Poor migraine control leads to chronic daily headache


Many patients manage their infrequent migraine headaches with triptan medications, such as sumatriptan.

We call these “abortive” medications – you take them as needed whenever you have a headache to make it go away.

These medications set off an “explosion” of chemicals inside the brain, “extinguishing” the migraine just like an explosion of dynamite can put out an uncontrolled oil rig fire:

However, sometimes, that “chemical explosion” doesn’t put the fire out completely, and it comes right back.

We call this “rebound” headache, and we have already blogged about how taking too much abortive medication (including over the counter medications like Excedrin Migraine) for migraines can lead to  headache all the time, chronic daily headache, because of analgesic rebound.

Data from a new study has recently confirmed this:  The large American Migraine Prevalence and Prevention (AMPP) study showed that patients with very poor headache control were 4 times more likely to progress into chronic migraine during the following year than those with better control.

Clearly, poor headache control leads to more and more headaches, presumably because of analgesic rebound.

The solution?  Obtaining more sustained migraine control by starting a daily preventative medication for migraine like topiramate, valproic acid or botulinum toxin.

If your headaches are getting more frequent or out of control, seek the help of a board certified neurologist sooner rather than later!


Memory Loss? Better check that medication list!

Memory Loss

Alzheimer’s disease is the commonest cause of memory loss and dementia.   We do not yet fully understand what causes Alzheimer’s.  However, we do know that the neurotransmitter acetylcholine is important in brain processing and memory.  We also know that the acetylcholinesterase inhibitors (drugs like Aricept<donezepil> , Exelon <rivastigmine> and Razadyne <galantamine>), which inhibit the breakdown of acetylcholine, do provide a symptomatic improvement in affected patients.



It is also known that many drugs can cause and/or exacerbate memory loss in elderly patients:

Anticholinergics block the effects of acetylcholine, causing confusion. They also negate the beneficial effects of aceylcholinesterase inhibitors in Alzheimer’s patients.  These drugs are commonly prescribed for urinary frequency and urgency, and include Ditropan <oxybutynin> and Vesicare <solifenacin>.  The tricyclics, including Elavil <amitriptyline> and Pamelor <nortriptyline>, commonly prescribed for insomnia and headaches, also have anticholinergic properties.

Benzodiazepine drugs like Xanax <alprazolam> Restoril <temazepam> and Klonopin <clonazepam>, most commonly prescribed for anxiety and insomnia, can also cause and/or exacerbate memory loss because of drowsiness and inattention.

A recent study of Alzheimer’s patients living independently in the community showed that as many 17% were taking anticholinergic drug and almost 9% were taking benzodiazepines.

As if that wasn’t bad enough, 16% of patients were taking both an acetycholineresterase (cholinergic) and an anticholinergic drug at the same time!

The bottom line here is that you should always bring a complete and updated list of all your medications with you to doctors appointments!

med list


Click here for a link to the full article.

Expensive Drugs Could Bankrupt Medicare!

Conceptual photo  illustrating expensive drugs and medicines

The United States spent about $98 billion on pharmaceuticals in 2006. This is despite 10% less drug use than other countries.  The problem is that our drugs, on the whole, cost about 50% more than other countries, 77% more for brand name medications.

Take the Lilly drug Cymbalta, for example – the average cost for a 1-month supply in the USA is $176, compared to $113 in Canada and $47 in France:

Think that’s expensive?  Sanofi will soon launch Lemtrada (alemtuzumab), an M.S. treatment that costs $60,000 per year. It will compete against Gilenya from Novartis, which is already on the market at $40,000 per year.

Why?  Some say that it’s because we’re wealthier and need to subsidize for the rest of the world. But even if we paid more based on our relative wealth, it would come to about a 30% premium, not the 77% we do pay. Some say that it’s because we in the US subsidize the massive research and development for drugs. But the entire bill for R&D for the pharmaceutical industry was less than $50 billion in 2006, far less than the “extra” we paid for drugs.  Some say it’s because we are subsidizing massive marketing in the US, which might be upwards of $40 billion in 2006. Again, far less than the “extra” amount.

Critics of pharmaceutical companies point out that only a small portion of the drug companies’ expenditures are used for research and development, with the majority of their money being spent in the areas of marketing and administration. The pharmaceutical industry has thousands of Washington lobbyists to protect their interests, and actually spent $855 million, more than any other industry, on lobbying activities from 1998 to 2006.

Prescription drug prices have become a real political issue in the United States.

Many third party payers can negotiate lower prices to control their low costs, but this causes pharmaceutical companies to raise their retail prices to offset costs.

Using a mail order pharmacy for a 3-month drug supply can save as much as a 29% in out-of-pocket costs and 18% in total prescription costs.

To save even more money, 10 million U.S. citizens bring in medications across land borders from Canada and Mexico each year.  Other patients shop on-line at lower cost overseas pharmacies, and an additional 2 million packages of medications arrive annually by international mail from Thailand, India, South Africa every year.