Cox 2 and prostacyclin
June 6, 2005 9:32 am
Research on the Cox-2 class of drugs continues. Researchers at the University of Pennsylvania School of Medicine studied the effect of Cox-2s on the wall of blood vessels. There is a fatty acid that comes from Cox2s called prostacyclin, which controls the response of the muscular wall of blood vessels. When that fatty acid is depleted, the blood vessels can't react to things like high blood pressure. It seems that Cox-2 drugs can help to predispose people to high blood pressure and heart attack risk, even when the patient was at low risk to start with.
Hopefully studies like this will help doctors know when and how to use this type of medication. For more on this story, read this article from AScribe.
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Cancer, aspirin and ibuprofen
June 6, 2005 1:36 pm
So what's the story with aspirin and ibuprofen? First they were telling us that they may have cancer-fighting properties. But a new study tells a different tale.
The research at the University of Southern California in Los Angeles, USA involved 114,460 women. The study followed the women from 1995 to 2001, and some interesting discoveries were made:
* Women who took ibuprofen every day for 5 years or more were 50% more likely to be diagnosed with breast cancer.
* Women who took aspirin every day for 5 years or more were slightly less likely to be diagnosed with the common breast cancer, but 80% more likely to be diagnosed with breast cancers that were not sensitive to the hormones estrogen or progesterone.
These findings are at odds with other papers that have been done on the subject. It's a long way from showing us what is actually making the difference, and it in no way proves that ibuprofen or aspirin cause cancer. American Cancer Society scientist Michael Thun even suggested that the findings were simply a fluke.
However, it does indicate that further study is needed on the long term effects of these medications. It also casts serious doubt on the belief that these are cancer-fighting drugs. For more on the study, read "Study links pain relievers and breast cancer" in USA Today.
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Menstrually-Related Migraines trial
June 6, 2005 9:57 pm
They're a huge problem - menstrual migraines. You've probably heard about tennis pro Serena Williams, who is doing the rounds promoting Endo Pharmaceuticals' Frova (frovatriptan) for menstrually related migraines (MRM). Frova is yet another triptan that does work well...for some people. But new treatments are needed for those who still aren't finding relief.
A new study is being done, and if you live in the USA or Canada you can be a part of it. You need to be 15 years old or older, you must be diagnosed with MRM, and you must have had at least two MRM attacks in the last three months. To find out if you qualify to try this new oral treatment, just call [trial has ended]. You could be part of a new treatment for many women out there.
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Chiropractic and headache
June 8, 2005 8:01 am
You've been seeing more and more information on non-drug treatments for headache here. One notable addition over the past few days is an interview with Canadian chiropractor, Dr Michael Kricken.
If you've been considering chiropractic care, or you've tried it and have been disappointed, I highly recommend you read this article. It will give you a better understanding of what chiropractic can do related to headache, how to find a good chiropractor, and what else you can do along with chiropractic care to end headaches. Read about Chiropractic and headache here!
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Keeping track of medications
June 10, 2005 4:24 pm
The Mayo Clinic has an excellent health newsletter called HealthQuest. It contains some very practical tips for medications, various common conditions, and simple healthy living and eating tips. I thought that their tips for a medication log would be helpful to many readers here.
When you're taking multiple medications (and I include herbal remedies and other supplements), sometimes it's hard to remember what the differences are - when you should take them, when they expire, and so on. This can get especially tricky if you have an upset in your schedule. To make a medication log, the newsletter suggested that you make a chart with these headings:
* Name of medication
* Prescribed by (name of doctor)
* Date prescription filled
* Expiry date
* What it's for
* How long it should be taken
* Dosage (how much, when, how many times a day)
* How to take it (with food? empty stomach?)
List of medications that caused an allergic reaction or other side effects (If I understand correctly, this would be a seperate list)
I would add that you should also keep track of common interactions. For example, if you shouldn't take this herb along with aspirin, or if you should avoid alcohol. This list will also help others help you in case of emergency.
