UPDATE: Getting the Correct Information on Migraine Drug Treximet

The comments I made to the The Real Cougar Woman in reference to the misinformation in the article Migraine Sufferers - This New Drug Might Help You are now showing. I don't know if they were removed intentionally or if it was just one of those "things" that sometimes happens in cyberspace.

I was hoping that because my comments weren't there, the article might be corrected. But noooooo, the article remains the same. Wait, something has been fixed. It's so small that I almost missed it. The last sentence no longer says:

If you are a migraine sufferer ask your doctor if treximent is for you.

Now it says:

If you are a migraine sufferer ask your doctor if treximet is for you.

The spelling of the word "treximent" has now been corrected to "treximet". YIPPEE!

One down, a bunch to go...

This updates my previous blog entry Getting the Correct Information on Migraine Drug Treximet

Who is GINA? And What Does She Have To Do With Migraine Disease?

GINA is not a "who" but a "what". GINA is the Genetic Information Nondiscrimination Act of 2008. GINA was signed into law by President George W. Bush on May 21, 2008.

On April 24, 2008, the Senate passed this bill 95 - 0. It was sent back to the House of Representatives on May 1, 2008 and passed 414 - 16 - 1. Congressman Ron Paul (R-TX) was the only person to vote against this bill.

GINA makes it illegal for insurance companies and employers to discriminate against you because of your genetic makeup. A press release issued by Coalition for Genetic Fairness explains that this legislation protects against this discrimination by:

• Prohibiting group health insurance plans and issuers offering coverage on the group or individual market from basing eligibility determinations or adjusting premiums or contributions on the basis of an individual's genetic information. Insurance companies cannot request, require or purchase the results of genetic tests, and they are prohibited from disclosing personal genetic information.
• Prohibiting issuers of Medigap policies from adjusting pricing or conditioning eligibility on the basis of genetic information. They cannot request, require or purchase the results of genetic tests, or disclose genetic information.
• Prohibiting employers from firing, refusing to hire, or otherwise discriminating with respect to compensation, terms, conditions or privileges of employment. Employers may not request, require or purchase genetic information, and they are also prohibited from disclosing personal genetic information. Similar provisions apply to employment agencies and labor organizations.

Congresswomen Louise Slaughter (D-NY), who first authored and introduced genetic nondiscrimination legislation thirteen years ago, issued this press release explaining the historical precedents for GINA:

• In the 1970s, many African-Americans were denied jobs, educational opportunities, and insurance based on their carrier status for sickle cell anemia, despite the fact that a carrier lacked the two copies of a mutation necessary to get sick.
• In 1998, Lawrence Livermore Laboratories in Berkeley was found to have been performing tests for syphilis, pregnancy, and sickle cell on employees without their knowledge or consent for years.
• In 2000, the Burlington Northern Santa Fe Railroad performed genetic tests on employees without their knowledge or consent.

So, what does all this have to do with Migraine Disease?
Migraine is a hereditary condition. It is a genetic neurologically-based disease. The MAGNUM article, Migraines: Myth Vs. Reality explains:

Migraine is a genetically-based disease. We first learned this in the mid-90's, as it was specifically stated in correspondence with M.A.G.N.U.M. by Dr. Stephen J. Peroutka, M.D., Ph.D., President & CEO of Spectra Biomedical, Inc., a group of research physicians dedicated to understanding the genetic basis of Migraine and other illnesses, the "data are unequivocal: Migraine is a genetically-based illness. Individuals with a single parent having Migraine have approximately a 50% chance of having Migraine. This susceptibility is neither psychological nor induced by environmental causes."

Although Griffith University's Genomics Research Centre (GRC) in Australia is not the only one doing genetic research for Migraine disease, it is the home of the world's largest collection of DNA samples from migraine patients. The GRC has discovered different genetic regions on chromosomes 1, 19 and X where Migraine genes are found. Through genetic research, they have identified a link between hormones and Migraine and a link between Migraine genes and stroke saying:

There's a mutation in this gene that makes people more likely to suffer stroke and also increases the risk of migraine. We believe this to be a link between migraine and stroke.

