Dealing With Headaches

The good news is that when I was at the doctor’s last week, I managed to get a hold of a box of Treximet samples. The bad news is that I managed to get a hold of a box of Treximet samples. Although it sounded at first like I’d struck gold getting the sample box, things turned south mighty fast when I opened the box and saw the packaging the Treximet is in.

Yet Another Reason to Hate GSK

Treximet is made by GlaxoSmithKlien (nee: SmithKline Beecham). I have family who used to work at GSK and that’s one reason why I hate Big Phrama so much — because I got to see firsthand how they waste money in order to justify jacking up prices.

Case in point — the Treximet sample cases. I don’t know for sure if the Marquis deSade has any decnedants, but if he does, this has got to be the person who designed this prurple plastic torture device.

What’s So Bad About It?

I’m glad you asked. Just imagine yourself with a migraine — you’re shaking, you can barely see because the slightest bit of light feels like staring into the heart of the sun and you are this < --> close to throwing up.

But AHH, you have the Treximet. Hope, for one shining moment, gleams with the promise of a rainbow after a storm.

And then you try to open the case.

First off, you have to squeeze the sides. Not just any sides — two specific places on the sides. If you’re off by a millimeter, you’re screwed. Then, after you’re squeezing, the case is suppossed to pop open. Except it only pops open a centimeter. You then have to pry a hyperdermic needle (or something similar) under the ridge and push up.

Needless to say, I have had a migraine since getting the Treximet and I could not actually get to the Treximet because I could not open the freaking case.

I hate you, GSK.

Ever envied guinea pigs? Lord knows I have. Well, you may not have the fuzzy fur or the little pink lips or the jellybean-like physique, but you can play the metaphorical guinea pig in helping out with a Phase Two clincial trial for a new migraine drug made by Big Pharma giant Eli Lilly.

Say Hello to LY2590443

This will be the usual double blind study, so nobody knows what drug you get. The choices could be the mystery new drug, sumatriptan, a placebo pill or a placebo injection. I do not know if this new migraine drug will be in a pill form or an injectable form.

You need to be between the ages of 18 - 65 and have been diagnosed with migraines and get from between 2 - 8 migraines a month. You need to have had migraines (with or without aura) for at least one year. All sexes are welcome.

For more information about joining the cinical study, call 1-877-CTLILLY or 1-317-615-4559.

Don’t Apply If

Eli Lilly has listed some exclusions that can keep you from becoming a human guinea pig. These include:

• Being a drug addict or alcoholic
• Being pregnant
• Recently donating blood of 500ml or more
• Suffering from a “major psychiatric disease” (I do not know if depression would be included in that category).
• Being otherwise unhealthy or having some sort of chronic medical condition

The study also prefers people fluent in English and are willing to keep a diary about their experinces with the new migraine drug. There are several medical centers participating in the clinical trial all over America.

And the best part is that this time around there are no actual guinea pigs being used.

People with migraines or cluster headaches may be perscribed anti-convulsants at one point or another. As their name implies, these are drugs that were originally meant for helping people with epilespy or other conditions that cause seizures. Now, anti-convulsants are prescribed off-label for bipolar disorder, schitzophrenia, Alzheimer’s, obsessive-compulsive disorder, restless leg syndrome, drug addiction rehabilitation and pre-menstrual syndrome.

Common Anti-Convulsant Meds

These can include Stavzor, depakote, gabepentin and the big one — Topamax (topamirate).

Normal Side Effects

These include feeling dopey all of the time, having nightmares and having an increase in appetite. Many people also loose interest in sex. Your blood pressure may go down when on these, so guys — your body may not be able to pump enough blood to Mr. Happy in order to get or maintain an erection. Some people also lose their hair or get thinning hair.

Long-Term Effects

These are a little more serious. For some people, the loss of interest in sex winds up being a long-term side effect instead of a short-term side effect. Same for baldness or thinnng hair and feeling sleepy all of the time.

Perhaps the most common long-term side effect is weight gain. You feel sleepy and your appetite increases, so weight gain is kinda inevitable. You need to be sure you are eating sensibly when on thiese kinds of medications.