The Mayo Clinic also has email newsletters, such as the Mayo Clinic Health Letter and the Mayo Clinic Women's Health Source.
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Love lavender?
June 11, 2005 9:38 pm
You go into the health store and see rows and rows of essential oils. You've read the explanations on this website about what aromatherapy is, and what kind of oils to buy. But there are just so many choices!
When it comes to research, one of the best herbs for headaches seems to be lavender. Lavender has been used for 200 years to treat various conditions. Today it's one of the most common for headache, when it comes to aromatherapy. It's used to relax, and to treat insomnia, which is important for most headache sufferers. Lavender is also used in various forms to treat some skin conditions such as eczema, though one study recently suggested that the therapeutic effect of massage was helpful with the oil or without.
In some countries, such as France and Germany, lavender is eaten or sipped in tea. As a tea in Germany it has been approved for use for restlessness and stomach irritation, according to a 2002 article at the University of Maryland Medical Center.
Side effects and irritations are rare when it comes to lavender, which makes it an excellent herbal choice. Still, pregnant and nursing mothers should avoid it, and you should always check with your doctor if you're taking actual doses of it internally.
Ok, so it will help you relax and should ease that headache. But hold on to your hat. Research by Dr Alan Hirsch, a neurologist and psychiatrist in Chicago, suggests that the scent of lavender may also be one of the best for male sexual desire. But not lavender by itself - lavender and pumpkin pie. Not sure that you'll see that combination in the health food store any time soon!
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Migraine as a disability
June 14, 2005 6:04 am
It's the latest news out of Virginia, USA. Carin Manders Constantine was taking her constitutional law final exam, but asked for extra time. Why? Migraine. The school (George Mason University) refused, and she failed.
Of course, the whole thing is more complicated than that, and I don't know all the details of the case. But I do know that this brings up some very important issues about migraine and disability. It certainly is time that migraine was treated like the disability it truly is. But what does that really mean in practical terms? There are a whole host of things that need to change before that can really become a reality. How can schools be fair to students and at the same time take into consideration diseases like migraine?
At this point, Carin is winning. The lawsuit was rejected, but in appeals court reinstated. Carin is in Florida now, and is preparing to take the Florida bar exam.
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Migraine muscle surgery
June 21, 2005 7:15 am
Surgery certainly isn't the first thing to try to relieve migraine, or even the second or third. But for those who really have tried everything else and just can't get relief, some types of surgery may be the way to go.
That was the situation Arlene from Cleveland was in. At 53, her symptoms just seemed to be getting worse, and medication did little more than take the "edge" off the pain. So, she went to Dr Bahman Guyuron, a professor of plastic surgery at Case Western Reserve University. He did an operation which involved removing tiny bits of muscle to relieve the stress on the nerves. Areas targeted include around the temples, forehead, neck and other parts of the face. Three years later, Arlene is almost migraine free - she's gone from a few attacks a month to a few a year.
For more on Arlene, and Dr Guyuron's particular brand of migraine surgery, check out this article from The Globe and Mail.
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Will Botox work for you?
June 23, 2005 8:35 am
This month Dr David Dodick reported that Botox didn't work as well as all the hype said it would. Botox is one of the latest and hottest treatments for migraine, but when he tested 355 patients with Botox and a placebo over 11 months, he didn't find the amazing improvements you might expect. Well, for most people he didn't. But there was a small group that did improve - their attacks were less frequent and less severe - exactly what you might hope.
Who was this group? It was the group that was the worst off - the ones who had the most migraine attacks, the worst migraine attacks, and the ones who had to take more medicine to find relief. The more chronic and painful your migraine attacks, the more you may benefit from Botox treatment. For more, read this article on Botox migraines treatment.
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Zolmitriptan for kids
June 23, 2005 8:55 am
Researchers reported this month on another study on children with migraine. It was a meeting of the American Headache Society in Philadelphia, USA. This particular study was on zolmitriptan nasal spray.
