What Should Work, What Might: Migraine Meds Reassessed

ID-100308698

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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Episode Durations & Number Cutbacks With Diamine Oxidase Pills

swanson-ultra-daosin-30-capsules-300mcg

Diamine Oxidase Supplements May Reduce The Number, Duration, Intensity of Attacks (1)

Researchers have found that taking diamine oxidase supplements significantly reduces the duration of a migraine episode, especially if the migraine has been brought on by food triggers like cheese, caffeine, red wine etc. They have also observed that there exists a mildly indirect relation between to the total number migraine attacks itself in the mid to long run.

Diamine oxidase (DAO) is an amino acid that helps metabolise (break down) histamines released by our bodies. When we eat foods that we are allergic to (because our body cannot handle it’s digestion for any number of reasons specifically lack of appropriate enzymes) then the body perceives the situation as a threat to it’s well being. As a result it begins an immune response. In such as case histamines are released causing the capillary walls to give more access to proteins and white blood cells to engage with the pathogen/trigger/danger. This increase in histamine triggers migraines.

Histamines are also present in certain foods itself that when consumed raise histamine levels of the body and then trigger a migraine. Thus it is obvious that if migraineurs with food or weather triggers are administered an enzyme (such as DAO) that is responsible for the breakdown of histamines, migraine duration and number of attacks would reduce.

According to Joan Izquierdo, MD, from the Faculty of Health Sciences at the International University of Catalonia and the neurology service at Catalonia General Hospital in Barcelona, Spain, who studied men or women between ages 18 to 60 years old with an attack within the previous 6 months, “We diagnosed 137 patients who have a migraine, of who 119 showed deficits of the activity of the enzyme DAO, around 87% of the total patients that we have studied.” (2)

The study did not take into consideration alcoholism, psychiatric disorders, or a diagnosis of any disorder for which a treatment could be used as migraine prevention in the previous 1 month or those who could not consume pork-based products (DAO source).

Normal DAO enzyme activity is considered to be a score of 80. In the study, he found that there was a clear correlation between enzyme score and migraine episodes and intensities. Symptom scores rose progressively as enzyme activity dropped below 80 HDU/mL, with scores 50% to 120% higher in the 30-40 HDU/mL range compared with enzyme activity >80 HDU/mL.

Two groups were made and the control group was administered placebos and the other group was given the DAO supplements. The participant dosage was 2 capsules each after breakfast, lunch and dinner. To understand the pain factor, researchers noted the consumption of triptans by the participants. Those who were on placebos consumed 20% more triptans than those on DAO capsules. The diminished triptan use among patients receiving DAO suggests that the compound may have also reduced the intensity of pain during an attack, the researchers suggest.

Dr. Izquierdo also said, “Diamine oxidase supplementation has shown a significant reduction in crisis duration and a tendency toward a reduction in number of crises,” he said. “The treatment is [safe] because we don’t have any adverse events.” (3)

However, to be sure about the outcome of the research, a larger population needs to be studied cutting across ethnic groups and races. At it’s current stage, it is important thus to educate migraineurs of triggers whether they are of food, hunger, exposure to sun, sleep deprivation or weather and environmental conditions.

SOURCES:

  1. Swanson Ultra Daosin Diamine Oxidase; HealthMonthly.co.uk; Web October 2013; http://www.healthmonthly.co.uk/swanson_ultra_daosin_diamine_oxidase
  2. Migraine Attacks Shortened by Diamine Oxidase Supplements; MedScape.com; Web October 2013; http://www.medscape.com/viewarticle/811920
  3. 90% of Migraines Could Be Prevented with Enzyme; Universitat Internacional de Catalunya; Web October 2013; http://www.uic.es/en/news?id_noti=3273

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Peak Bio-availability in 2-3 Minutes: Aegis Awarded 3rd Patent for Intravail(R)

Aegis Therapeutics LLC

Aegis’ Non-Invasive Drug Delivery System For Migraines (1)

Aegis Therapeutics LLC, the developers of drug delivery and drug formulation technologies has announced that it has received it’s 3rd patent for fast acting formulations of triptans, a widely used class of drugs including Sumatriptan, Zolmitriptan, Naratriptan, Rizatriptan, Eletriptan, Almotriptan and Frovatriptan. The total triptan class of drugs has a market of over $3 billion of which Sumatriptan alone accounts for $2 billion.

Trials on humans have demonstrated that the now patented Intravail® formulation of sumatriptan is bioavailable in 2-3 minutes of administration.  This is a 20-30 times faster achievement of therapeutic drug levels than what is currently marketed non-invasive/non-injectable sumatriptan products. (2)

The most common triptan formulations currently available commercially – the oral tablet and the nasal spray reach peak blood level concentration of the drug in 60-120 minutes – many times slower than Intravail® formulation of sumatriptan and thus delaying onset of pain relief.

