by admin | May 9, 2012 | Medication
Treating Migraine with Medication
Mild Analgesics in the Treatment of Migraine
If you have mild migraine attacks, your migraine headaches may respond to over-the-counter medications. However, these should be taken in moderation as excess doses can increase headache frequency and severity. International Headache Society recommendations are to limit the use of over-the-counter medications to no more than 15 days a month, which averages out to three days a week.
The frequent use of over-the-counter medications can also result in other problems if used year over year. Acetaminophen (paracetamol) can cause liver damage if overused. Non-steroidal anti-inflammatories such as ibuprofen can result in stomach irritation, and can contribute to risk of heart disease. Long term excessive use of either type of over-the-counter medication can result in kidney damage.
Migraine Prescription Medications
Most migraine sufferers have attacks that are moderate or severe. These usually do not fully respond to over-the-counter medications. Fortunately, there are a variety of migraine-specfic medications designed to abort an acute migraine attack. If you have tried one or two, there may still be others that would work. Sometimes, pills do not work fast enough, as it takes at least 30 minutes for a pill to get from your stomach to your bloodstream. If this has happened to you, be aware that there are migraine-specific medications in both injectable and nasal spray forms.
Migraine and Medication: Prevention
Until we learn more about the primary prevention of headache disorders, medications remain the mainstay of treatment. Learn how to most effectively manage your headaches with medication when trigger management and lifestyle management are not adequate to keep your headaches at bay. At present, preventative medication therapy is under-utilized in the management of migraine headache. If you have three or more days of disabling headache per month, migraine prevention may be helpful for you, and you should discuss this with your physician. Even if you have as few as two disabling headache days a month, but cannot use triptan medications to abort them because of other medical conditions, you may be a candidate for migraine prevention medication.
There are many preventive medications. Even if you have tried three or four, there are likely to be other medication options available.
by admin | Apr 18, 2011 | Medication
Can painkillers affect how well other migraine medications work?
Migraine patients who used opiate medications first were found to have a less effective triptan response than those who did not use opioid painkillers (also called opiate or narcotic analgesics). This was consistently found in seven different studies of rizatriptan (Maxalt®). The authors of this review concluded, based on these results, that the recommendations to use triptans as first-line treatment rather than using narcotic painkillers are confirmed.
Studies of Opioids and Triptans
The authors reviewed seven studies of rizatriptan that had been done in order to assess the medication for safety and effectiveness prior to submission to the US Food and Drug Administration for approval. (These are called phase 3 studies.) In all seven of these studies, subjects were instructed to wait and treat attacks that were moderate to severe. Altogether, there were over 2000 individuals in these studies who received the active drug, rizatriptan, and not placebo. (In some studies, both rizatriptan and sumatriptan were compared to placebo, but this did not affect the results reported here.)
In addition, the authors reviewed the results of two studies designed to look at the early treatment of migraine. Subjects generally treated a mild migraine with rizatriptan in these studies. Recent prior opiate use was based on medication use reported in the 30 days previous to the study. About 13% of subjects in the moderate-to-severe migraine treatment studies and about 5% of the subjects in the early treatment migraine studies reported recent use of narcotic painkillers. There were fewer study subjects who had recent prior opiate use that achieved pain freedom at the two-hour mark than those who had not used opioids.
In other words, the people that did not use narcotic painkillers were more likely to become pain-free at two hours. This data is retrospective—a look back at the information, and this is never as powerful as what we call a prospective study. But, as the authors of this study comment, this does suggest that a prospective study would be useful to gain further insight into the effect of opiate analgesics on the effectiveness of triptans in the treatment of migraine attacks.
reference:
Ho, T, Rodgers, A, Bigal, M. Impact of recent prior opioid use on rizatriptan efficacy. A post hoc pooled analysis. Headache. 2009;49(3):395-403.
by admin | May 13, 2010 | Medication
Common side-effects of opiate analgesics
Opioid analgesics, which are also commonly called narcotics or opiates, are derived from the medicinal poppy and have been with us for centuries as a means of relieving pain. Only recently have we begun to unravel some of the deeper secrets of exactly how these medications may affect us at a cellular level.
The more common side effects of these painkillers are probably pretty well-known to most who have taken these medications: constipation, sedation, itchiness, urinary retention, nausea, and respiratory depression. What you may not know about is some of the less commonly discussed side effects of these commonly used pain medications.
One of the problems associated with opioid medications is suppression of the immune system. A variety of studies have found that chronic use of these medications is strongly associated with increased risk of infection or worsening or existing infection. This has been found to be true for both bacterial infections and for HIV/AIDS.
Another problem that can occur is called opioid-induced hyperalgesia. When this happens, pain increases despite increasing doses of opiate painkillers. This occurs because of chronic narcotic medication use, and occurs independently of allodynia. (Allodynia means you feel pain from touch or other stimulus which would not be painful normally.)
Less usual side-effects of painkillers
Chronic use of opioids can also result in hormonal imbalance, known in technical terms as hypogonadal hypogonadism. In men, this results in fatigue, depression, anemia, decreased libido, erectile dysfunction, and bone loss (osteopenia). This affects most men who are on a chronic opioid regimen or on methadone maintenance. This hormonal imbalance can also affect women, and results in fatigue, depression, anemia, decreased libido, menstrual and ovulatory difficulties, and bone loss.
In a few alarming studies, there is some evidence to suggest that there may be some effect of opioids to accelerate growth of some tumor types. Further follow-up studies are underway to confirm this possibility.
