ppp 09-08-08

Quote of the day: Half of the modern drugs could well be

thrown out of the window,

except that the birds might eat them.

Dr. Martin Henry Fischer

Over the weekend I received a request from a friend for some advice on migraine prophylaxis. It is easier to say what does not work than to find the magic bullet of prevention. The use of “triptans” is very effective against most migraines (contraindicated in “hemiplegic migraines”). Some patients insist on taking their “triptan” every day in an attempt to prevent a potentially disabling attack. Unfortunately, the daily use of “triptans” have been shown to NOT prevent migraine while exposing patients to all of the side effects. Daily “triptans” are both expensive and ineffective.

So what might actually prevent migraines or at least reduce their frequency and/or intensity? I use an aspirin a day to prevent migraines. In theory, the platelet aggregation that triggers vasospasm in the coronary arteries and causes heart attacks can also trigger vasospasm in the circulatory system in the head and trigger migraines. Since starting the aspirin I went from one every 2 weeks to 1 per year. (What works for me may not work for you.)

Prescription drugs from many therapeutic classes can provide protection but they also carry a greater potential for serious side effects. Blood pressure drugs used for prevention are: Clonidine, propranolol, atenolol, metoprolol, nadolol, timolol, amlodipine, diltiazem, verapamil, lisinopril and nimodipine. Antidepressants used include: Phenelzine (MAO inhibitor), amitriptyline, nortriptyline, fluoxetine, sertraline, venlafaxine, and paroxetine. Anticonvulsants may be started in less than anticonvulsant doses include gabapentin, keppra, topiramate, valproate, and zonisamide. Some have started using BOTOX for migraines but that seems a little extreme (although actually approved).

Each of the above drug carries its own laundry list of potential side effects. The body dose not know the reason the drugs are taken and thus the side effects will not vary from those seen when used for their primary indications. Are all of these choices giving you a tension headache? With all of the choices available it would be best to be under the care of a neurologist who is interested in migraines.

Should you get a migraine there are several things you can do that are not pharmacological. Seek a quiet area away from light (like you have to be told to avoid these noxious stimuli… “to the bat cave!”). Placing your hands in warm water may also provide some relief. A biofeedback study in the 80’s showed that patients could get relief if they could raise the temperature of their hands by concentrating. Again, consult your physician.

ps. Best answer this week to the question "How are you?" was "I’m so far behind today that I’m ahead for tomorrow."

pps. Please note that some of the links may not be up for very long and that you should capture or print anything that you may wish to keep.

Bristol-Myers Squibb has disbanded it corporate fleet of 4 aircraft in a cost cutting move. Thirty two employees go as well. Don’t worry for the big wigs… there’s always first class on commercial planes.

$5 billion per year does not produce the desired results. Consumers can’t just go out and purchase drugs that they see on TV… there is that required prescription thing that gets in the way. I expect medical/pharmaceutical journal advertizing to increase as the pharma companies will be restricted in the gift area (pens/paper/meals etc).

“Free” drug samples cost patients more money than going directly to generics or less costly alternative drugs. Copay will be higher for brand name drugs vs generic drugs and formulary copays will be less than non-formulary copays. A short term supply for no direct cost to the patient can lead to a larger out of pocket expense. Employers outlay is even greater in that they pay a great proportion of drug costs than their employees.

Increase in deductables, co-pays and out of pocket spending limits will reduce the rate of increase in healthcare spending by companies while making the use of the benefit a little more expensive to employees.

Article wants to place the blame on the use of antidepressant medications. The medical community and parents want to blame things on physical outside influences such as drugs. Maybe it has something to do with a loss of moral grounding of youth. (I’m sure that each case is different… always sad… but unique).

Some feel that vaccination of seniors over 70 against influenza is not useful. The latest barrage was published in the edgy Lancet. If the value of retired citizens lives were seen as less economical than the additional spending on influenza vaccine and the presumed increase in longevity and health cost burden then withholding vaccination might be logical. I’ll still insist that my mother receive the “flu shot” this and every year. (Many “flu” vaccine have already shipped… get yours early!)

Manufacturers of Remicade, Humira, and Enbrell have to add the risk of potentially fatal, systemic fungal infections to their warnings. The drugs work against arthritis by suppression of inflammatory/ immune resposes which help us discriminate between self and non-self (fungi in this case). http://www.nytimes.com/2008/09/05/washington/05arthritis.html?_r=1&ref=us&oref=slogin

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