The new technology – Intravail® formulation of sumatriptan is widely applicable to other small molecule as well as biotherapeutic drugs that step up

The enabling Aegis Intravail formulation technology is broadly applicable to a wide range of small molecule and biotherapeutic drugs to increase noninvasive bioavailability by the oral, nasal, buccal, and sublingual routes especially in those cases where speed is important to the patient. Acute symptoms and A&E cases with severe pain, nausea, emesis, convulsive disorders, spasticity is expected to be greatly helped by the new Intravail® formulation of sumatriptan by Aegis Therapeutic LLC.

SOURCE:

  1. Image credits: Aegis Therapeutics LLC; Web August 2013; http://aegisthera.com/
  2. Aegis Awarded 3rd Patent for Fast Acting Migraine Nasal Spray Treatment; Aegis Therapeutics LLC; Web August 2013; http://aegisthera.com/aegis-awarded-3rd-patent-for-fast-acting-migraine-nasal-spray-treatment/

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Migraine Symptoms & Some Fixes

Besides the debilitating pain, migraineurs often experience some symptoms that precede and/or last during the time the migraine episode is on. Here’s a list of some of the symptoms a migraineur may experience before or during an attack:

  • Nausea
  • Dizziness
  • Sleep disturbances
  • Visual disturbances/aura
  • Hyper-sensitivity to sound
  • Hyper sensitivity to light
  • Increased sensitivity to odours
  • Frequent yawning
  • Frequent need to urinate
  • Constipation
  • Diarrhea
  • Non-visual aura
  • Confusion
  • Fatigue

Symptoms and Some Fixes (1)

The exact reason why a migraine attack begins is not yet clear to scientists. However, based on years of data gathered from cases that report for treatment assistance to clinics and hospitals, several migraine triggers have been identified.

Despite the extreme discomfort migraines give, it is possible to obtain symptomatic relief at least some extent. Here are a few tips at what can be done should you be in the grips of a migraine attack. However, it is important to keep in mind that the priority is get a medical help and consultation at the earliest. The tips below are to serve only till you are able to see a doctor. (2)

  • Excruciating pain

Pain may be tackled with NSAID (Non-Steroidal Anti Inflammatory Drugs) brufen, naproxen, diclofenac sodium etc. It may also be managed by analgesics such as paracetamols, spirins etc. However, it is recommended that you take any one of them as per the dosage and instructions on the label after a light meal of complex carbohydrates or some non-acidic foods. It is important that painkillers be taken at the first signs of migraine. Putting an ice pack on the painful area also helps. (3)

  • Nausea

Nausea may be tackled with taking of anti-emetic along with the analgesic in the prescribed dosage. It is also important to not stay on an empty stomach for long durations. A light snack taken frequently helps in stubbing the queasiness and helps by utilising the excessive bile migraineurs release during attack episodes.

  • Visual Aura

The best way to manage a visual aura is to stop or put down what you are doing and stand until you can get to a place where you can sit or lay down. It is dangerous to operate any machinery or drive at such times. Breathing in deeply and fully and massaging of temples with a balm may aid temporarily.

  • Light and sound sensitivity

Going to a dark room or one with curtains drawn and lights turned off helps. Wearing dark glasses helps when outdoors. Noise disturbances may be managed with an earplug or by putting cotton wool in the ears to keep out or dull the surrounding noises.

  • Constipation

Constipation may be helped by taking tepid fluids such as warm milk or ginger tea or warm water etc. It is also advisable to have allergy-free natural laxatives like flaxseeds and high fiber diet including wholegrain cereals if you are gluten tolerant.

  • Diarhhea

Yet another accompanying nuisance with migraines, diarrhoea may be managed by taking stomach-binding foods and avoiding those with high fibre content.

DIET INCLUSIONS:

Holistic Health Therapist recommended the inclusion of herbs such as feverfew, St. John’s Wort and butterbur in one’s diet. Conventional physicians are of the opinion that calcium and magnesium supplements help take the edge off migraines. Tryptophan and omega 3 rich foods and B vitamins are also advised by doctors.

Complementary Alternative Medicines offer support therapy that aid in the management of migraines. Help comes from the sciences of yoga, aromatherapy, massage, reflexology, shiastu, acupuncture, sujok, biofeedback, chiropractic, cranial osteopathy, homeopathy, ayurveda, reiki, Alexander technique, autogenic training etc

MAINSTREAM MIGRAINE MEDICATION

  • Excedrin Migraine

Excedrin is a leading non-prescription drug from Novartis from the acetaminophen or paracetamol family that uses a combination of paracetamol with caffeine and aspirin designed especially to tackle migraine pain. Excedrin is available in geltab, tablet and caplet forms. Dosage and frequency of drug intake should be as per label instructions or doctor’s advice. It is important to understand and comply by the contraindications and warnings mentioned on the label of Excedrin Migraine and all other drugs.