A new class of medications has been developed to combat some of the side-effects of opioids. These peripherally-acting mu-opioid receptor antagonists (PAMORAs for short) work outside the brain to block many of the more common side effects of opioids—and a few of the less common ones. The PAMORAs were developed to combat opioid-related constipation. Recent research suggests that they might have some ability to suppress viral activity in HIV and Hepatitis C, and to prevent the development of certain bacterial infections in ICU patients, although this very preliminary. Further studies are needed.
PAMORAs may also have the ability to block the tendency of opioids to promote the spread of tumor cells. Again, further research into this is in process. Will PAMORAs have a role beyond treating opioid-induced constipation? It’s far too early to tell. For now, though, you are more informed about opioids.
references
1. Portenoy RK, Forbes K, Lussier D, Hanks, G. Difficult pain problems: an integrated approach. In Oxford Textbook of Palliative Medicine 3rd edn. (ed. Doyle D, Hanks G, Cherny N, Calman K). 2004. p. 439. Oxford: Oxford University Press.
2. Wang J, Barke RA, Ma J, Charboneau R, Roy S. Opiate abuse, innate immunity, and bacterial infectious diseases Arch. Immunol. Ther. Exp. (Warsz.). 2008 Oct ;56(5):299-309.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18836861
3. Sacerdote P. Opioid-induced immunosuppression. Curr Opin Support Palliat Care. 2008 Mar ;2(1):14-18.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18685388
4. Wei G, Moss J, Yuan CS. Opioid-induced immunosuppression: is it centrally mediated or peripherally mediated? . Biochem. Pharmacol. 2003 Jun 1;65(11):1761-1766.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12781327
5. Peterson PK, Molitor TW, Chao CC. The opioid-cytokine connection. J. Neuroimmunol. 1998 Mar 15;83(1-2):63-69.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9610674
6. Weber RJ, Pert A. The periaqueductal gray matter mediates opiate-induced immunosuppression. Science. 1989 Jul 14;245(4914):188-190.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2749256
7. Moss J, Rosow CE. Development of peripheral opioid antagonists’ new insights into opioid effects. Mayo Clin. Proc. 2008 Oct ;83(10):1116-1130.[cited 2009 May 12] Available from: http://www.mayoclinicproceedings.com/content/83/10/1116.long
by admin | Sep 23, 2009 | Medication
Allergic Reaction or Medication Reaction — Do You Know What To Do?
You have taken your headache medication, and now you are feeling a little odd. Now what? Is it the medication? Is it part of the headache? Are you having an allergic reaction? How do you know, and what should you do?
This really depends on what you are feeling, how long you have been feeling this way, whether you have ever felt this way before, and on what you took. Here are some helpful facts.
Drug Allergies
True drug allergies occur in only 5-15% of people exposed to a given drug. Immediate reactions take place in 0-60 minutes; accelerated reactions take place in 1-72 hours, and a delayed reaction would be one that occurred in greater than 72 hours. Symptoms of a true drug hypersensitivity are fever, rash, and internal organ involvement, which could be breathing difficulty or involvement of the liver or blood, for example. Fever and rash are usually the first signs of medication allergy. If you experience this, stop the medication and call your doctor. If you develop breathing difficulty, you may need to go to the emergency room, or call 911 in North America or 112 in the EU.
There is a difference between a drug allergy and what is known as an adverse effect of a drug. Many medications have adverse effects—or what you might call a “side effect.” These are things that might be uncomfortable, but are not necessarily dangerous to you. For example, the triptan medications, commonly prescribed for migraine headaches, can cause a hot sensation in the head, or a tight or pressure sensation in the throat or chest. This can be alarming if you have not been warned to expect this, or have not experienced it before. These sensations, however, have nothing to do with your heart—this has been tested extensively. Believe it or not, even though you feel it in your chest, it is coming from your brain.
Sometimes, when you take medication for a migraine, it seems like you are getting nauseated. It is hard to tell if this is due to the medication itself, or if this is just the headache progressing. If this happens to you regularly, you might want to ask your doctor for anti- nausea medication.
In order to tell if the symptoms you are experiencing might be due to the pill you took, you can look at the package insert—the paper that comes with the prescription—and see if the symptom is listed. The problem here is that when the drug is tested prior to being marketed, all symptoms reported by the test population have to be listed, regardless of whether they were experienced by the people taking the experimental drug or whether they were experienced by the people taking the placebo (the “sugar pills”). This is what is listed in the package insert, as required by the FDA. Some package inserts will list a comparison chart of the drug group side effects alongside the placebo group side effects, so that you can sort this out better. So if it seems like a lot of fine print, this is why.
Medication Interactions
Many headache sufferers are on more than one medication. Mixing medications can result in drug- drug interactions. Often, your pharmacist will catch a potential problem when your prescription is filled. However, your pharmacist may not know about everything you are taking, especially if you are on herbal preparations. (See article on drug-herb interactions also.)
Foods can affect your medication as well—if you are on certain antidepressants, for example, you should not drink grapefruit juice. Also, sometimes the inert ingredients in medications can be a problem. If you are lactose-intolerant, some pills contain lactose, and this can create a problem for you. And finally, some of the orally-disintegrating tablets contain aspartame. If that is a migraine trigger for you, this could be a problem, although the amount in the tablet is so small it is probably not an issue unless you are very, very sensitive.
The best thing to do if you think you are having a reaction to a medication is to read the literature that came with the medication. If you are still concerned, call the pharmacy for advice. If the pharmacy is closed, and you are experiencing serious symptoms, call your doctor. If you are having difficulty breathing, go to the emergency department. The good news is that serious medication reactions are rare, and most are treatable simply by stopping the medication.
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