, I took four at a time more than twice a day. I tried special pillows, thinking that my neck got strained in the night. I thought grinding my teeth might be the culprit, so I had a mouth guard made. I also had TMJ surgery. Nothing helped.

In the year before I graduated from college, I had an illness that couldn’t be diagnosed. I was nauseated and tired, and had dizzy spells. I had headaches at the same time, but they were still “just headaches.” The doctor eventually told me that sometimes people can’t deal with major life events, like graduating from college, so they invent illnesses to avoid dealing with the events. To him, I was one of these people.

The headaches got worse over the next few years, but were still secondary to vertigo and nausea. I was diagnosed with and treated for Meniere’s disease (a diagnosis that was later dismissed). Then I sought to treat the headaches separately. I didn’t think I could have migraines – I don’t have auras and rarely have one-sided pain – and it never occurred to me that the three symptoms could be related. I went through round after round of allergy tests, got weekly allergy shots, medicated for sinus infections and had multiple scans of my sinuses. I had surgery to correct a deviated septum and had small structures and the top of my nose shaved to reduce pressure. None of the tests showed much and the treatments didn’t help.

At the end of 2001, the headaches began to wake me up every night, about four hours after I went to sleep. This had happened before, in spells that lasted no more than a few months, but this time it scared me. I went to my GP in mid-January to see if he had any ideas about what was going on. He recommended treating the headache pain and figuring out its cause.

This started me on several years of seeing specialists and trying practically every medication and treatment available: triptans, ergots, anti-depressants, anticonvulsants, sleep aids, painkillers, Botox, massage, acupuncture, relaxation, diet modification and so on. After all the tests, the diagnoses were migraine and transformed migraine (a.k.a. chronic daily headache).

Having a name for the problems didn’t help much. I still had daily headaches and migraines at least four times a week. I kept working for a while, but wasn’t up to par. I went down to part-time and then, when we had to move for my husband’s job, quit working altogether. I spent the majority of my time in bed and wondered how long it was worth living with the pain.

I didn’t respond to any treatments that usually help those with hard-to-treat headaches, so my doctor told me about occipital nerve stimulation. This experimental device, which is for people with untreatable migraine, essentially scrambles the pain signals that are sent along the nerve responsible for communicating migraine pain. An expensive and unproven treatment, a nerve stimulator seemed like my last resort. I had it implanted in December 2003. The stimulator has definitely reduced the pain, but it hasn’t given me any pain-free days. My daily headaches now hover around 3 on the 1-10 pain scale and, on average, I’m bedridden one or two days a week. I still can’t work.

After the stimulator was in, I spent more than a year adjusting my expectations. More than having to learn to live with constant pain, I had to face – and accept – that I may never find a miracle cure. I can’t describe how horrible this was and how shattered I felt. It was ugly. I was so tired of fighting that it took me 16 months (and trouble with the stimulator) to go back to the doctor.

I’m coping pretty well now. I take Cymbalta, Wellbutrin and amitriptyline. I’m on a restricted diet to sleuth for food triggers. I do a modified form of yoga that doesn’t interfere with the stimulator. I try to relax and let go of my perfectionism. I drink a lot of decaf lattes. I have fun when I can.

I have an appointment in October with a headache specialist in the city I now live in. I may try anticonvulsants again and I’m already testing a new triptan. Most of the time I’m willing to fight, but some days I only seek escape. My days aren’t easy and I haven’t beaten this disease. At least now I have the energy, mindset and reduced pain levels to try to keep it from beating me.

What’s your story? Share it in the comments section if you’re comfortable with that, otherwise you can e-mail it to me.

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Education or Advertising?

Pfizer, the maker of Relpax, announced a new migraine education – and advertising – campaign today. Called “Be Stronger Than Your Migraine,” the company says the campaign provides migraine patients with tools to identify how migraine affects their lives, recognize how they interfere with their own treatment and ways to have a better relationship with their doctors.

There’s not much information available on it yet, but I’ve requested the “toolkit.” At the surface, it appears to be little more than a direct-to-consumer drug ad. You know the line: If you tell your doctor to prescribe Relpax, you’ll be in control and your pain will go away.

Am I being cynical? Yes. Volatile? Certainly. I’m tired of drug companies and media outlets telling me that I just have to be strong and my headaches will go away. Yes, it’s important to be assertive with your doc and to think about ways to become more involved in your treatment. It’s also important to grieve the losses that you’ve had because of your headaches. And to think critically about who is giving you such advice.

Mostly I’m angry because Pfizer, like many other drug companies, is promoting the idea of the miracle cure for migraine. Relpax might be the drug that improves migraine pain. But it isn’t going to work for everyone. It’s dangerous to believe in a miracle cure, because you’ll be crushed if it doesn’t exist for you.

This might turn out to be a great and empowering campaign and I’ll have egg on my face. I’ll share the information with you when I receive the materials. You can also look into it for yourself. Yahoo! has the press release, the campaign site has an overview and the Relpax website has more detailed information.

I have a Relpax prescription waiting for me at the pharmacy. Who knows, maybe it’ll be my miracle drug. In any case, you should know that one of the reasons I started this blog is because so much migraine information online is from advertisements thinly disguised as education campaigns. You can be sure that I’ll never push one medication or treatment over another.