But you may not be that hungry, because some anti-convulsants like depakote give chronic heartburn. Yummy.

With some meds like depakote, you may need to take tests to be sure your liver is functioning properlym because the medicine could make your liver very cranky.

For a more complete look at anticonvulsant medications, I recommend taking a look at Crazy Meds.

From the “Yet Another Reason Why Not To Have Kids” Department:

If you are a woman who has migraines (or a man who is a mad scientist experimenting in male pregnancies) really reconsider having a pregnancy. Althugh it’s been known for some time that women with migraines are more at risk of stroke than women without migraines, the time women migraineurs are at most risk of getting a stroke is when they are pregnant.

So Says This Study

Published in British Medical Journal, “Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study” looked at a mountain of data on pregnant women in the United States in the years 2000 - 2003. After sifting through over 18 million cases recorded in data from various hopitals, researchers came to these conclusions:

• Migraineurs had a “15 fold” increase in having a stroke while pregnant. (I’m still trying to figure out how a “fold” is different from a “percentage”.)
• This comes to about 4 cases of pregnancy-related stroke in 100,000.
• The study notes that it did not look at which condition was diagnosed first — migraines, pregnancy or a vascular condition.
• More studies need to be done. (Surprize.)

What About The Pregnant Man?

The study also didn’t mention women who got sex-change operations but still kept their uteruses, like Thomas Beatie, the fifteen minute wonder pregnant man did. I wonder if that gal-guy gets migraines? Could the sex change have helped any? Would the kid have migraines? And what about Thomas Beatie’s wife? If she didn’t have migraines before, she probably does now.

Moral of the story: Forget having kids. Adopt a pet, instead.

I forgot all about submitting to the March 2009 edition of the Headache and Migraine Blog Carnival. (DUH!) And I get two reminders, as well. I guess I could blame the ear raisins for blocking my memory neurons as well as my ear canals.

This month’s blog topic was admittedly a tough subject to write about this time around — creating a migraine-friendly environment. This means living in a way to keep migraines at a minimum, not inviting them inside your home to party. This is best expressed in Diana Lee’s Coping with a Migraine: My Three Step Approach. (Meds, darken the room, get as comfy as possible).

Other Links

Since I screwed up in forgettting to submit an article to this blog carnival, I thought I’d bounce around the web and find a few hopefully helpful websites about how to best survive a migraine attack. Think of this as March 2009 Headache Blog Carnival, Part 2:

• Living With Migraines: What to Expect is a HubPages testimony of one young migraineur’s struggle with her chronic pain. The article stumbles a bit in the beginning, but smooths out once she gets going. There are some nice tips in side grey boxes. She also can’t use triptans like Imitrex because of the cost (something many migrainuers can identify with).
• Migraine Prevention: Early Success by the ever-reliable Megan Oltman includes a very important tip for all migraineurs — keep your voices down when discussing migraine treatments or the migraine monsters might hear and come get you. These monsters are the offspring of Sod’s Law. Another important tip — don’t skip breakfast or lunch.
• And, for general all around advice about migraines, there’s Migraine Headaches: Ways to Deal with the Pain over at FamilyDoctor.org.

Let’s see if I forget to submit an article for next month’s blog carnival, which won’t have a theme. Darn, now I have too many choices!

Recently, I had a client ask me if I was interested in doing a series of articles on vascular migraines. (Remember, I’m not a doctor –I just know too much.) I’d never heard of vascular migraines. I am familiar with the now mostly shelved theory that migraines are caused by blood vessels ( the vascular system) expanding and contracting. (It’s not thought that migraines are caused by chemical imbalances, but no one is 100% sure).

There are also a lot of health websites out there that claim that migraines are “vascular headaches”. Huh?

Migraines and Headaches

Migraines are different from headaches in that the pain is one side of the head, while in a headache, both halves of the head are unhappy. Migraines also can involve auras or other crippling symptoms like extreme senitivity to light, dizziness and writing blogs about migraines and headaches. (OK I made that last one up).

But many doctors and nuerologists do make a distinction between headaches and migraines.