Other ABORTIVE MEDICATIONS sometimes used by doctors are:

  • Analgesics: Aspirin, Paracetamol/Acetaminophen
  • NSAIDs: Ibuprofen, Diclofenac sodium, Fenoprofen, Ketorolac, Indomethacin, Tolmetin, Celecoxib
  • Ergotamines: Dihydroergotamine mesylate, Ergotamine tartrate
  • Corticosteroids: Methylprednisolone, decsamethasone
  • Opiods: Morphine, Codeine, Oxycodone
  • Combination: Analgesics containing barbiturates, analgesics containing opiods/narcotics
  • Triptans: sumatriptan succinate, Elitriptan hydrobromide, Almotriptan malate, Frovatriptan, Naratriptan

SECONDARY PROPHYLACTIC DRUGS (those that would keep the symptoms from getting worse) could also be recommended by the doctor to manage migraines. Examples are:

  • Anti-depresants: Phenelzine, Nortriptyline, Amitriptyline
  • Beta Blockers: Propanolol, Atenolol, Verapamil
  • Anti convulsants: Topiramate, Divalproex sodium
  • MAO inhibiters: Phenezine sulfate
  • Calcium channel blockers: Flunarazine (4)

SOURCES:

  1. Image by Michal Marcol; Freedigitalphotos.net. April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=371
  2. How Can We Manage The Common Symptoms At Home; Migraines For The Informed Woman (Book); April 2012; http://www.amazon.com/Migraines-Informed-Woman-Tips-Sufferer/dp/8129115174
  3. Migraine Awareness Group: A National Understanding For Migraineurs (M.A.G.N.U.M); Treatment and Management- Current Treatment Methods – General Pain Management; http://www.migraines.org/treatment/treatctm.htm; 2006
  4. MedicineNet.com; Migraine Headache; Dennis Lee, MD, Harley I. Kornblum, MD, PhD; http://www.medicinenet.com/migraine_headache/page6.htm; 2010

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CGRP Blockers & SRAs – The New Faces In Research For Migraine Management

CGRP stands for Calcitonin Gene-Related Peptide. It is a calcitonin group compound made up of polymers of amino acid monomers. CGRP is manufactured in the human body in the nerve cells (neurons) of the central nervous system and the peripheral nervous system.

Research – New Migraine drugs In The Pipeline (1)

So what is the function of CGRP? Of the many functions, CGRP is a powerful vasodilator and it contributes significantly in the transmission of pain message through the body. It is also believed to play a critical role in cardiovascular homeostasis as well as in processing noxious stimuli that has the potential to damage the tissues of the heart.

The development of drugs which are essentially CGRP receptor antagonist is in the pipeline aimed at helping migraineurs the world over cull the pain of their migraine episodes. How does the CGRP receptor antagonist do this? It has been observed that during the onset of a migraine attack, CGRP binds to CGRP receptors and activates these receptors which then transmit pain signals. CGRP receptor antagonist prevents the CGRP from binding on to CGRP receptors thus circumventing the transmission of pain signals causing migraine pain.

Telecagepant was such a CGRP receptor antagonist drug developed by Merck & Co. and was undergoing Phase III clinical trials but the trials were abandoned after identification of two patients with significant elevations in serum transaminases indicating liver damage. However, similar drugs without such side-effects are now being designed. CGRP receptor blockers also significantly reduce nausea and are more desirable in total benefit than triptans. As per Peter Goadsby, MD, PhD, director of UCSF’s Headache Center, “So this is a way for it to be effective and adds a safety bonus to the patients and it seems to be better tolerated.” (2)

There is another approach to drug design and development aimed at reducing the misery of migraineurs and it comes from the side of serotonin activity. In this class, one investigational drug of note is Lasmiditan thought of by Eli Lilly & Co and being designed to treat acute migraine by CoLucid Pharmaceuticals. These drugs are technically serotonin receptor agonists and selectively bind to the 5-HT1F receptor subtype. Unlike triptans these drugs do not constrict the heart vessels and have lesser side-effects. Trials have shown that administration of this drug reduced migraines to almost nothing within a two-hour period in almost 60% of the patients also tackling nausea and photophobia beautifully. The drug is expected to be ready by 2014. As per Dr. Goadsby, “Lasmiditan is now that finished its phase two studies and clearly works. It does not have the same sort of liver effects as its predecessors and will move on into phase three. That is again for acute migraine treatment. So it is a safe and totally different action than what we currently have.” (2)

 

SOURCES:

  1. Image by Ponsulak; Freedigitalphotos.net; March 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=1983
  2. Cutting Edge Treatments For Migraines: More Than Just A Headache; Ivanhoe.com; March 2012; http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=29106&channelid=CHAN-100018

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