It is possible for genetic testing to play a huge role in finding a cure for Migraine and other diseases and conditions. GINA will allow those of us with a genetic disease or condition to participate in testing without the fear that our insurance companies and employers find out. Those who may be predisposed to a specific genetic condition now have the opportunity to be proactive by monitoring their health and possibly preventing a genetic disease or condition.

For more information on genetic discrimination, you can read the 25-page report in pdf format: Faces of Genetic Discrimination: How Genetic Discrimination Affects Real People. (I did say it was 25-pages and in pdf format, right?)

The Pitfalls of Over-The-Counter Pain Medications for Migraine and Other Types of Pain

Next time you grab that bottle of over-the-counter (OTC) pain medicine for your Migraine, neck, headache, back, knee or other pain make sure you know the facts. Acetaminophen, aspirin, ibuprofen, ketoprofen and naproxen CAN hurt you. Two articles published this past week discuss the overuse of OTCs. The June 2008 issue of Consumer Reports features the article, Beware of overusing over-the-counter pain relievers and U.S. Pharmacist features the May 20, 2008 article, Common Adverse Events and Interactions with OTC Pain Medications.

The Consumer Reports article contained the results of an online survey regarding how people use OTCs. The Consumer Reports National Research Center surveyed 47,283 subscribers in 2007. They found that 14,658 (31%) of the survey participants did not always follow instructions on the label. The also found that:

• 5 percent used OTC pain relievers daily for two weeks or more without a health expert's approval, ignoring label directions.

• 4 percent routinely took excessive doses without consulting a health professional.

• 4 percent experienced serious side effects, including ulcers and kidney, liver, and heart problems, that a health professional said could be traced to use of OTC drugs.

The three main excuses reasons survey participants used to explain why they were overusing OTCs were 1) They were in severe pain, 2) They didn't experience any side effects, or 3) They weighed more or they were taller than average.

Published research indicates OTC overuse is more prevalent nationally than among Consumer Reports subscribers. A 2005 study, published in The Journal of Rheumatology, claims:

...36 million Americans are using OTC pain medications daily, with roughly 23 million using NSAID. Further, one-fourth of users exceeded the recommended dose of OTC medication, and the belief that OTC are safer than prescription doses was common. More disturbing is that about half of the interviewees either were unaware of the potential toxicity of these agents or were unconcerned. These findings strongly underscore the need for educational interventions directed to the general public as well as physicians.

There are dangers of OTC analgesics that many people are not aware of. Most healthcare providers believe that using analgesics for Migraine pain, regardless of whether they are prescribed by your healthcare provider or purchased OTC, more than 2 or 3 DAYS a WEEK or consecutively can cause Medication Overuse Headache (MOH) also known as Rebound Headaches. The article, Medication Overuse Headache - When the Remedy Backfires explains:

Medication-overuse headache is an interaction between a medication used excessively and a susceptible patient...
... What is crucial is that treatment (resulting in MOH) occurs both frequently and regularly, i.e., on several days each week...
...the headache associated with medication overuse often has a peculiar pattern shifting, even within the same day, from having migraine-like characteristics to having those of tension-type headache (i.e., a new type of headache).
The diagnosis of medication-overuse headache is clinically extremely important because patients rarely respond to preventative medications whilst overusing acute medications.

Acetaminophen is not recommended for those with liver disease, kidney disease or those who consume 3 or more alcoholic drinks per day. The FDA warns that exceeding the recommended dosage or overdosing on acetaminophen can lead to liver damage.

NSAIDs, include aspirin, ibuprofen, ketoprofen and naproxen. With the exception of aspirin, NSAIDs can increase stroke and heart attack risk. (Aspirin combined with another NSAID carries the same risk.) They can also be harmful to the liver, kidneys and stomach. NSAIDs can cause ulcers, bleeding, perforation and other gastrointestional effects. The FDA says:

The risk for bleeding is low for those who take these products intermittently. For those who take the products on a daily or regular basis, the risk is increased, particularly for those over 65 years of age or those who take corticosteriods (such as prednisone). Those who use hormone therapy (estrogens and progestins) for post-menopausal symptoms or birth control do not have an increased risk for bleeding.