In Conclusion

In my research on migraines over the years, I haven’t found anything to support the idea that vascular migraines exist. Vascular headaches could be a whole other story. There are two reasons why some doctors still think that blood vessels play a big part in migraines:

• Beta-blockers that lower blood pressure like verapamil taken daily can often reduce the number of migraines a migrainuer gets
• Migraineurs are more prone to getting stroke or “mini-strokes” than people who don’t get migraines.

However, many people with migraines also have either epilepsy or clinical depression. All three of these have one similarity (other than they all suck) — the chemical serotonin. Antidepressants like SSRIs can sometimes help migraineurs — even if they aren’t depressed.

It’s enough to give you a migraine, isn’t it?

On Wednesday, March 4, 2009, the Supreme Court of the United States rules in favor of the case of migraineur and musician Diana Levine, who had to have her arm amputated because the anti-nausea drug Phenegen was administered incorrectly during a migraine attack that required a visit to a local health clinic. She won a $6 million lawsuit against Wyeth from the State of Vermont, but Wyeth appealed.

Wyeth claimed that since their drug’s label had been approved by the FDA, then federal laws trumps Vermont state law, so there, nyaah-nyaah!

The Ruling

And now the Supreme Court has told Wyeth to shut up and pay up. (No, they didn’t use those exact words — I’m exaggerating just a tad bit here in my excitement. This is a blog, remember.) Anyway, Wyeth now has to fork over $6.7 million, (which is probably less than the cost of one television drug ad campaign).

Woot

The Supreme Court voted 6 -3 in favor of Ms. Levine, who received the original injection way back in April 2000. Justice Paul Stevens stated:

“Wyeth has not persuaded us that failure-to-warn claims like Levine’s obstruct the federal regulation of drug labeling. Congress has repeatedly declined to pre-empt state law, and the FDA’s recently adopted position that state tort suits interfere with its statutory mandate is entitled to no weight.”

Prior to a 2002 President W ruling (I’m still trying to find out which one), anyone could sue a drugmaker on a “failure to warn” basis in state court and have a pretty good chance of winning. That was another legal leg Ms. Levine’s lawyers had to stand on.

Off to celebrate.

A happy thought for a Monday, I’m sure. But if you are a woman with migraines, you can’t take your heart health for granted. You will be more prone to having heart attacks and strokes than women who don’t have migraines. Yet more proof that life is not fair.

But why do women migraineurs have more strokes and heart attacks? New research from America may find that the culprit is a gene varaint called angiotensin-converting enzyme (ACE) D/I polymorphism. (Can’t exactly make a greeting card poem out of that one, can you?) It might not even be that particular variant, but another variation that is often found in women containing the aforementioned gene variant.

Damn, I need an Excedrin. And I really wish I had paid attention more in science class.

Study Specs

This research was a follow up to this study published in Neurology in July 2008. The study consisted of a questionnaire sent to 25,000 white women (why only white women, I have no idea). All of these women were tested to see if they had the gene variant with the really long name.

Of that 25,000, only 4,577 were migraineurs. Narrowing it down even further, 1,275 had migraine with aura and 625 had a heart attack or a stroke. There was an initial hypothesis that women that had migraines with aura were more prone to stokes and heart attacks than women that have migraines without aura, but that didn’t pan out.

Practical upshot: more research needs to be done.

In The Meantime

You know the drill — quit smoking, limit alcohol intake, eat a low-fat, varied diet, exercise regularly and work on non-chemical means of stress management — like not trying to understand these genetic research papers.

I think they probably get a lot of headaches in Bangledesh and not just because of the flooding or poverty. Before I comment further, here’s the YouTube clip and no, I don’t know who filmed this. Perhaps if someone sends this clip to Ellen DeGeneres, her magic elves can find out for us:

Many migraineurs are prescribed beta-blockers taken daily in order to prevent migraines. This is an off-label use, but many migraineurs have benefited. Now, a Dutch study has come out suggesting that beta-blockers may have another potential off-label use — blocking bad memories in the brain.

Study Specs

The study was on 60 people with a laboratory-induced phobia. 30 of them were given propranolol (stuff I was on for a month, but my body hated it) and the other a placebo. They tested how startled a person was by flashing a picture up of the thing they had been conditioned to hate.

