Wednesday, August 15, 2007

migraine news roundup 41

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A new study supports the notion that women who experience migraines with aura are at increased risk of stroke. Researchers suggest these women seriously consider lifestyle changes, such as quitting smoking.

Women with Migraines at Higher Risk of Stroke

They found that women with migraines with visual symptoms had a 1.5 greater risk of stroke, compared with women with no history of migraine.

However, women who had migraines and used oral contraceptives and smoked had a sevenfold increased risk of stroke, compared with women who had migraines with visual symptoms and didn't smoke or use oral birth control.

The researchers also said that the recent onset of migraines, as well as more frequent migraines and migraines that lasted longer, may play a part in increasing the risk of stroke.

"Migraine with visual symptoms should be considered a weak risk factor for stroke," Kittner said. "You can't do anything about it, but it may influence what other prevention measures one may take," he said.

The findings are published in the September issue of the journal Stroke.

Research indicates it may soon be possible to tailor anti-depressants to a particular person's genetic make-up and environmental influences.

Custom-Made Antidepressants

The most important consequence of research on interaction between genetic and environmental factors is that, in a foreseeable future, scientists will be able to produce measures to predict response to antidepressants taking into account each individual’s genotype, i. e. they will be able to design tailor-made drugs according to each person’s genetic configuration and their exposure to environmental factors.

The Wall Street Journal Health Blog reports that Canada has approved a marijuana-based pain medication, which was previously approved for cancer-related pain, for use by patients with multiple sclerosis. The drug has not been approved in the U.S. or Europe.

Canada Approves Marijuana-Based Pain Drug
Sativex, a marijuana-based pain drug that has yet to be approved in the U.S. or Europe, has seen some success in Canada. It was approved there two years ago for pain associated with multiple sclerosis, and it has just been approved to treat pain in cancer patients. The oral spray is made from cannabis plants grown under a special license from the British government. The drug’s name calls to mind marijuana’s latin name Cannabis sativa, and the spray works on the same brain receptors as the garden-variety version of the drug. But the plants were bred to remove many of the mind-bending effects of the drug,
The FDA has approved a Phase III trial of the drug, but the political climate could mean Sativex will face an uphill battle here. “The deepness and polarity of the [marijuana] debate in the U.S. is unique,” GW’s chairman told the WSJ.

According to the New York Times, increased availability of generic drugs will slow the rise in drug prices.

More Generics Slow Rise in Drug Prices
A quiet coup is taking place in American medicine cabinets. Prescription bottles bearing catchy brand names like Zoloft and Flonase are being pushed aside by tongue-twisting generics like sertraline and fluticasone propionate.

While the trend is already pinching the profits of big pharmaceutical companies, it is rare good medical news for American pocketbooks.

The nation currently spends $275 billion a year on prescription medicines. But over the next five years, analysts forecast a golden era for generic drugs, as patents begin to expire on brand-name medications with more than $60 billion in combined annual sales. That will open the door to copycats that may be 30 percent to 80 percent cheaper.

Research that seems to explain why more women than men experience migraines may also lead to development of even better prevention and treatment options.

Why Women Get More Migraines than Men

For every man with a migraine, three women are struck by the severe headaches that often come with nausea, sensitivity to light and sound, and aura. That means a staggering 18 to 25 percent of women suffer from migraines, making it one of the most common disabling conditions faced by women around the globe.

This 3-to-1 ratio raises the obvious question: Why? The reason, suggest researchers at UCLA, is that women may have a faster trigger than men for activating the waves of brain activity thought to underlie migraines. If the theory is correct, this triggering mechanism may be a new target for migraine treatment.

Reporting in the Annals of Neurology, currently online, Dr. Andrew Charles, director of the Headache Research and Treatment Program in the UCLA Department of Neurology; Dr. Kevin C. Brennan, a clinical and research fellow in Charles' lab; and colleagues used a mouse model to discover a big difference between males and females with regard to a phenomenon called cortical spreading depression (CSD), which is thought to be a chief culprit in causing migraines.

In a separate study, to be published in the September issue of the Journal of Headache and Pain, the researchers report preliminary success in preventing migraines using memantine, a drug that blocks CSD waves.

Scientific American reports that the U.S. Court of Appeals for the District of Columbia ruled this week that terminally ill patients do not have a constitutional right to access experimental drugs.

Court Sees No Right to Unapproved Medicines

The U.S. Food and Drug Administration requires a wide battery of research, ranging from animal and laboratory tests to advanced trials with people, before it will consider approving a new drug. Manufacturers say the process can take up to 10 years.

Two advocacy groups have sued the FDA seeking greater access for dying patients to unapproved medicines that have cleared early safety tests, which usually include 20 to 80 people.

The Abigail Alliance for Better Access to Developmental Drugs and the Washington Legal Foundation argued that patients have a constitutional right to try experimental drugs that have passed that hurdle, if they choose.

The 8-2 ruling by the full U.S. Court of Appeals for the District of Columbia reversed a May 2006 ruling by a divided three-judge appeals panel, which overturned a 2004 district court decision to throw out the case.

"The FDA's policy of limiting access to investigational drugs is rationally related to the legitimate state interest of protecting patients, including the terminally ill, from potentially unsafe drugs with unknown therapeutic effects," Judge Thomas Griffith wrote in Tuesday's majority opinion.

The Abigail Alliance and the Washington Legal Foundation said they planned to appeal the latest ruling to the Supreme Court.

The New York Headache Center blog has a fascinating entry on the idea of using plastic surgery to prevent migraines.

Surgery for Migraines
Their premise is that since Botox injections relieve migraines, why not go a step further and cut those muscles in the forehead for permanent relief.

When I asked my friend Ken Rothaus, a plastic surgeon at the New York Hospital, about this approach, he was not excited—despite the potential new pool of patients. Ken feels that even in the best hands (and his are superb, surgically speaking) surgery can cause scarring; retraction of sectioned muscles, resulting in a lumpy appearance requiring more surgery; and hair loss, since the incision to reach forehead muscles is made above the hair line.

Another strong argument against surgery is the very nature of migraines. They come and go for long periods of time, and on their own improve with age in most patients.

An additional reason, and perhaps the most compelling: Plastic surgeons lack training in diagnosing and treating headaches. They do not know how to properly diagnose different types of headaches, how to detect potential triggers, and how to combine different treatments into a comprehensive plan.

The LA Times' Healthy Skeptic column examines products that utilize acupressure for nausea reduction.

Acupressure Bands for that Sickening Feeling

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