Migranes And Sleep Disorders Linked In Children

Children with a migraine headache are more likely to have sleep disorders, such as obstructive sleep apnea (OSA) and lack of sleep, than children without a migraine, according to a research abstract on the effects of headaches on children's sleep patterns presented on Tuesday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

More on this research study can be found HERE.

FDA Recall - ETHEX Recalls ADDITIONAL Lots of Extended Release Morphine Sulfate 30mg and 60mg

ETHEX Corporation announced today that it has voluntarily recalled specific additional morphine sulfate 60 mg extended release tablets, and specific lots of morphine sulfate 30 mg extended release tablets, as a precaution, due to the possible presence of oversized tablets. Oversized tablets may contain as much as two times the labeled level of active morphine sulfate. The recalled lots were distributed by ETHEX Corporation under an "ETHEX" label between June 2006 and May 2008.

The 30 mg extended release tablets are pink oval tablets with "30" on one side, and "E" on reverse the 60 mg extended release tablets are white oval tablets with "60" on one side, and "E" on the reverse.

This FDA expanded recall can be found HERE.

FDA Recall - Morphine Sulfate 60 mg Extended Release Tablets

ETHEX Corporation announced today that it has voluntarily recalled a single lot of morphine sulfate 60 mg extended release tablets (Lot No. 91762) due to a report of a tablet with twice the appropriate thickness. Oversized tablets may contain as much as two times the labeled level of active morphine sulfate. The lot was distributed by ETHEX Corporation under an "ETHEX" label between April 16th and April 27th of 2008. No other dosage strength, nor any other lot of the 60 mg strength is affected by this recall.

The entire FDA recall can be found HERE.

Get a Head S.T.A.R.T on Your Headaches - National Headache Awareness Week

This week, June 1-7, 2008, The National Headache Foundation (NHF) is sponsoring National Headache Awareness Week. The NHF wants you to get a head S.T.A.R.T. on your Headaches by remembering these 5 strategies:

Seek diagnosis - Obtaining the correct diagnosis for your headache is the first step toward effective treatment.

Triggers - Identify and track your triggers (e.g. foods, stress, hormonal or weather changes) by keeping a headache diary and share this information with your healthcare provider.

Advocate - Be an advocate. Be informed. Be a participant in your headache care.

Resources - Use the National Headache Foundation as a resource. For the latest information about headache causes and treatments visit www.headaches.org

Treatment - Successful treatment may include medications and lifestyle changes. Work with your healthcare provider to find the right plan for you.

Events taking place country-wide can be found HERE. The NHF is also hosting a 5-part podcast aimed at women.

6/2 - Dr. Susan Hutchinson - Hormones & Headache
6/3 - Dr. Susan Broner - Contraception & Migraine
6/4 - Dr. Lisa Mannix - Menstrual Migraine
6/5 - Dr. Grace Forde - Pregnancy & Migraine
6/6 - Dr. Merle Diamond - Menopause & Headache

These podcasts are available for download on the NHF site.

More information on National Headache Awareness Week can be found in this press release.

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!