Conditioned to hate? These 60 were given “mild electric shocks” whenever pictures of spiders were flashed before them, in the hopes of creating bad memories with spiders (or pictures of spiders). I thought getting mild electric shocks would condition you to hate medical researchers and not spiders, but that’s why I don’t volunteer for these things.

Anyway, the propranolol group were far less started by pictures of spiders than the placebo group. The theory is that the beta blocker has somehow blocked the way the brain processes attaching emotionas to memories, particularly bad ones. The participants claimed that they still could remember being shocked when shown pictures of spiders, it just didn’t seem all that frightening to them.

Also, the researchers say that more work needs to be done before anyone with a severe phobia or post traumatic stress could be helped by this.

More Harm Than Good?

Although I’m not a doctor, I think I can safely claim that it’s never a good idea to take medications you really don’t need to take. There’s also concerns over whether taking a pill to block out bad memories may also block out good memories. There is also a concern that this may predispose someone to Alzheimer’s.

If you are concerned about long term side effects with beta blockers for your migraine prevention, then talk to your doctor. Don’t just stop them, because then you will get a migraine, and that will definately leave a bad memory.

Only on the blogosphere do migraines and sex go together. Most times migraine pain makes sex impossible, although a few migrainers claim that the release of the orgasm can help temporarily relieve pain. If you are having sex and suddenly get the worst migraine you ever have, then call an ambulance.

On that happy metal image, let us now turn to the February 2009 edition of the Headache and Migraine Blog Carnival, hosted by the lovely and talented Diana Lee over at Somebody Heal Me. A blog carnival, once again, is a selection of blogposts that all loosely revolve around a particular theme.

And yes, there’s one from me entitled Sex, Orgasms, Headaches.

Highlights

This is the time in the post where I announce my personal favourites among the seven entries. As always, this is not meant to slight any blogger in any way. These are picked solely on my personal tastes (or lack thereof).

• Jasmine over at Jasmine’s Cove gets the Best Title Award for Tonight Dear! I Have A Headache. The article itself is funny, sexy and practical (as well as the comments afterwards.
• The “let’s get right to the point” award goes to Headache During Sex over at Headache Advisor. Covers the topic from a variety of angles.
• The “‘Depends Who You Ask” award for Megan Oltman’s Migraine Consolation, which asks the question “Either it’s just a god-awful mess, or you have to spread out a towel and wear rubber gloves, and really, how sexy is that?”

Next Month’s Topic

Diana is accepting submissions for next month’s topic - “Advice for Creating a Migraine-Friendly Living Environment” due of Fraday, March 6. Your blog does not have to be solely realted to migraines or headaches, but the particilar post should have something to do with it. There’s no money, but it sure brings traffic to your blog.

It’s cold, heavy, slippery and needs to be removed from vehicles, roofs and roads. Depending on where you live, if you don’t shovel and salt your walk within 24 hours of a storm, you get fined. But snow also has yet another evil invloved with it — it can be a migraine trigger.

The easiest way to avoid snow migraines (as I call them) is to not leave your bed. But, for many people, staying in bed with the blankets pulled over your head is not an option — although that is a good way to avoid snow migraines.

What Is A Snow Migraine?

This is when you get a migraine that is triggered from looking too long at bright white snow. Your eyes are so dazzled that when you shut your eyes, you still see the snow or see a neon green as opposed to the usual dark color of the inside of your eyelids. This is worse if the sun is out than when the sky is cloudy. The snow serves as one tremedous reflector of the sunlight.

If you are prone to migraines, then snow can trigger one. If you usually get auras before a migraine, you may not be able to recognise your aura because your eyes are so dazzled by the snow.

Some Tips

The best thing you can do to avoid snow migraines is to wear very dark sunglasses. You should also limit your time outside. When you can, shut your eyes, just to give your head a break. Only shovel the snow a few minutes at a time and as soon as you feel light-headed, go inside for a rest, even if it’s only for a coupel of minutes.

Pay attention to feeling a bit dizzy. For me, a snow migraine also includes being so dizzy I get naueseated. But, if I take frequent breaks when outside or don’t push myself physically, then I can at least postpone the worst of the nausea for a while.

