Migraineurs’ Likelihood Of Getting Stroke Graded

Migraine Blog Stroke

Migraineurs with Aura Double the Risk of Stroke…and more… (1)

A study conducted by the senior neurologists at the Loyola University Medical Center has put forth its findings that:

  • People who experience migraines with auras are at roughly double the risk of ischemic strokes.
  • The study also arrived at the shocking conclusion that such migraineurs as those who smoke were thrice as likely to have stroke in their lives.
  • Migraineurs who smoked and used birth control pills were 7 times more likely to suffer strokes.
  • Migraines also pegged a person’s risk of heart attacks and arterial claudication – a condition that causes poor circulation of blood in the legs and limb extremes causing pain.

The conclusion was put out after the results several independent studies were analysed. This meta-analysis has brought out the direct link between migraines and stroke risk. This and similar other studies have been discussed by lead neurologists Dr. Michael Star and Jose Biller M.D at the Loyola Medical Center in the chapter Headache and Migraine Biology and Management.

As per Drs. Star and Biller, “Taking all of these possible explanations into account, the research may point to stroke and migraine sharing a reciprocal causal relationship.” (2) Ischemic strokes or brain attacks cause brain cell death by the limiting or totally stopping the supply of blood to certain brain tissues. Most often an ischemic stroke can be caused by thrombosis or the obstruction of blood vessel by a blood clot forming locally. Almost 85% of all strokes are of ischemic nature (thus making them the most common types of stroke). Some evidence also exists showing a link between migraines and hemorrhagic strokes. Hemorrhagic strokes are caused by rupture of blood vessels of the brain and are considered the more deadly of stroke types.

So far the biology that exists and underlies the relationship between migraines with aura and strokes has been sketchy and poorly defined at best. According to the neurologists, “There is a significant amount of research attempting to further elucidate this multifaceted relationship.” (3)

Through these studies the researchers have proposed several explanations that could explain the linkage between migraines with aura and stroke occurrence:

  1.  Increased risk of cardiovascular diseases in migraineurs
  2. Low levels of HDL or good cholesterol in migraineurs
  3. High levels of c-reactive protein
  4. Presence of specific genes that predispose them to migraines and strokes
  5. Consumption of certain medications that pegs the migraineurs risk of stroke
  6. A phase-phenomenon that occurs in migraine attacks called cortical spreading depression during which strokes occur. During this phase there occurs a slowly propagated wave of depolarization, followed by depression of brain activity setting into motion changes in neural and vascular function.

SOURCES

1.     Woman Having Headache At Home; Stock Photos; Image by Marin; Web April 2015; http://www.freedigitalphotos.net/images/woman-having-headache-at-home-photo-p173634

2.     People who suffer migraine headaches may be at double the risk of stroke; Science Daily News; Web April 2015; http://www.sciencedaily.com/releases/2015/03/150324111326.htm

3.     People who suffer migraine headaches may be at double the risk of stroke; Loyola Medicine – Newswire; Web April 2015; http://www.loyolamedicine.org/newswire/news/people-who-suffer-migraine-headaches-may-be-double-risk-stroke

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Danger Of Ischemic Stroke In Older Migraineurs

stroke_isc_web Older Migraineurs Have Higher Chances Of Suffering Silent Brain Injuries – (1)

A new study published in the May 15th issue of American Heart and Stroke Association’s medical journal Stroke, suggests that older migraineurs have an double the risk of suffering from silent brain injuries and ischemic stroke than those who do not experience migraines.

Silent strokes can be asymptomatic i.e they do not show symptoms but increase the risk of future strokes. Silent stroke or a silent brain infarction is caused by a blood clot getting into the brain artery and thus interrupting the supply of blood, oxygen and nutrients to brain tissue surrounding the clot thus killing it.

As per Teshamae Monteith, M.D., lead author of the study, “I do not believe migraine sufferers should worry, as the risk of ischemic stroke in people with migraine is considered small. However, those with migraine and vascular risk factors may want to pay even greater attention to lifestyle changes that can reduce stroke risk, such as exercising and eating a low-fat diet with plenty of fruits and vegetables.” (2)

He raised caution that if an older migraineurs had other coexisting conditions like a high blood pressure (hypertension) or a sedentary lifestyle, it would add to the risk factor for suffering silent strokes and brain damage. He thus advised them to take medication to address hypertension and to bring it under control.

The study was a research on diverse ethnic groups including people of Hispanic and African origin. It was a collaborative investigation conducted by University of Miami and Columbia University.

Some of the highlights of the study were as follows: (3)

  • Approximate 40% of the population studied comprised of men.
  • The average age of the population was around 71 years old.
  • 65% of the population under study was of Hispanic origin.
  • Of the 546 studied, 104 had a history of migraines.

Some conclusions arrived at were as:

  • Risk of silent brain infarctions in those with migraine double even after adjusting other stroke risk factors.
  • Migraines with aura were not a deciding factor in measuring risk of silent strokes.
  • No real increase in the volume of white matter/ Small blood vessel anamolies was associated with migraines.
  • Some lesions came across in radiographic images as having ischemic origins but more research was required to confirm this.

