Therapy could eliminate medication overuse headaches
Story and photo by Greg Harris
Tracey Peters first started getting migraine headaches when she was 15 years old.
She’s found little relief over the years and, on more than one occasion, has wound up in hospital emergency departments with intense pain.
“I’ve tried just about everything,” the Strathmore resident says. “I would sometimes take a handful of Advil at a time, but even that amount wasn’t enough to touch it.”
Like many migraine sufferers, Peters is likely susceptible to what’s known as a medication overuse headache, a phenomenon that can occur over time in migraine patients when analgesics (painkillers) are taken day after day.
“For people with chronic migraine, medication overuse headache is fairly common,” says Dr. Farnaz Amoozegar, a neurologist with Alberta Health Services and a member of the University of Calgary’s Hotchkiss Brain Institute.
“Ultimately, the way to treat this type of headache is to discontinue the overused medication(s). However, for the short term, that can make things worse for some patients before they start to get better,” she says.
Now Dr. Amoozegar and other researchers are evaluating a new medication that could provide a bridge therapy to help people like Peters during the transition. Bridge therapy is a short course of another medication given to patients who discontinue the overused analgesic in the hope of easing the short-term increase in discomfort.
The new medication, called Frovatriptan, has been used successfully to treat acute migraine attacks but hasn’t yet been tested as a bridge therapy.
In the current study, participants either stop or taper off from their overused medication, depending on what type it is. They are randomized to receive either the Frovatriptan for a 10-day period, or a placebo.
If the headaches worsen, participants are allowed to take some additional medications to help them through.
Study participants are recruited from the Calgary Headache Assessment and Management Program (CHAMP) at South Health Campus. Patients whose family doctors refer them to CHAMP get access to educational workshops and lectures focusing on lifestyle factors, opportunities to participate in research, as well as medical management of their condition.
Peters says she got involved in the study in the hopes of helping others who experience regular migraines, including her teenage daughter, who has begun to have them.
She says she isn’t sure whether she was in the treatment or the placebo group, but that the study did help her see that she was relying too heavily on pain medications.
“Since then, I have really cut down a lot on the Advil,” she says. “I’ve learned I have to avoid certain triggers, such as chocolate or wine, and I’m also sensitive to perfumes and air fresheners. Fluctuations in the weather can be a problem, too.”
People who live with recurring migraine headache often suffer debilitating symptoms. Aside from the pain, which can be severe and sometimes last for days, people can also experience nausea, vomiting, sensitivity to light or sound, and other neurological symptoms.
Some estimates suggest migraine affects up to 12 per cent of the total population and nearly twice as many women as men. The exact causes of migraine are not yet fully understood, but it’s thought a combination of predisposing genes and environmental factors lead to the condition.
Researchers are looking for 56 participants in the Calgary arm of the study and currently have enrolled about half that number. The study is also being conducted at a site in Ottawa.
(Alberta Health Services)