In addition, consumers should ask health care providers about NSAID use if they have kidney disease or are taking diuretics (fluid pills).

The U.S. Pharmacist article, geared towards pharmacists rather than the public, discusses the dangers of these medications in more detail:

OTC pain medications should be used at the lowest effective dose for the shortest duration possible to minimize the potential risk for an adverse event. Patients taking acetaminophen should not exceed the recommended maximum daily dose, while patients taking NSAIDs should not exceed the recommended single or daily dose.

The article also discusses the pharmacist's duty to play a critical role in educating patients of the dangers of OTCs and how to use them safely. To decrease accidental overdoses, pharmacists should encourage people to read labels and learn the ingredients in the product. To prevent using a combination of products containing the same ingredient, pharmacists should provide educational material on generic names. And to prevent dangerous or fatal results, pharmacists should caution people on the misuse and overuse of OTCs.

WOW! What a novel idea; pharmacists educating patients about their medications regardless of whether it's available OTC or requires a prescription! Sarcasm aside, this would be great but there's no way our pharmacists can do this alone. The Consumer Reports article tells us:

Debra Latimore, 52, of Whiting, Ind., told us she's been taking Advil for osteoarthritis pain daily since 2006 without telling her internist. "I forget to list it on doctor forms because it's over-the-counter," she says. "It's not something I think of as a drug."

How are our pharmacists supposed to educate people about OTCs if they don't know who the consumers are? Latimore didn't tell her doctor she was taking an OTC medicine every day, so how is her pharmacist supposed to know about the bottle of ibuprofen she (probably) bought at Wally World? The majority of responsibility must lie with us patients. We have to be the ones to seek out our pharmacist's guidance and we have to be the ones to initiate discussions with them. It's our responsibility to be informed patients and learn all we can so that we use OTCs properly and according to their labels. Way better than my advice though, is Schoolhouse Rocky's great words to live by:

As your body grows bigger,
Your mind must flower,
It's great to learn,
'Cuz knowledge is power!

Migraine and the Energy Independence & Security Act of 2007

Last year Congress passed the Energy Independence and Security Act of 2007. This federal law requires incandescent lighting to be phased out in favor of energy efficient bulbs starting in 2012. The law doesn't say that compact fluorescent light bulbs (CFLs) are required but because fluorescent, the tube-like bulbs that are mostly found in public places such as offices, schools, and stores, and CFLs, the ones designed for home use, are the most available and less expensive, it's likely that these types of bulbs will be the most used.

Many Migraineurs find that CFLs trigger Migraine attacks. CFLs also affects others who suffer with health conditions such as Epilepsy, Lupus and Autism. As use of CFLs increase, those of us with health conditions will find it very difficult to have a public life; to go to the store or bank, attend school and go to work in offices and factories alike.

Opposing CFLs does not mean that Migraineurs and other people with health concerns are opposed to "Going Green". Of course we are in favor of saving our environment and our planet as much as anyone who's health is not affected by this lighting but we believe that alternatives such as light emitting diodes (LEDs), halogens and improved energy efficient incandescents , would remedy this issue without hurting or endangering our health.

A group of us who write, blog and advocate for Migraine Disease have created a petition asking for an amendment to the Energy Independence & Security Act that emphasizes energy standards and encourages the development of other energy saving technology instead of focusing on the elimination of existing technology. If you feel the same way we do please head over to ipetitions and sign the Protect migraineurs from compact fluorescent bulbs ipetition HERE.

Getting the Correct Information on Migraine Drug Treximet

I was just over at Migraine News Network reading Raingem's interesting article, "Treximet or TrickThem-et?" She provides us with good information about this new Migraine medication and points us to something:

Debbie who runs Down The Rabbit Hole blog:, has noticed something interesting - a little subversive disinformation campaign as propagated by sloppy journalists and uninformed patients alike. There are plenty of little news blips if you care to search for them that say pretty much the same as this little article: New Drug Could Be Best Migraine Medicine On Market.

