04/03/04 Podcast: The Most Frequently Asked Migraine Question.

The transcript of this podcast is below. Ifyou prefer to listen to it, you can do so easily from the MigraineCast Web site.

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Welcome to MigraineCast the weekly podcast brought to you by MyMigraineConnection.com and the HealthCentral Network. This week, I want to address the question that's asked more than any other single question. We hear and read this again and again from people who say, "I've tried every preventive medication out there, but nothing works. Now what?" There is an answer to that one, "It's literally impossible to have tried every preventive option available." There are now over 100 medications and dietary supplements and virtually endless combinations of them in use for headache and Migraine prevention. Yes, you heard correctly -- over 100, and there will undoubtedly be more added to the list.

At this point, some people would reply that their doctor has told them they're out of things to try. The most likely scenario here is that they've run out of the medications they know about. Migraine and headache treatement has become a specialized field. We may have family doctors and even neurologist who are excellent, dedicated, and very caring, but don't have the experience or advanced education to handle difficult headache and Migraine cases. This is when it's important to know that there are doctors who specialize specifically in the treatment of headaches and Migraine disease.

In the United States, there are four medications that have actually been approved by the FDA for Migraine prevention:

1. Propranolol, which is also sold under the brand name Inderal, is a beta blocker. It was first developed to treat heart disease and high blood pressure.
2. Timolol, another beta blocker sold under the brand name Blocadren.
3. Divalproex sodium, brand name Depakote, is a neuronal stabilizing agent, also called an antiseizure medication. It was originally developed to treat seizure disorders; as was the fourth medication approved by the FDA for Migraine4 prevention,
4. Topiramate, brand name Topamax.
   

Do you see the commonality among these four medications? All four were developed for purposes other than Migraine prevention. When they were prescribed for their original purposes, people who were being treated for those conditons and also happened to have Migraine disease, noticed a decrease in their Migraines. This led to researching them for Migraine prevention, and it led to a very common practice, off-label prescribing. That's when a medication that's been approved by the FDA for human use is prescribe for a condition other than those for which the FDA has approved it. Not only is that legal, its how additional uses for many, many medications are discovered. In a few people, a condition improving by taking a medication for another condition might be coincidence. But this anecdotal evidence leads doctors to prescribe it for other patients, and it sparks clinical trials of medications for other purposes.

Migraine disease and other head pain disorders have been such a mystery that not a single medication has been developed specifically for Migraine prevention. Not one. Yet we have more than 100 medications that can be used and endless combinations of them. Many people discover that the most effective preventive regimen for them is a combination of medications. We also find that when one medication of a particular class is ineffective for us, that doesn't mean that others in their class will be. Unfortunately, since our bodies respond so differently to medications, it can be time consuming to find that magic combination, but patience and perseverence pay off in fewer and less severe headaches and Migraines.