Tag: painkillers

Community, Meds & Supplements, News & Research, Treatment

Potential Liver Damage When Combining Caffeine and Painkillers

Kerrie Smyres

My response to Painkillers, Caffeine May Cause Liver Damage, a post on Somebody Heal Me, was much stronger than “Oh darn.”

[P]reliminary research indicates that people who take in large quantities of painkillers containing acetaminophen [Tylenol] and ingest large amounts of caffeinated beverages may be at increased risk for liver damage. Migraine medications that intentionally mix acetaminophen and caffeine are also suspected of increasing the risk of liver damage when taken in large quantities. This would include over the counter medications such as Excedrin and prescription medications such as Fioricet. The danger is similar to that of consuming alcohol and acetaminophen, which scientists have warned about for many years.
(emphasis mine)

Knowing how effective acetaminophen and caffeine are for many people with headache, the research deserves consideration. I’m especially interested what role drinking caffeine (or eating caffeinated doughnuts) may play.

Caveat: This study used very high doses of both caffeine and acetaminophen. Still, the potential toxicity of acetaminophen — with or without caffeine — should not be overlooked. Overdoses of products containing acetaminophen account for 40 to 50% of all acute liver failure cases each year in the United States. If you ever take acetaminophen, please read Toxicity and Tylenol to understand the dangers.

Favorites, News & Research, Society, Treatment

“Potheads and Sudafed,” a New York Times Editorial

Kerrie Smyres

“Potheads and Sudafed,” a NY Times editorial that ran yesterday, caught the attention (and raised the ire) of About.com’s headache page guide, Teri Robert. The article addresses issues raised by the FDA’s denial of medicinal marjiuana’s efficacy. Columnist John Tierney writes of the conundrum:

Officially, the D.E.A. says it wants patients to get the best medicine. But look at what it’s done to scientists trying to study medical marijuana. They’ve gotten approval for their experiments from the F.D.A., but they can’t get the high-quality marijuana they need because the D.E.A. won’t allow it to be grown. The F.D.A. actually wants to know if the drug works, but the D.E.A. is following the just-say-know-nothing strategy: as long as researchers can’t study marijuana, they can’t come up with evidence that it’s effective.

And as long as there’s no conclusive evidence that medical marijuana works, the D.E.A. and its allies on Capitol Hill can go on blindly fighting it. Representative Mark Souder, the Indiana Republican who’s the most rabid drug warrior in Congress, has been pressuring the F.D.A. to crack down on medical marijuana. Last week the agency finally relented: in return for not having to start busting anyone, it issued a statement stressing the potential dangers and lack of extensive clinical trials establishing medical marijuana’s effectiveness.

For more information about the DEA’s stance, see this post.

FYI: The article is only available on the Times site if you have a paid subscription, but you can probably use your public library card to read it in a full-text newspaper database online. (The database I used is called ProQuest and I accessed it trhough the magazine and newspaper section of the library’s databases. These specific details are only applicable through my library, of course, but I hope they help you navigate your library’s website.)

Meds & Supplements, News & Research

Tylenol in Pregnancy Linked to ADHD in Kids?

Kerrie Smyres

Children of women who take Tylenol (acetaminophen) during pregnancy have a 37% increased risk of being diagnosed with ADHD and a 29% increased risk of needing ADHD medications over kids whose mothers didn’t take the drug while pregnant, according to a large-scale Danish study. This is a correlation, not proof of causation. The two factors occur together, but they could be entirely unrelated.

Scientifically, a single study showing a correlation should not be a cause for alarm. This is pregnancy we’re talking about, a time when women are extra cautious and extra worried about everything they ingest. As one of the study’s authors said,

“As a scientist, I never want to be alarmist and use one study [to make clinical decisions]. But as a woman, when I see something like that, I would be worried, and wouldn’t take Tylenol during pregnancy any more.”

For most women, this is a fine, if sometimes uncomfortable, option, but having a headache disorder complicates the issue. Not taking any medication during pregnancy could mean months of severe pain and symptoms like nausea and vomiting (which could also be problematic in pregnancy). Women are frequently told that acetaminophen (or occasionally opioid painkillers that include acetaminophen) is the only safe option. What if the safe option isn’t actually safe?

What’s the best choice — a horribly painful pregnancy or the possibility of impaired fetal development from taking medication? Whether you’re deciding if you should take painkillers or triptans, that’s a decision you can only make for yourself. Consider how a medication-free pregnancy would affect your life and talk to both your headache specialist and obstetrician about options. They are likely to give you conflicting opinions; you’ll either need to get them to talk to each other or choose the one you trust most on the issue.