Hope this helps.

Migraines cost a lot of money and time, not only for the migraineur, but for their employers, their families and for society at large, so more attention needs to be paid to treating this disease. This was the conclusion of a new study published in Value in Health. It has the exhausting title of The Burden of Migraine in the United States: Current and Emerging Perspectives on Disease Management and Economic Analysis. It also states that families with at least one migrainuer in it have to spend 2.3 times more money on health care than “normal” families.

Study Specs

The study was a paper chase, in a way. They went through archives on medical costs from PubMed MEDLINE database as well as any articles relevant to their topic. Interesting note that the oldest article they found on the outrageous cost of triptans like Imitrex was from 1992.

Practical Upshot

There wasn’t any final figure about how much migaines cost the US in its history, although the estimated direct cost of migraines for one year is $1 billion (and the authors say that’s a low estimate). By direct cost, that meant the cost of any hospitalization, drugs needed or appointments with a doctor.

It certainly does have a lot of impressive graphs, charts and percentage statistics, which is always good in trying to get politicians’ attention. Hopefully, it will also impress people who don’t have migraines into finally believeing that we migraineurs are not faking our attacks.

The obvious pain migraine attacks bring doesn’t seem to bring much in the way of sympathy or serious work on finding a cure — but perhaps showing what the impact on their wallets migraines cause will.

If you have one head trouble, it can easily lead into another. The current issue of General Hospital Psychiatry features a study done by the University of Manitoba that says the first symptom of mental disorders — is a migraine.

Just one note before we move on. The writer of this blog not only has migraines and chronic headaches, but she also had endogenous recurring depression (yes — that’s a mental problem. No surprise there, huh?)

Study Specs

4,181 mental patients were studied, with 11% of them reporting problems with migraines. This is apparently considered too high of a number to be considered a coincidence. The mental disorders the participants had included “major depression, general anxiety disorder, dysthymia, bipolar disorder, panic attacks, panic disorder, substance abuse disorders, agoraphobia and simple phobia.”

Having one physical problem (like migraines) that compunds another problem (like depression) is called comorbidity. I like to think of it as the “misery loves company syndrome”.

It is unknown why one head problem brings on another, although the study gives out some theory about “the low acticity of enzymes”. If you have migraines and aren’t depressed or anxious, then either you have some deep-seated problems or are taking some really painkillers.

11% Seems Damn Low

I’m really suprised that the researchers only came up with a figure of 11%. In my family, it’s 100% — all of my family members have depression and some sort of chronic pain. I was lucky enough to get migraines.

Others may agree that the 11% number is too low. The Park Nicollet Headache Clinic in St. Louis claims that 83% of the migraineurs they see have mental or mood disorders.

Seriously — has anyone ever met a person who had migraines and wasn’t just a little loopy?

Nope — you can’t get away from Obama — not even here! BWHA-HA-HA!

No, seriously, since it’s inaugeration week and President Obama seems serious about changing some things like closing down Gitmo and pulling out of Iraq, there may be a possibility of a federal government change on the stance of medical marijuana, which is a very effective painkiller. Although medical marijuana is usually prescribed for glaucoma, cancer and inoperable tumors, there are many migraneurs who use it to kill the pain and nausea of a migraine attack.

There are a few clips on YouTube that deal with Obama talking about marijuana in general, but I think this is the best one. Why? Well, he does mention that decriminalizing medical marijuana would not be very high on the priority list as soon as he got into the White House. That brief moment of honesty is rare in any politician. Also, he does state that he doesn’t think the Justice Department should wste it’s resources on busting someone for medical marijuana possession or to bust doctors who prescribe it. Every little bit of a change helps here.

Do I take medical marijuana? No. But I have taken it for a toothache when I was homeless and seeing a dentist was out of the question. For many people, going to a dentist or doctor is out of the question. But they still have pain. Medical marijuana is a cheap way to not only manage pain, but to make sure you eat and sleep regularly. And it helps you keep a sense of humor.

Granted, there are people who can’t tolerate pot at all. They get paranoid or suicidal after a toke. But then again, this happens to people taking any medication.