What Should Work, What Might: Migraine Meds Reassessed

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New Studies Re-assesses Migraine Drug Efficacies (1)

Efficacy of migraine drugs was under another new review from researchers who have examined all of the scientific literature available on the treatment as well as followed up on migraine patients and the scientists have come up with what in their view prove effective in acute cases of migraine. Besides these 2 criteria the study was also based on the depth of the published research done on the medications as well as the quantum of studies on them.

The conclusions of the new study at a glance are:

DEEMED EFFECTIVE (LEVEL A) PROBABLY EFFECTIVE (LEVEL B)
TRIPTANS – Sumatriptan, Zolmitriptan, Rizatriptan, Frovatriptan, Almotriptan, Naratriptan, Eletriptan, Avitriptan OPIOID – Codeine+Acetaminophen, Tramadaol+Acetaminophen
Dihydroergotamins
NSAID – Aspirin, Ibuprofen, Naproxen
OPIOID – Butorphanol Nasal Spray
Caffeine with NSAIDS

Findings of the study were published in the January 2015 issue of the medical journal Headache. As per Dr. Stephen Silberstein , professor of neurology and director of the Jefferson Headache Center of Thomas Jefferson University in Philadelphia, “We hope that this assessment of the efficacy of currently available migraine therapies helps patients and their physicians utilize treatments that are the most appropriate for them.” (2)

Based on the study criteria, drugs were thus rated as deemed effective (Level A), probably effective (Level B), possibly effective (Level C). For such medications where the proof was found either inadequate or gave such results which refutes the use of that medicine, was classified as Level U. For a drug to be classified as deemed effective or a Level A drug, the studies done on the drug must be supported by at least well-designed, double-blind, randomized, placebo-controlled clinical trials.  (3)

The American Headache Society will soon be translating the research findings that will aid in providing evidence-based guidelines to clinical practice. In any case, doctors treating migraine patients must consider the individuals on a case to case basis keeping in view the drug side-effects, patient history, costs and drug efficacy.

SOURCES

  1. Image credit: Pills and Capsules – Stock Photo; freedigitalphotos.net; Web February 2015; http://www.freedigitalphotos.net/images/pills-and-capsules-photo-p308698
  2. Study Rates Migraine Medications; WebMD.com; Web February 2015; http://www.webmd.com/migraines-headaches/news/20150120/study-rates-migraine-medications
  3. American Headache Society Provides Updated Assessment of Medications to Treat Acute Migraine; Newswise.com; Web February 2015; http://www.newswise.com/articles/american-headache-society-provides-updated-assessment-of-medications-to-treat-acute-migraine

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Drug Effectiveness & Power of Suggestion: Migraine Study

Role of Self Suggestions In Migraine

Doctor’s Words Affect Migraineurs’ Response To Drug (1)

A recent study conducted by researchers from Harvard Medical School and Beth Israel Deaconess Medical Center in Boston on migraineurs has shown that the type of labeling on the drug affects the body’s response to pain, nausea, photo-sensitivity, sound-sensitivity as well as vomiting (symptoms associated with a typical migraine attack).

According to Dr. Andrew Charles professor and director of the headache research and treatment program in the department of neurology at University of California School of Medicine, Los Angeles, who was not involved in the research, “When migraine patients were told by their doctor that a pill would help ease their headaches, this advice seemed to produce results whether or not the pill was a real migraine medication or a dummy placebo. Relief was still higher with the actual medicine, so drugs do work beyond the placebo effect, but the researchers say that the placebo effect may still account for half of the therapeutic value of a drug.” (2)

The research studied over 450 migraine attacks in total of 66 migraineurs over a period of their seven attacks.

  • The first attack was to go untreated but the migraineurs were expected to self-rate their pain and migraine-associated symptoms on a scale.
  • From the second attack up to the seventh attack the migraineurs were given medication (pills) in packets that were labelled.
  • The packets were labelled ‘Maxalt’ (Rizatriptan) – positive suggestion ( a drug that will help); ‘Placebo’ – a negative suggestion (drug with no effect on pain); ‘Maxalt or placebo’ – neutral suggestion (unknown if the drug will help or not).
  • But for two situations, one of the “Maxalt” envelopes actually held a placebo and one of the “placebo” envelopes contained Maxalt.
  • The migraineurs were to record the level of pain and discomfort 30 minutes from the onset of the migraine attack (for each of episode 2 through 7th episode)
  • Then they were to take the pills in the labelled packets.
  • Then they were to record their pain and discomfort two our thence ( A total of 2.5 hours after the commencement of a migraine attack)
  • In addition, they were also given a rescue medication in the event that the study medicines did not provide them with any relief. This rescue medication consisted of 1 Maxalt and 2 Naproxen tablets.
  • But for two situations, one of the “Maxalt” envelopes actually held a placebo and one of the “placebo” envelopes contained Maxalt.