According to Monteith, “We still don’t know if treatment for migraines will have an impact on stroke risk reduction, but it may be a good idea to seek treatment from a migraine specialist if your headaches are out of control. (4)

Previous studies indicated migraine could be an important stroke risk factor for younger people.

SOURCES:

  1. Image Credit: Ischemic stroke; Heart & Stroke Foundation – Canada; Web May 2014; http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484151/k.7916/Stroke__Ischemic_stroke.htm
  2. Older migraine sufferers may have more silent brain injury; Science Daily News; Web May 2014; http://www.sciencedaily.com/releases/2014/05/140515163826.htm
  3. Abstract of the study can be accessed at: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.abstract
  4. Older people with migraines ‘more likely to have silent brain injury’; Medical News Today; Web May 2014; http://www.medicalnewstoday.com/articles/276842.php

Details of the study published in AHA journal, Stroke: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.full.pdf+html

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Newly FDA-Approved Topamax For Migraines Raises Concerns Over Serious Side-Effects

Topamax

Recently-approved Topiramate For Adolescents Needs A Look Into Serious Side-Effects (1)

The Food and Drug Administration of USA recently (end of March 2014) approved the use of chemical topiramate in the 12 – 17 years of age group to prevent migraines. Topiramate is manufactured by drug corporation Janssen and sold under the name of Topamax. Such adolescents who report to a minimum of migraine episodes every month and have been given a clinical diagnosis of migraines in the last 6 months qualify for receiving a prescription of Topamax from their doctors to be used as a prophylactic medication.

Topamax originally came into the market in 1996 to treat seizures experienced in epileptic patients and was later also extended to manage other conditions such as need to reduce weight in obese and overweight patients.

However, the initial euphoria of being able to avail of the benefits of this drug are now subsiding with concerns that have been put forward by analysts from consulting firm GlobalData, on the severe side-effects Topamax comes with and those that have long been known to occur in adult patients. They are likely to be experienced by the adolescent migraining population as well and require a serious risk-benefit analysis before receiving a prescription.

Topamax is known to cause side-effects such as tiredness, dizziness, coordination problems, speech problems, changes in vision and sensory distortion.(2) In some cases it may cause sudden loss inn vision, memory problems, problems remembering words, brain fog, decline in cognitive condition and behavioral changes and the like.

As per GolbalData analyst Alvina To, “Migraine is experienced by both children and adults alike. For children in particular, these symptoms can affect school performance, social interactions and family life. The good news is that Topamax proved safe and well-tolerated in this patient group. But as with all anti-epileptic drugs, Topamax may also increase the risk of suicidal thoughts and behaviors in patients, as well as boosting the chances of cleft lip and/or cleft palate development in infants born to women who take the drug during pregnancy. It is therefore essential that all associated risks and benefits of Topamax are carefully assessed.” (3)

Randomized and placebo-controlled tests on Topiramate as well as trials on safety for this young age group was conducted on 103 patients who were diagnosed with migraines. In 72% of these patients, migraines were significantly reduced compared to 44% who took placebos.

Thus instructions have been given to neurologists to dispense a Medication Guide that spells out the safety and what to expect from the drug at time of giving a prescription. According to Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, “Adding dosing and safety information for the adolescent age group to the drug’s prescribing information will help to inform health care professionals and patients in making treatment choices.” (4)

Topamax tablets are available in potencies of 25 mg, 100mg and 200 mg.

SOURCES:

  1. Image Credits: Topamax; Pharma Agora; Web April 2014; http://www.pharma-agora.com/product/detail/1524-topamax-sprinkle-25mg; http://www.pharma-agora.com/product/detail/1524-topamax-sprinkle-25mg
  2. Topamax Side Effects Center; Rx List; Web April 2014; http://www.rxlist.com/topamax-side-effects-drug-center.htm
  3. Topamax safety concerns as a treatment for migraines in adolescents, despite recent FDA approval; The Pharma Letter; Web April 2014; http://www.thepharmaletter.com/article/topamax-safety-concerns-as-a-treatment-for-migraines-in-adolescents-despite-recent-fda-approval
  4. FDA approves Topamax for migraine prevention in adolescents; FDA News Release; Web April 2014; http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391026.htm

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Health Canada Recalls GSK’s Imitrex

Imitrex syringe

Potentially Infected Needles In Injection Form Of Imitrex (1)

Pharmaceutical giant GlaxoSmithKline (GSK) has recalled lot number C637078 and C632842 of it’s migraine drug Imitrex. The recalled drug is not of the tablet or nasal spray form but it’s injection form which comes in syringes pre-filled with the sumatriptan solution along with sterile needles that are to be injected.

The decision to recall has been made in discussions with Health Canada. Health Canada is Canada’s federal department that helps its citizens maintain, regulate and improve their health.