I find all this ironic. Two days ago I was reading Migraine news. It seemed that article after article was bullshit, misinformation, unreliable and lies. So when I stumbled on this Treximet article Migraine Sufferers - This New Drug Might Help You on The Real Cougar Woman I started to get mad. This article was filled with inaccurate and misleading information and I couldn't take it anymore, So I did something I usually don't do. I wrote a letter to the author, pointed out the incorrect information and provided her with the correct information. I told her that she didn't have to post my comments but I would like her to fix the stuff that was wrong. She ended up posting my comments instead.

You can read them below or read them in context on The Real Cougar Woman. Since my comments were removed two days after being approved, here's part of the article including the incorrect information in red:

...This month, a new drug is expected to land in pharmacies that combines two existing migraine drugs. It promises to offer relief without the fear of addiction. It's called treximet.

Apparently it works by combining two existing drugs that control two different aspects of migraine headaches. First, it prevents blood vessels in the head from narrowing. Second, it blocks the brain from releasing chemicals that signal pain.

If you are a migraine sufferer ask your doctor if treximent is for you.

My comments in their entirety follows:

Treximet is NOT the combination of two existing Migraine drugs. It combines a Migraine medication with an NSAID. The Migraine medication, Sumatriptan, is a Triptan (technical name is selective serotonin receptor agonists), and is the ingredient found in Imitrex. The NSAID is naproxen sodium, the same ingredient found in the over-the-counter medicine Aleve. This is used for many other conditions. You say "It promises to offer relief without the fear of addiction". Even though it's not very common, NSAID addiction can occur. Additionally, using these products separately and/or together can cause a serious condition for Migraine sufferers called Medication Overuse Headache also known as Rebound Headaches.

I know that all medications including vitamins and supplements have side effects but your article makes it sound as if there are no risks associated with using this medication. Yes, there are benefits of both medications but it should be noted that NSAIDs can be FATAL. It increases heart attack and stroke risk and can be harmful to the liver, kidneys and stomach. NSAIDs can also cause ulcers, bleeding, perforation and other gastrointestinal effects.

You're incorrect to say that this medication prevents blood vessels in the head from narrowing. Treximet does NOT prevent blood vessels in the head from narrowing. During a Migraine attack the blood vessels in the head DILATE. Sumatriptan causes vasoconstriction. This means that this medication does the exact opposite of what you said it does and constricts, or narrows, the blood vessels. You can verify this information on MAGNUM, the same site you cited http://www.migraines.org/treatment/treathis.htm

Treximet is misspelled "treximent" in the last sentence.

Using the phrase "Migraine Headache" is also inaccurate. Migraine is a genetic neurological disease. Migraines are NOT headaches. Headache is just one symptom of a Migraine and there are many other symptoms such as, aura, nausea, vomiting, photophobia, phonophobia and vertigo. Some people don't have headaches during a Migraine attack so calling it a "Migraine Headache" is misleading.

I'm not asking you to publish my comment, I'd just like you to fix the misinformation.
Pam
http://pinkpurlgurl.blogspot.com

LPGA Tour Pro Diana D'Alessio Takes Swing at Menstrual Migraines

PARtnering Against Menstrual Migraine Campaign Will Raise Awareness of Widespread, Treatable Condition

CLIFTON, N.J., May 15 /PRNewswire/ -- Ladies Professional Golf Association (LPGA) Tour Professional Diana D'Alessio is teaming with Endo Pharmaceuticals and the National Headache Foundation to launch the PARtnering Against Menstrual Migraine campaign, an educational initiative to raise awareness about menstrual migraine and how women can effectively manage this condition. The campaign will feature free migraine screenings with headache specialists and appearances by D'Alessio at information booths during select LPGA events in 2008.
Click HERE to read the entire press release.

For a menstrual migraine tracker, quiz and more information on the condition go to www.partneringagainstmenstrualmigraine.com.

Photo courtesy of Jeremy Brooks

Serotonin Syndrome in the News

MedlinePlus, a service of the US National Library of Medicine and the National Institutes of Health defines Serotonin Syndrome:

Serotonin syndrome is a life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.

And cites the cause:

Serotonin Syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area.

