Do you ever have one of those days?

The Ultimate Migraine

A rhetorical look at treatments, research trials, and why having one is such a headache

Overview

• Migraines – What are they? What are the symptoms? What causes them? Is there a cure?

• Treatments – Do they work? Are there side effects? How effective are they?

• Clinical Research Trials – Purpose(s); How do they work? Are they a treatment alternative?

• Non-Prescription Meds – Are they a valid treatment option? Plus, one company’s success at snowing the public for a bigger piece of the Kopfschmerzen pie.

What is a Migraine?

• Recurring headache, mild to severe

• Often one-sided, but not always

• Characterized by throbbing, pulsating sensations

• Usually last from four to 72 hours, though may last a number of days or weeks

Causes

• Blood vessels in the head constrict, then dilate

• Low neurotransmitter levels may be a factor

• Heredity

• Age

Types of Migraines• Classic

• Common

• Hemiplegic

• Abdominal

• Transformed

• Chronic

• Probable

Symptoms

• Sensitivity to light• Sensitivity to sound• Nausea, with or w/o vomiting• Scotomata (blind spots)• Teichopsia (bright shimmering or wavy

lines) • Fortification spectra (zigzag pattern)• Photopsia (flashing lights)• Paresthesias• Visual and/or auditory hallucination

Common Triggers

• Certain foods, including cheese, chocolate and processed meats

• Smoking and nicotine• Caffeine• Monosodium glutamate • Aspartame• Weather• Allergies• Bright lights incl. Sunlight• Loud noises• High altitudes

Other Headache Types

• Tension

• Sinus

• Acute

• Medication Overuse

• Hormone

• Cluster

Evolution of Medication

1899 Aspirin1928 Ergots1974 Antiemetics1979 NSAIDs1990s Triptans

Abortive Therapy Treatments

• Aspirin – painkiller

• Ergot(amine) – suppository

• Antiemetic – anti-nausea therapy

• NSAID – anti-inflammatory

• Triptan – serotonin receptor antagonist

Triptans

• Imitrex (sumatriptan succinate)• Amerge (naratriptan hydrochloride)• Zomig (zolmotriptan)• Axert (almotriptan malate)• Relpax (eletriptan hydrobromide)• Maxalt (rizatriptan)• Frova (frovatriptan)

Imitrex

• First introduced in 1991• Revolutionized migraine

treatments• Available three ways

tablets injectionnasal

Imitrex Tablets

• 25mg, 50mg, 100mg• Mild, short-lived side effects• No more than 200mg in 24 hrs.

Imitrex Nasal Spray

• 20mg• Bad taste common• No more than 40mg in 24 hrs.

Imitrex Injection

• 6mg.• Injection site irritation common• Mild side effects• No more than two in 24 hrs.

Preventative Meds

• Calcium Channel Blockers

• Beta Blockers

• Vitamin B2 (riboflavin)

• Antidepressants

• Anticonvulsants

‘Dopamax’

Rescue Meds/Other

• Celebrex (celecoxib capsules)

• Vioxx

• Midrin (isometheptene mucatate, dichloralphenazone, acetaminophen)

• Stadol (butorphanol tartrate)

Clinical Research Trials

• Test new drugs and treatments• Provide alternatives to standard

treatments• Ensured safety is sought by strict protocol• Risks, therapeutic benefits involved• Informed consent• Phase I, II, III (IV)• Patient progress carefully monitored

Clinical Research Trials, cont.

• Placebo• Blind/masked trials, randomization• Rescue Medication• Costs• Criteria, medical or otherwise• Trial results

Non-Prescription Meds

• May provide temporary relief

• Shorter effects; more pills may be needed

• Some doctors this is an unsafe practice.

• Overmedication and rebound headaches may result.

Excedrin Migraine

• Active ingredients: Aspirin, acetaminophen, caffeine

• First non-prescription medication for migraines approved by the FDA

• Designed to treat ALL symptoms

• One of the least expensive meds

• Contains “same enhancing ingredient” as some prescription drugs

More on Excedrin Migraine

• Three studies conducted• 1,250 evaluated• After two hours, 59% reported pain

diminished or gone.• After six, 79% reported pain as mild or

gone.• Placebo patients: 33% saw pain diminish

after two hours; 52% reported mild or no pain after six hours

The Problem?

Bristol-Meyers Squibb already had an identical product on the market,

one that already carried the Excedrin moniker and contained

the same active ingredients.

Extra-Strength Excedrin

• Active ingredients: aspirin, acetaminophen, caffeine

• Same ingredients and amounts as Excedrin Migraine

• Indicated for temporary pain relief

Comparison?

Is it really that difficult to figure out? (Well, maybe if you’re the FDA!)

Vs.

Rhetoric

• Television

• Magazines

• Web

• Medical pamphlets

Summation

• No two migraines are the same

• Symptoms and triggers vary

• Variety of treatments available

• Non-prescriptions may worsen headaches

• Most marketing leans toward women

The End