Prescribing power for pharmacists
June 2, 2006 1:35 pm
An interesting development is taking place in the province of Alberta, in Canada. A law passed on May 31, 2006 gives pharmacists new power to prescribe drugs, without the involvement of a doctor.
Starting in the fall, pharmacists who complete a special training program will be able to prescribe certain drugs, and also administer vaccines. This is something pharmacists have long wanted, a survey in 2002 showing that 96% felt they should be allowed to prescribe drugs. The move is largely focused on drugs for chronic illness. Since chronic illness is such an expense on the system, it's hoped that the move will make the system all around more efficient. Read about the pharmacist prescription law here.
This is a first in Canada. Pharmacists in a couple other provinces are allowed to prescribe emergency contraception, but that's all.
Would you welcome such a policy in your area? Would you feel comfortable having a phamacist prescribe your medication? Are there situations where this would help you get help faster?
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Depression and Migraine Study
June 6, 2006 7:58 am
I've never mentioned this study, published in 2003, but it may help us clarify the relationship between headache, migraine and depresssion. Dr Naomi Breslau, of the Henry Ford Health System in Detroit, headed up a two year long study, which was published in the journal Neurology.
Dr Breslau and her team interviewed 1186 people - about 42% had migraine, 13% had severe headaches, and 45% had no history of headache or migraine. So the question was, who had suffered major depression?
We already know that there's a link between migraine and depression, and this study confirmed it. 42% of migraine patients had experienced major depression sometime in their lives. But there were some interesting findings beyond that which caught my attention.
First, although a large percentage of the headache (non-migraine) sufferers had also suffered from depression, the numbers were far lower that with migraine - 36%. This seems to lend credence to the belief that there's a biological factor here, it's not just a psychological response to the suffering. Only 16% of the non-headache/migraine group had suffered from major depression.
It also may come as a surprise to some people that the numbers were so low. Not even half of the migraineurs had ever had major depression. Of those that did, it was not necessarily constant, just "some time in their lives". Although the link is clear, the belief that all migraineurs are depressed just doesn't hold up.
Dr Breslau has studied migraine and depression for a number of years. In 1994 she published a study which confirmed her belief that migraine and depression were bidirectional - each one seemed to make the other worse. This study showed also that people who had major depression tended to get migraine attacks, even though they had never had one when first interviewed.
These are still only basic studies - much more needs to be done to understand exactly how this relationship works, and what can be done about it. Read more about the "Comorbidity of migraine and depression".
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Trexima in the quagmire
June 10, 2006 8:21 pm
Yes, the new drug Trexima was supposed to be out sometime soon. But the FDA (in the USA) wants more information about just how safe the drug is, and that could mean more studies and trials and tests. If that's really the case, we might not see it for months - even years.
Pozan, the makers of Trexima along with GlaxoSmithKline, were originally working on a drug called MT 100, when the FDA asked for more safety trials. Rather than taking the time, Pozen changed its focus to Trexima, and things were looking pretty positive until the FDA's announcement on Friday. This was not good for Pozen's shares, and not good for migraineurs who were hoping for great things in Trexima. As I said back in February, there's nothing else quite like it out there, even though it contains drugs already available.
Read more about Trexima and its ingredients here.
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Tyramine - correction
June 22, 2006 10:12 pm
Special thanks to Dawn, a HeadWay subscriber, who caught a mistake in the last issue of our free e-zine.
I called tyramine an amino acid, which it is not (as far as I understand it!). But it is related. If I've got it right this time, it's actually called an amine or monoamine, an organic compound which helps to make up the various kinds of amino acids. In this case, as Dawn said, tyramine "is actually a breakdown product of Tyrosine, which IS an amino acid".
Dawn is a former biochemistry student, which is a good thing because this is not a simple topic. In fact, I found a number of sources that called tyramine an amino acid, both online and off. It can get pretty complicated, because when we're dealing with cluster headaches or migraine, we're often talking about chain reactions - one thing is a breakdown of another, which leads to the creation of this, which triggers that. It can be easy to get mixed up about what comes next in the chain, and which molecule is which!
It doesn't really make an immediate difference what you call it - if you avoid it in your diet, and if it helps you, great! But it's important to be accurate because the better we understand the details, the closer we'll be to finding solutions, instead of chasing shadows. Thanks, Dawn!
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Cardiovascular disease and migraine
June 26, 2006 1:40 pm
The connection between cardiovascular disease and migraine - how far does it go? We've talked here before about the connection between migraine and stroke, the connection between migraine and the heart defect known as Patent Foramen Ovale, and so on. E.N. Liberopoulos and D.P. Mikhailidis have suggested another possible connection for treatment purposes, and they're calling for research to be done.
Their article in Headache revolves around a type of drug known as a statin. Statins are a type of lipid reducing drug, called hypolipidemic drugs, which are used for coronary heart disease, specifically to deal with cholesterol issues.
The researchers report on a patient who had frequent migraine attacks. When this person went on a statin drug, the attacks vanished. Now, that's right, we're talking about one (1) patient here. However, it is enough to make you sit up and take notice, especially when we're discovering more and more that there is an important link between migraine, especially migraine with aura, and heart disease. This could be a life-saving study, because not only would migraine issues be resolved, the related (and potentially fatal) heart disease issues could be fought as well. This one's worth watching.
Here's more in the article Statins may be useful in treatment of migraine headache.
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US Soldiers in Iraq getting migraine...
June 30, 2006 8:30 am
Now here's an interesting article for your Friday reading. Or whatever day you're reading this. Apparently American soldiers in Iraq are getting far more migraine attacks than most people.
At first glance you'd think that the trauma of combat would be the cause. This is one of the suggestions of Drs Erickson and Theeler at the Madigan Army Medical Center at Fort Lewis, Washington. But they suggested a number of theories - in other words, we're just not sure.
The soldiers not only had more attacks while in Iraq, they also had more migraine attacks in the months after they returned. Why? Interestingly, the overwhelming majority in the survey were male; males generally get less migraine attacks than women.
The other thing that was noted in the survey was that many of those that had migraine were not using the standard triptan treatment. So the question is raised - are they getting the treatment they need?
(Note: I often see this used as a measure of how well people are being treated - whether or not they're taking triptans. It's true triptans have helped many people, but this can be deceiving. It doesn't note whether or not they've tried triptans, or if they've gotten good treatment in other ways. Many people have found excellent help without triptans. This is an interesting measure, but not the only measure.)
In the end, it seems that migraine is a major problem for American military in Iraq, and by extension may be a problem for military posted in various areas from other countries. The reason why it's such a problem is unclear. But as in any vocation, migraine is a serious problem which cannot be ignored.
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