An example of this is taking a Selective Serotonin Receptor Agonist also known as a Triptan while you are taking a Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin and Norepinephrine Reuptake Inhibitor (SNRI). In other words using Imitrex aka Sumatriptan (a Triptan) while taking Prozac (an SSRI) or Cymbalta (an SNRI) can cause Serotonin Syndrome.

It is believed that changes in serotonin is involved in causing Migraine attacks. More about it can be found HERE. This information has been around for a while so.....

Why is Serotonin Syndrome in the news?

In the May 15 issue of the New England Journal of Medicine, Georgetown University researchers and the U.S. Food and Drug Administration detail 11 cases of Serotonin Syndrome associated with the use of triptans alone that were reported to the FDA's Adverse Event Reporting System (AERS)."

Offie Soldin, an associate professor of medicine and oncology at Georgetown University Medical Center and the study's lead author said:

The FDA has already issued an advisory and an alert that when triptans are used in combination with SSRIs, there is a possibility of serotonin syndrome. The news here is that it doesn't have to be in combination, triptans alone can cause serotonin syndrome

Soldin also stressed that this is very rare and unlike to happen saying:

...you just need to stop taking the drugs when it does happen. If you're taking these medications and you have strange muscular, mental or hyperactivity symptoms, contact your doctor.

More information can be found in this Washington Post article.

How To Integrate Exercise Into a Life Filled With Migraines

Check out the May 12th edition of the Headache & Migraine Blog Carnival posted over at Diana Lee's site Somebody Heal Me. The topic for this edition is "How to integrate exercise into a life filled with migraines."

Don't know what a blog carnival is? A blog carnival is a collection of links to a variety of a blogs on a central topic. The Headache & Migraine Blog Carnival provides both Headache and Migraine Disease patients and people who blog about headache disorders with unique opportunities to share ideas on topics of particular interest and importance to us. Visit this month's carnival for a collection of informative entries on how other Migraineurs fit exercise into their lives.

Kid NEVER Sleeps!

Pain keeps me awake a lot and I rarely get more than six hours of sleep at night. After I read about three-year-old Rhett Lamb, I consider my six hours precious.

Rhett NEVER sleeps. I mean NEVER -- not a nap, not a snooze, zero, zilch, nil, nothing EVER. He's been awake for the last three years since the day he was born. Dad gave up his job to take care of him. Mom works extra to pay for his medical bills. Both mom and dad share the night shift because someone has to be awake with him at all times. Doctor's say Rhett can't sleep because of chiari malformation. To learn more about Rhett click HERE.

Pain Medication Does Not Lead to High Risk of Addiction

Using strong pain medications, including opioids, for long-term, chronic pain puts you at high risk of addiction, RIGHT? Srinivasa Raja, MD, a professor of anesthesiology at Johns Hopkins University Medical School says that is WRONG.

Raja presented the lecture: From Poppies to Pill Popping: Is There a "Middle Way"? at the 27th Annual Scientific Meeting of the American Pain Society (APS) Raja reported that less than 3% of all chronic pain sufferers, with no history of drug abuse of any kind, will show signs of abuse or dependence. He urged clinicians not to allow this small percentage to prevent them from prescribing pain medications to patients who are more likely to benefit from them than be hurt by them. Raja also said:

We also are dealing with unfounded accusations in the media that increased prescribing of opioids for severe chronic pain is responsible in large part for reported upswings in the abuse of pain medications

Raja stressed the importance of communication between doctor and patient, the importance of patient monitoring to identify addictive behavior, and the importance of monitoring patients to see if doses can be lowered as pain control improves. He also suggests alternative treatments such as cognitive behavior and physical therapy to supplement pain medication whenever possible.

His lecture asked federal and state regulatory agencies to aim for state-to-state consistency in regulating controlled substances and called for a crack down on illegal internet pharmacies and prescription thefts and forgeries. He applauded teen drug awareness campaigns as a means of preventing this type of drug abuse. Raja's also had a message to the pharmaceutical industry and said:

the key challenge is to match clinical needs for less addicting pain medication with drug development priorities. “There are novel analgesic formulations in various stages of development that we hope can be prioritized and expedited for clinical use

Raja cited two outdated beliefs about pain that were later disproved by scientific evidence. The first, a commentary published in the Journal of the American Medical Association fifty years ago that said cancer patients shouldn't use opioids due to the possible risk of addiction and secondly, the belief, twenty years ago, that infants shouldn't receive anesthesia because they didn’t feel pain. Both beliefs are now abandoned and Raja feels that the fear of addiction in pain management should be abandoned too.

sources: Chronic Pain Meds Unlikely to Cause Addiction and Risks for painkiller abuse do not outweigh benefits in chronic pain

May is Stroke Awareness Month - Do You Know the Warning Signs?

