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Insurance Coverage of Triptans

Insurance is an ongoing nightmare for practically everyone. If you need more triptans (a common type of migraine abortive) a month than your plan allows, you’re in for a real hassle. Without insurance they are, of course, mighty pricey.

Kathy, a reader, is faced with a new bureaucratic hurdle that I’ve never seen before. Her story follows. She’d appreciate any advice you can give.

I just had to share this with someone that could understand, and maybe you have some suggestions as to whether anything can be done. I was just informed by my insurance company that I can now only get 4 Maxalt tablets at a time. I can get 8 per month (down from the 9 per month it used to be) but I have to go in to the pharmacy TWICE per month. Maxalt is the least troublesome of the triptans for me and enables me to keep working with a migraine. My migraines usually last 3 days (requiring 6 Maxalt) and CAN last 5 – 6
days. It is so infuriating that an insurance company can do this.

Their explanation was that studies have shown that most people (?) only refill their prescription of 9 tablets once every 3 months. 38% of the prescriptions are never refilled. So they decided that 3 pills is a 30 day supply. Have you ever heard of anyone being successful in fighting something like this? Any ideas on what to do?

Even if you don’t have suggestions for Kathy, eave a comment with your story — whether good or bad — about getting the meds you need. I and other readers will certainly benefit from your experience.

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Migraine Treatment News

Here’s the roundup of migraine treatments. Other news posts I’m working on are about presentations at the International Headache Society’s conference (including cluster headache news), depression and chronic pain.

Migraine Patients Who Take Triptans Report Greater Satisfaction Than Patients Taking Barbiturates or Opioids
Survey: Migraine Patients Taking Potentially Addictive Barbiturate or Opioid
Medications Not Approved By FDA as Migraine Treatments

The survey found that patients taking triptans are significantly more likely than those taking barbiturates or opioids to report that their medication works well at relieving migraine symptoms, with sixty percent of triptan patients reporting that it describes their medication “extremely” or “very” well to say it relieves their migraines symptoms completely compared with 42 percent of patients taking barbiturates and opioids.

Patients taking opioids and barbiturates for their migraines also reported a lower quality of life than patients taking triptans, according to the survey. Patients taking these drugs were twice as likely as patients on triptans to say that migraines “always” limited their ability to exercise or play sports (35% vs. 14%), engage in sexual activity (33% vs. 17%), drive a car (28% vs. 14%), spend time with family and friends (28% vs. 8%) or simply get out of the house (33% vs. 15%).

Though many patients are prescribed barbiturates and opioids for their migraines, the majority indicated that they prefer their migraine medication to be FDA approved for the disease, not addictive and have few side effects. Seven out of ten patients (72%) surveyed said it’s “extremely” or “very” important that their prescription medications not be addictive, and eight out of ten patients (79%) said it’s “extremely”
or “very” important that their prescription medication have only minor side effects. Sixty-five percent said it’s important that their migraine medication be approved by the FDA to treat the disease.

Frova for Menstrual Migraine
Endo’s Menstrual Migraine Treatment Better Than Placebo in Study

Endo Pharmaceuticals said that its Frova 2.5mg tablets reduced the frequency and severity of difficult-to-treat menstrual migraine in women when used as a six-day preventative regimen.

Predicting Botox ‘s Effectiveness
Cutaneous Allodynia Predicts Response to Botulinum Toxin Type A in Migraine Patients

Botulinum toxin type A has been reported to be effective in preventing migraine attacks in some patients but not in others.

[R]esearchers found that patients with cutaneous allodynia had experienced significant reductions (P <.01) in migraine frequency and number of headache days in response to botulinum toxin type A, whereas patients without cutaneous allodynia had no such improvement in symptoms.

[I]nvestigators concluded that cutaneous allodynia could be used to predict which migraine patients are likely to respond to prophylactic therapy with botulinum toxin.

DHE Relieves Skin Sensitivity (Allodynia)
Migraine With Skin Sensitivity Eased By Older Drug

Dihydroergotamine or DHE, an established drug for migraine, works well even when the attack is accompanied by super-sensitivity to touch or heat and cold, according to researchers.

Many migraine sufferers get relief from the newer drugs known as triptans, but these are less effective when people also have heightened skin sensitivity. This condition, called cutaneous allodynia, makes even a light touch to the face or neck feel painful.

“Unlike triptans, DHE works in the presence of allodynia, any time in the migraine attack,” lead investigator Dr. Stephen D. Silberstein told Reuters Health.

Migraine Preventives
Migraines: Symptoms Disappear With The Right Prevention

According to Greek researchers, migraine sufferers can eliminate symptoms altogether if they take higher doses of anti-migraine medicine for a longer period of time than is now customary. Another team of researchers has found that certain psychopharmaceuticals could serve as a new therapy option for persistent chronic headaches.

“In treating migraines, optimizing the effect of already available agents is at least as important a task as developing new substances.”

I’m a little wary of this article, but wanted you to know about it. Take it with a grain of salt.

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Serotonin Syndrome

Serotonin syndrome, a drug poisoning caused by excessive serotonin in the brain, has made the news again. This is a serious drug reaction that people who take SSRI antidepressants and/or triptans should be aware of. Despite the hype, rest assured that serotonin syndrome is rare in people with headache.

The most important step to prevent serotonin syndrome is to give all your health care providers a complete list of all the drugs that you take — not only prescription meds, but OTCs, supplements and recreational drugs. Today’s NY Times article lists a variety of drugs that can contribute to serotonin syndrome.

When you are given any new prescription or supplement, double-check if it increases your risk of serotonin syndrome. Triple-check this with your pharmacist when you pick up the drugs, whether they are prescription or OTC.

According to the Mayo Clinic’s website, “Signs and symptoms of serotonin syndrome typically occur within several hours of taking a new drug or taking a previously used drug at an increased dosage level. . . .”

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Headache & Migraine News

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.

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Serotonin Syndrome: Don’t Panic!

The FDA issued an alert yesterday about the possibility of serotonin syndrome when people on antidepressants use triptans. Yes, serotonin syndrome is potentially life-threatening. It is also rare under these conditions and is usually caused by high doses of meds.

“Serotonin syndrome can occur when medications are mixed; usually this would require a very high dose of an anti-depressant and injectable Imitrex.  Usual doses of SSRIs and oral or nasal triptans rarely cause the syndrome — there have only been a handful of cases reported,” said Dr. Christina Peterson, a headache specialist and founder of HEADQuarters Migraine Management and Migraine Survival, in an e-mail.

The February/March issue of the HEADQuarters newsletter describes serotonin syndrome, what causes it, its symptoms and who is at risk for it. The newsletter also lists the medications associated with serotonin syndrome.

If you check Google News for “serotonin syndrome,” you’ll find a long list of articles that will likely freak you out. Here’s the Associated Press release that most of the stories are based on. WebMD and the Mayo Clinic have stories that aren’t too alarmist. To really scare yourself, check out the FDA health advisory. It’s all the same information, it’s just presented differently.

If you think you may be at risk for serotonin syndrome, don’t just stop taking your antidepressants. Not only should you get your doctor’s input before making such a decision, you need to taper off antidepressants to avoid withdrawal symptoms (which can include nausea, dizziness, trouble sleeping, shaking or nervousness, sweating, trouble thinking and concentrating).