The answer is never simple, is it?

Learn more about the study’s findings:

Meds & Supplements, News & Research, Symptoms, Treatment

Migraine Treatment News

Kerrie Smyres

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.

Meds & Supplements, News & Research, Treatment

News, News, News

Kerrie Smyres

There is never enough time for me to post about all that I want to write about. And there’s been a ton of headache news lately. Here are some highlights.

Detailed Results of Trexima Studies (the drug isn’t named in the study, but it looks like Trexima to me)

  • Neck pain and discomfort decreased significantly at two hours for the compound versus placebo in study 1 (35 and 44 percent) and study 2 (28 and 54 percent).
  • Sinus pain and pressure decreased significantly at two hours for the compound versus placebo in study 1 (19 and 33 percent) and study 2 (23 and 38 percent).(1)
  • More patients were pain free at two hours in both studies (52 and 51 percent) compared to placebo (17 and 15 percent) and sustained pain-free response was maintained for significantly more patients (45 and 40 percent), without the use of a rescue medication, to 24 hours, compared to placebo (12 and 14 percent).
  • The compound was effective in rapidly eliminating migraine pain, as measured by pain-free rates at 30 minutes, one hour, two hours and four hours.
  • Incidence of migraine associated symptoms (nausea, phonophobia (sensitivity to sound) and photophobia (sensitivity to light)) was lower with the compound than with placebo.
  • The compound was generally well-tolerated. In both studies, only nausea (3 and 4 percent) and dizziness (1 and 2 percent) were reported in at least 2 percent of patients who took the compound versus placebo (1 and 2 percent for nausea, 0 and < 1 percent for dizziness).

Confusion Over Safety Of NSAIDs For Pain Relief Leads Patients To Suffer In Silence
Almost two thirds of people surveyed (64%) said they were confused about what to take for pain relief because of conflicting information on drug safety that has emerged following the withdrawal of Vioxx (rofecoxib), a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) . Around 4 out of 5 (78%) said they didn’t know enough about the risks and benefits of medicines, whether prescribed or bought over-the-counter. Almost half (47%) said they weren’t using any painkiller medication at all for a number of reasons. Some were concerned about side effects, often after reading worrying news stories about painkillers, some had been advised to stop medication by their PCP and some thought they could manage without them.

Triple Therapy Synergy for Frequent Severe Migraine (registration may be required to read this)
The combination of behavioral migraine management, preventive medication, and optimal acute therapy appears to provide a superior reduction in migraine activity measures, functioning, and quality of life compared with any one alone, according to a study presented at the American Headache Society meeting here.

For these patients, “effective migraine management may require three components: a tailored acute therapy, preventive medication and behavioral migraine management to get the optimal results,” said Kenneth Holroyd, Ph.D., a professor of health psychology at Ohio University in Athens, Ohio, in an oral presentation.

Overweight Kids More Likely to Get Headaches
Children with headaches are 36 percent more likely to be overweight, results of the new research suggest.

“The numbers tell us that being overweight may contribute to kids having more headaches, most often migraines,” said Andrew D. Hershey, M.D., Ph.D., director of the Headache Center and a pediatric neurologist at Cincinnati Children’s Hospital Medical Center. “There likely are a number of causes, including poorer general health, body stress, lack of exercise and nutrition. It may not be that being overweight directly causes migraine, but that the reasons for being overweight cause these children to have worsening headaches.”

Magnetic Device Short-Circuits Migraine Headaches, Suggests Early Research
A hairdryer-sized magnetic device held briefly to the back of the head may short-circuit migraines before the pain starts, suggests preliminary research being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

People With Near-Daily Migraine Headaches Get Relief From Anti-Seizure Drug
An anti-seizure medication “quiets the brain,” providing relief to people with near-daily migraine headaches, suggest results of a randomized, multi-center study being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

FDA OKs the Pain Drug Opana
The drug, called Opana, is an opioid pain reliever taken by mouth. It will come in an extended-release form, called Opana ER, and an immediate-release version, simply called Opana.

The drugs contain oxymorphone hydrochloride, which was previously only available by injection. Endo Pharmaceuticals plans to relaunch the drug’s injected version for hospital use under the new trade name.

If you know of an article that I missed, please add it to the comments. Thanks!