Did you know Migraine increases your Stroke risk? Information regarding the Migraine - Stroke connection can be found in MAGNUM's article Migraines: Myth Vs. Reality:

According to the New England Journal of Medicine, "migraine can sometimes lead to ischemic stroke and stroke can sometimes be aggravated by or associated with the development of migraine." Twenty-seven percent of all strokes suffered by persons under the age of 45 are caused by Migraine. Stroke is the third leading cause of death in this country. In addition, twenty-five percent of all incidents of cerebral infarction were associated with Migraines, according to the Mayo clinic. Most recently the British Medical Journal reported that after evaluating 14 major Migraine & stroke studies in the U.S. and Canada that Migraineurs are 2.2 times greater risk for stroke than the non-migraine population. That risk goes up to a staggering 8 times more stroke risk for women Migraineurs on the pill!

Can you recognize ALL five correct Stroke symptoms? Can you identify an incorrect Stroke symptom? Do you know when you need to call 9-1-1 when someone appears to be having a Stroke? If you answered "no", you're not alone.

Results of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey that was used in 13 states and the District of Columbia (DC) to examine public awareness of Stroke warning symptoms and the importance of seeking emergency care were examined in this week's issue of the CDC's Morbidity and Mortality Weekly Report article Awareness of Stroke Warning Symptoms --- 13 States and the District of Columbia, 2005. Out of 71,994 participants only 16.4% of respondents could recognize all five correct symptoms, identify an incorrect symptom and recognize the need to call 9-1-1.

May is Stroke Awareness Month. The National Institute of Neurological Disorders and Stroke (NINDS) developed the Know Stroke, Know the Signs. Act in Time campaign to educate the public about recognizing Stroke symptoms. If you don't know these five symptoms, take the time to learn them. If you already know them, teach them to someone else. At the very least, print them and attach them to your refrigerator so that your family can learn them.

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

These five symptoms can also be found HERE.

The NINDS says you may not realize you're having a stroke and you may not be able to call 9-1-1 on your own. The people around you may not know you're having a Stroke and just think you're confused. Don't waste precious time. Arriving at the hospital within 60 minutes after experiencing symptoms can greatly reduce Stroke damage. If you or someone you know is having a Stroke call 9-1-1 IMMEDIATELY.

Migraine and Post-traumatic Stress Disorder (PTSD) linked?

A small study has shown that Post-traumatic Stress Disorder (PTSD) may be more common in Migraine sufferers than in the general population. 32 of the participants had less than 15 Migraines per month and 28 had more than 15 per month. The study showed PTSD was more frequent in those experiencing more than 15 Migraine attacks per month and concluded that PTSD may be a risk factor for Migraine.
To read the article click HERE.

A study last year showed that almost one in every five US soldiers returning Iraq was being diagnosed with Migraine. Questionnaires completed by almost 2,200 US Army soldiers within the first 90 days of returning from a year of combat duty in Iraq were evaluated. 19% were found to suffer from Migraine, 32% tested positive for depression, 22% met the standard for PTSD, and 13% tested positive for anxiety. 50% of those who suffered with Migraines and 27% of those who did not were also clinically depressed. 39% of the Migraine sufferers and 18% of non-Migraine sufferers also had PTSD. 22% of those with Migraine and 10% of those without experienced anxiety disorders.

The study author Maj. Jay C. Erickson, M.D., a neurologist at Madigan Army Medical Center at Fort Lewis, in Tacoma, WA said that this information should serve as a wake-up call to both military and civilian doctors to evaluate for psychological troubles when a patient suffers with Migraine.
Click HERE to read this article.


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