Fears have been allayed with clarifications from the regulatory body that it is not the quality of the drug that was suspect but that the needles were protruding past their plastic shields thus compromising their sterility thus posing potential risk of infection to consumers. (2)

SOURCES

  1. Image Credit: Health Warehouse; Disposable Syringes 5/8” Needle; Web November 2013; http://www.healthwarehouse.com/needles-syringes/disposable-syringes/needle-length/5-8-needle-length
  2. Migraine medication Imitrex recalled by Health Canada; CBC News, Calgary; Web November 2013; http://www.cbc.ca/news/canada/calgary/migraine-medication-imitrex-recalled-by-health-canada-1.2350615

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Cambia Approved For Migraines In Canada

Health Canada has given a notice of compliance/approval to Stellar Pharmaceuticals’ generic drug Cambia. Cambia is used for the treatment of acute migraines in adults with or without aura. The chemical composition of this oral solution comprises of diclofenac potassium. Cambia is actually manufactured by Tribute Pharmaceuticals, a wholly owned subsidiary of Stellar Pharmaceuticals. (1)

Cambia (R) – Diclofenac Potassium Approved In Canada For Migraineurs(2)

This is a relief to the Canadian migraineurs as the generic drug is affordable. In Canada Cambia will be marketed exclusively by Nautilus Neurosciences. Oral tablets of diclofenac potassium have been available to the U.S patients since May 2010 after FDA approval. Diclofenac Potassium is a non-steroidal anti-inflammatory drug (NSAID) and a benzeneacetic acid derivative.

Cambia and other brands of diclofenac potassium are contraindicated for use in persons with cardiovascular condition, peri-operative pain in the setting of coronary artery bypass graft and those with gastrointestinal sensitivity and conditions.

According to Rob Harris, President and CEO of Stellar Pharmaceuticals, “We feel that CAMBIA(R) represents a logical first line prescription treatment choice for acute migraine, especially when over-the-counter medicines that offer some relief with milder forms of migraine pain fail, and where side effects or tolerability issues with the triptan class of drugs becomes a concern. With CAMBIA(R), Canadian physicians now have a new treatment option with comparable efficacy to the oral triptans but with a faster onset of action.”(3)

SOURCES:

  1. Nautilus Neurosciences, Inc. Announces a New Approval for CAMBIA® for the Acute Treatment of Migraine; Marketwatch -PR Newswire; March 2012; http://www.marketwatch.com/story/nautilus-neurosciences-inc-announces-a-new-approval-for-cambia-for-the-acute-treatment-of-migraine-2012-03-19
  2. Image by Stuart Miles; Freedigitialphotos.net; March 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=2664
  3. Health Canada Approves CAMBIA(R) for the Treatment of Acute Migraine; Marketwatch – Marketwire- Press Release; March 2012; http://www.marketwatch.com/story/health-canada-approves-cambiar-for-the-treatment-of-acute-migraine-2012-03-16

 

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Co-morbidity of Migraine and Depression In Women

Most of us are aware that migraineurs have some comorbid conditions like generalised anxiety disorder, cardiovascular conditions and gastrointestinal disturbances. Research now has it that migraineurs especially women who have either experienced repeated episodes of migraines in the past or continue to have migraines are more likely to experience depression.

Women Migraineurs Very Likely To Develop Depression (1)

In fact another report goes on to suggest that the most ‘important’ comorbidity of migraines is depression with as many as 40% of all migraineurs also suffer from forms of depression. (2)

New research released on 23rd of February which was presented at the American Academy of Neurology’s 64th Annual Meeting showed that migraining women specifically had a higher risk of almost double for developing depression than those women who did not experience migraines.

This study had examined the medical history of 36,154 women participants. The whole population studied were classified into 4 groups:

  • Women with migraines and experiencing aura
  • Women with migraines who do not experience aura
  • Women who had suffered migraines in the past but have not in the last one year
  • Women who never had migraines

It was observed after collection and analysis of data that as many as 18% of the studied population had either current or past history of migraines and that of this group of 6, 456 women almost half of them developed depression 14 years on.

Another observation of note was that the results in terms of the probability of developing depression for women migraineurs remains almost same regardless of the type of migraines they experience (i.e. with or without visual aura)

The results did not vary substantially, regardless of the type of migraine. Those with aura, which is described as visual disturbances that appear as flashing lights, zigzag lines or a temporary loss of vision, had the same risks as other types of migraine.

According to Tobias Kurth, MD, ScD, with Brigham and Women’s Hospital in Boston and Inserm in France and a Fellow of the American Academy of Neurology, “This is one of the first large studies to examine the association between migraine and the development of depression over time. We hope our findings will encourage doctors to speak to their migraine patients about the risk of depression and potential ways to prevent depression.” (3)

This is a cue to doctors and headache specialists who treat migraineurs for assessing the patient for possible symptoms of depression and chalking out an appropriate management program for them.

SOURCES:

  1. Image by David Castillo Dominici; Freedigitalphotos.net; February 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=3062
  2. Comorbidities of Migraine – Page 4; Lisa K Mannix, MD; February 2012; http://www.headaches.org/pdf/CME_Mono02.pdf
  3. Migraine Increases Risk Of Depression In Women; Medical News Today; February 2012; http://www.medicalnewstoday.com/articles/242091.php

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