I will get back to my previous two questions, with the remaining one being “What do we have to offer?” But first, I want to do a quick update in some of the thinking and research in headache.
Last year a warning was given regarding Topamax and its use in pregnancy. The risk level was raised to a “D” meaning that there was evidence that taking Topamax during pregnancy increase fetal risks. More recently a paper was published that discusses the possibility of that being overstated. The reason is, when you take away the other risks factors of being pregnant and being a serious headache suffer, there doesn’t appear to be any additional risks caused by being on Topamax. Does this mean that we will now prescribe it during pregnancy? If it were my own family and the headaches were severe enough, I would. But, there are already advertisements by lawyers on TV offering to sue anyone who prescribed Topamax while a patient was pregnant and there was a birth defect. Those birth defects mostly likely has nothing to do with Topamax, yet, because of the “D” classification, the suit would most likely prevail. The good news is that women who did inadvertently take Topamax while pregnant should not worry about birth defects.
Speaking of Topamax, you may have already heard that Qusmia, a new weight loss drug has hit the market. What you may not have known that in Quismia is a formulation of Topamax (plus phentermine). What is interesting is that the formulation of the Topamax seems to have lower side effects than the formulation we use for headaches. It would be nice to have the opportunity to prescribe Quismia for migraine prevention, however, as with all new drugs on the market, it is expensive and the insurance companies will not pay for it for migraine. But in the future, it could be a good alternative to the Topamax we now use. I personally prefer zonisamide because of its lower side effect profiles.
Another paper recently published showed that patients entrapped in chronic migraine and medication rebound can be helped. A multidisciplinary approach seems to be best.
There recently were a couple of new studies looking at brain activity at the heart of migraine, which is the periaqueductal gray area of the brain-stem. This may not help patients at this time, but, such research will eventually lead us to a cure . . . if there ever will be one.