Wednesday, November 01, 2006

migraine news roundup 24

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Heads up, all of you Topamax users out there:

Drug prescribed for migraines and seizures increases risk of kidney stones
Topiramate (Topamax), a drug commonly prescribed to treat seizures and migraine headaches, can increase the propensity of calcium phosphate kidney stones, researchers at UT Southwestern Medical Center have found.

A study – the largest cross-sectional examination of how the long-term use of topiramate affects kidney-stone formation – appears in the October issue of the American Journal of Kidney Diseases.

Several case reports have described an association between topiramate and the development of kidney stones, but this complication had not been well recognized and physicians have not informed patients about the risk, the UT Southwestern researchers said. More important, the mechanism of stone formation was largely unknown previously.

"The wide-spread and escalating use of topiramate emphasizes the importance of considering the long-term impact of this drug on kidney-stone formation," said Dr. Khashayar Sakhaee, senior author of the study and chief of mineral metabolism at UT Southwestern.

Researchers found that taking topiramate on a long-term basis, or for about one year, caused systemic metabolic acidosis – a buildup of excessive acid in the blood – as a result of the inability of the kidney to excrete acid. Topiramate use also increased the urine pH and lowered urine citrate, an important inhibitor of kidney-stone formation.

As a child, I was told over and over again to expect to "grow out of" having migraines. It obviously has not happened for me, but there is some support for this notion and reason to believe this is less likely for those with a family history of migraine:

Children May Outgrow Migraines
A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

However, adolescents whose parents or siblings have migraines may be less likely to outgrow their own.

The study showed migraine was most likely to persist in adolescents initially diagnosed with migraine without aura and least likely to persist in those initially diagnosed with migrainous disorder or non-classifiable headache.

It also showed a family history of migraine was a strong risk factor for migraine persistence. Adolescents who had parents or siblings with migraine were seven times as likely to still have migraine 10 years later as those whose first-degree relatives were migraine-free.

"Our data suggest that migraine without aura is probably genetically determined," Camarda says.

Though surgery may seem like a drastic option for migraine prevention, those of us who are constantly suffering with them and have had our lives upended by migraine disease may think otherwise:

Study: Surgery may help eliminate migraines
Migraine suffers who were treated surgically experienced a statistically significant decrease in frequency and intensity of migraine headaches as compared to the placebo group. One year after surgery, 90 percent of the surgically treated patients reported a complete elimination or significant decrease in headaches.

First patients were given Botox(r) injections to determine which muscles in the forehead, temple or back of the neck triggered their migraines and to assess their potential response to surgery. Those who reported improvement after Botox injections were selected for the study. Surgical treatment involved removing portions of muscle or a minor nerve, helping to relive nerve compression and inflammation.

"Elements of this procedure involve modifications of plastic surgery techniques traditionally used to minimize facial wrinkles," said Guyuron. "In fact, this research began when several of my patients mentioned that their headaches had disappeared after forehead rejuvenation."

This information would seem to support the inclination of well-informed doctors to focus not only on treating migraine disease itself, but also on treating co-occuring depression and anxiety:

Anxiety Disorders And Physical Conditions Linked
Anxiety disorders appear to be independently associated with several physical conditions, including thyroid disease, respiratory disease, arthritis and migraine headaches, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. This co-occurrence of disorders may significantly increase the risk of disability and negatively affect quality of life.

Although depression has long been linked to physical illness, evidence supporting an association between anxiety disorders and physical health problems is more recent, according to background information in the article. Anxiety disorders include panic disorder, agoraphobia (fear of being in a situation where panic or anxiety may occur and escape from the situation might be difficult), social phobia and obsessive-compulsive disorder.

Seroquel has been approved for use in treating the depression prong of bipolar disorder:

US approves Seroquel for bipolar depression

It will be interesting to follow the outcome of these trials of a completely different kind of migraine treatment medication. If it performs as expected, it could provide an important alternative treatment option for migraineurs:

TorreyPines Therapeutics Initiates Phase IIb Clinical Trial In Acute Migraine For Lead Compound Tezampanel
An AMPA/kainate (AK) receptor antagonist, tezampanel offers a non-narcotic, non-vascular approach to the management of headache pain and represents a potentially promising alternative to current migraine treatments.

The double-blind, placebo-controlled, parallel-group study will enroll approximately 300 patients and treat a single migraine attack, with or without aura. Equal numbers of patients will be randomized to one of four arms and receive a 40 mg, 70 mg, or 100 mg single subcutaneous dose of tezampanel or placebo. The primary efficacy endpoint is headache pain relief at two hours post-dose. Secondary efficacy endpoints include pain free at two hours, sustained pain relief and sustained pain free at 24 hours, and headache recurrence and relapse. Additional measures include assessments of functional disability and patient satisfaction, relief of migraine-associated symptoms such as nausea, vomiting, photophobia (sensitivity to light) and phonophobia (sensitivity to sound), as well as various assessments that characterize speed of onset. Safety, tolerability and pharmacokinetics will also be evaluated. The study will be conducted in approximately 25 centers in the U.S.

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