Dr Paul Winner's team studied 248 children ages 12 to 17. Within only an hour, 51% were able to resume their normal activities, and 28% were pain-free. After 2 hours, 39% said they were pain-free.
These are very encouraging results, considering the fact that there are many triptan class drugs to chose from, and none of them work for everybody. More studies will follow, as we try to understand how to treat the many children with migraine. The American Headache Society estimates 8-12 million children in the USA alone suffer from migraine, a huge chunk of the population.
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NSAIDs - better and worse than we thought
June 24, 2005 9:36 am
As the Cox-2 debate continues, other NSAIDs (nonsteroidal anti-inflammatory drugs)are coming under the microscope. And guess what? There's good news and bad news.
NSAIDs are still safer than many other drugs, as far as we know. But there is increasing concern about some of the heart risks, even in "traditional" NSAIDs, on top of the concern about stomach problems. It's all a good reminder that even though a drug may be "generally safe", that doesn't mean you can take it as much as you want and not do damage.
There is good news, however. Rami Burstein, an associate professor at Harvard Medical School and vice chairman of research of the Department of Anesthesia and Critical Care at Beth Israel Deaconess Medical Center authored a study on use of NSAIDs for migraine in the emergency room. The conclusion of the researchers was that intravenous NSAIDs (ketorolac - brand name Toradol) were as effective (if not more) as the narcotics that are often given to migraineurs. Compared to the narcotics, the NSAIDs are considered to be safer and are also less habit forming. But the dosage had to be intravenous to properly work on the nervous system.
According to a 1998 study, over half of migraineurs are given narcotics without even being told of their other choices. There are more and more options, most of them safer.
The patients in Burstein's study had allodynia - a hypersensitivity of the skin that often occurs with migraine. Previous studies indicate that triptan class drugs aren't very effective in these cases. 64% of patients were pain free within an hour of getting the ketorolac. The others all had a history of using opioids. "This immediately raised a red flag regarding treating migraine patients with opioids, which we believe is wrong practice," Burstein said. May this be another step to better treatments.
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Anti-convulsant warning
June 27, 2005 6:44 pm
A doctor from the USA wants to send out a reminder. Dr. Kimford Meador is a professor of neurology, and director of the epilepsy program at the University of Florida in Gainesville. The concern is with anti-convulsant drugs, many of which are used to treat migraine. This would include drugs like phenobarbitol and valproate (Depakote).
The problem? Risk of birth defects, such as cleft palate, spina bifida, or heart defect. There seems to be some risk with all anti-convulsants, but the risk with these drugs can be around 5-10% - pretty significant.
That's all very well, but what do you do, just stop taking the drugs? No. These are preventative drugs that are not only taken for migraine but also for dangerous seizures and bi-polar disease. You shouldn't go off them without talking to your doctor.
However, for most patients there is a viable alternative, usually a less dangerous anti-convulsant drug for the time when you are pregnant. Ideally, it's best to start on a new drug 6 months before conception, so you can be sure your body is reacting well to the drug.
If you're pregnant or trying, and taking anti-seizure meds, there are two things you should do right now:
1. See your doctor, and discuss your options.
2. If you live in the USA or Canada, visit the Antiepileptic Drug Pregnancy Registry, where you can be a part of a study on pregnancy and anti-convulsants. See a list of the drugs here that qualify in the study. Best of all, there are prizes to be won by the participants (who can complain about that?). I could use the DVD player, but I'm not a woman, and I'm not pregnant. Are you?
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Free migraine leaflet
June 28, 2005 7:24 am
If you live in Ireland (and, actually, even if you don't) you can make good use of the new leaflet on migraine put out by the Migraine Association of Ireland. This leaflet is an excellent summary of migraine, its types, treatments, and theories about its causes. [note: this leaflet is no longer available. Visit the link above for other migraine information]
Be sure to visit the site and poke around - you'll probably come away with better understanding than you came with. The association is 11 years old, and still growing strong.
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