Here is a chart depiction of the study methodology: (3)

Migraine Placebo Effect

As per Dr. Ted Kaptchuk, a senior author of the study, director of the Program in Placebo Studies, Beth Israel Deaconess Medical Center, and a professor of medicine at the Harvard Medical School, “We found that under each of the three messages, the placebo effect accounted for at least 50 percent of the subjects’ overall pain relief. When Maxalt was labelled “Maxalt,” the patients’ reports of pain relief more than doubled compared to when Maxalt was labeled “placebo.This tells us that the effectiveness of a good pharmaceutical may be doubled by enhancing the placebo effect.”

The authors were surprised to find that even when patients were given a placebo labeled as “placebo,” they reported pain relief, compared with no treatment. They had no idea why this occurred.

However, the findings of the study are best used for indicative purposes only and more research will be needed to be done to find out these results could be applied to clinical care and how placebos might help boost drug treatment care. As per Kaptchuk it is possible that simply hearing the words of medicine can have a healing effect, he noted.

SOURCES:

  1. Image Credit: Help Yourself Key Shows Self Improvement Online; Image by Stuart Miles; Freedigitalphotos.net; Web January 2014; http://www.freedigitalphotos.net/images/help-yourself-key-shows-self-improvement-online-photo-p211446
  2. Power of Suggestion Shown in Study of Migraine Drug; WebMD.com; January 2014; http://www.webmd.com/migraines-headaches/news/20140108/power-of-suggestion-revealed-in-study-of-migraine-drug
  3. Table Credit: Placebo effects are not the “power of positive thinking”; Science-Based Medicine; Web January 2014; http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-placebo-effects-again/

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New Guidelines from American Academy of Neurology On Reduction of Migraine Frequency

New guidelines or strategy if you will, have been chalked out and released by scientists at the American Academy of Neurology in conjunction with the American Headache Society on the approach migraineurs should take to reduce the frequency of their attacks. These guidelines have been released just this week and basically are a little different from the previous guidelines in terms that they reduce the ranking of certain migraine drugs (such as Verapamil and Gabapentin) which were highly recommended in the last guidelines due to evidence gathered against them. In addition, the new guidelines are based on evidence-based research on a larger population than were done for the last set of guidelines covering various demographics – gender, races etc. (1)

Want Fewer Migraine Attacks? Follow a Preventative Regimen Everyday (2)

As per the neurologists, almost 38% of all migraineurs should follow a preventative strategy to reduce the number of their migraine episodes. But only a third of that percentage followed a daily preventative regimen with the rest of them only resorting to band aid approaches and tackling the pain once they are in the throes of a migraine attack or are expecting one within a few hours. The approaches they often took were such as were not proven effective in scientific testing before.

According to Mark Green, MD, director of the Headache Center at Mount Sinai School of Medicine, in New York, “What the guidelines do is pinpoint first-line treatments based on evidence and effectiveness.  If these guidelines are used widely, we will be able to up the odds of reducing headaches by 50 percent. Moreover, the stakes may be high if we undertreat migraines. Evidence is building to suggest that if we allow migraines to progress, the frequency of attacks may increase, and they may also become harder to treat” (3)

Here’s a quick look at what the evidence-based preventative guidelines suggests to migraineurs:

  1. First line prescription drugs must be taken on a daily basis to bring down the number and intensity of the attacks.
  2. Effective For Prevention: Anti-seizure medications Divalproex sodium, Sodium valproate, Topiramate, Metoprolol, Propranol, Tumolol.
  3. Effective Herbal Preparations: Butterbur / Petasites.
  4. Probably Effective: Nonsteroidal anti-inflammatory drugs or NSAIDS such as Fenoprofen, Ibuprofen, Ketoprofen, Naproxen, Naproxen Sodium, Subcutaneous histamine, Complementary treatments, Magnesium, Riboflavin, Feverfew.
  5. Found Not Effective: Anti-seizure drug lamotrigine was not effective in preventing migraine.

SOURCES:

  1. New Guidelines Assert That Daily Preventive Therapies Significantly Reduce Migraines; Newswise; April 2012; http://www.newswise.com/articles/view/588495/?sc=rsmn&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewswiseMednews+%28Newswise%3A+MedNews%29
  2. Image by Ambro; Freedigitalphotos.net; April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=1499
  3. New Guidelines: Treatments Can Help Prevent Migraine; American Academy of Neurology (AAN); April 2012; http://www.aan.com/press/index.cfm?fuseaction=release.view&release=1062

Video of the 2012 AAN Conference may be accessed at:

  1. 2012 AAN Press Conference: New Guidelines on Preventing Migraine Headache; YouTube.com; April 2012; http://www.youtube.com/watch?v=LoKPwq9JcKE&feature=g-upl&context=G2423319AUAAAAAAAAAA

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