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News from Migraine Research
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Vision Loss During Migraines Linked to Strokes
Triptan Drug Now Available in England
Studies Offer Conflicting Views on Migraine-Heart Connection
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Vision Loss During Migraines Linked to Strokes
NEW ORLEANS, Feb. 3 - Two studies presented at the American Stroke Association's International Stroke Conference seemed to confirm a strong link between migraine headaches and strokes.
In the first study, Italian researchers investigated whether migraine (with or without aura) could be a risk factor for strokes in patients ages 16 to 44. Examining data from 238 male and female stroke patients, and an equal number of control subjects, they found that 63 stroke survivors had experienced migraines compared with only 33 people in a control group. Researchers were able to rule out smoking, alcohol intake, and contraceptive pill use, as factors that might explain the difference. When migraine was combined with high blood pressure, the stroke risk increased even more, said Massimo Camerlingo, M.D., head of the neurologic unit at Policlinico San Marco in Osio Sotto (Bergamo), Italy.
The second study addressed the question of whether there is a link between strokes and migraine-related vision loss. Migraines are often preceded by aura, sometimes of an auditory nature but more often as visual phenomena including visioni loss. Migraines with visual aura have been associated with ischemic stroke, but researchers at the Centers for Disease Control in Atlanta wantedto know if strokes could be linked with any particular type of visual disturbance. Their study whoed that women who experience vision loss as a symptom of migraine have a 70 percent increase for the risk of stroke compared to women who don't have migraines.
"Our study found that women who suffer migraines with loss of vision or partial loss of vision were 1.7 times more likely to have stroke compared with women who do not have a history of migraines," said study author Wayne H. Giles, M.D., M.S., associate director for science in the Division of Adult and Community Health at the CDC. The study included 963 women between ages 15 and 49; 542 of them had suffered strokes.
Women who see spots and lines during or just before migraine had a 25 percent increased risk of stroke over women without migraines. But women who experience vision loss during or before migraine had a 70 percent higher risk. This may indicate that vision loss is more likely to represent transient cerebral ischemia than seeing spots and lines.
The prevalence of migraine - in general - is about 17 percent in women, and the prevalence of migraine with aura, is about 5 percent in women, Giles said. Of those with aura, more than 90 percent of patients report visual symptoms, such as light sensitivity; seeing lines or spots; seeing flashes of light or temporary loss of vision, he said.
"Other case-control studies had shown that migraine with aura was more strongly associated with stroke, but ours is the first to examine the type of aura symptom and the likelihood of stroke," Giles said.
These findings need independent confirmation from other investigators, but they indicate that women with migraine and aura should address all other stroke risk factors, particularly smoking. Women with migraine and aura should also be aware that oral contraceptives may increase their risk of stroke, and they should discuss the risk/benefit ratio of these agents with their doctors, Giles said.
Giles emphasized that migraine sufferers who experience new neurological symptoms, including transient loss of vision, should be evaluated by a doctor to exclude other causes such as transient ischemic attack (TIA). A TIA, which is caused by reduced blood flow in the brain, can result in a temporary loss of vision and can occur independent of migraine, he said.
[SOURCE: American Heart Association.]
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Triptan Drug Now Available in England
British regulators have approved for the first time the over-the-counter sale of a triptan drug. The approved drug is called Imigran Recovery, a GlaxoSmithKline product, which contains the active ingredient sumatriptan. Sumatriptan was the first of the "triptan" drugs -- the first non-narcotic medications that can reduce or eliminate a migraine in most persons.
Imigran Recovery contains 50 mg of sumatriptan. The prescription drug Imitrex, also by GlaxoSmithKline, contains 50 mg or 100 mg per tablet. Imigran Recovery will be sold for $15.00 US for a two-pack, about half the cost of the prescription 50 mg Imitrex tablet. (At the same time, a generic version of Imitrex should be available soon in the U.S. See related article below.)
Sumatriptan (Imitrex) was the first of the triptan drugs. It was approved as a prescription medication in England in 1990, and a few years later was approved for sale in the U.S. by the Food and Drug Administration. Sumatriptan is the most widely prescribed medicine in this category with over 800 million prescriptions world-wide since launch.
It is likely that GlaxoSmithKline and other manufacturers of triptan drugs will now be looking for approval of over-the-counter triptan drugs in the U.S. (See related story below.)
[SOURCE: Food and Drug Administration, GlaxoSmithKline, Ozone Communications.]
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Studies Offer Conflicting Views on Migraine-Heart Connection
Conflicting reports on whether migraine headaches are linked in some way to heart disease illustrate the fact that researchers are still a long way from having a good understanding of the pathophysiology of migraine.
A major study in The Netherlands, involving nearly 6,000 participants, seemed to show that people with migraine headaches are at greater risk for developing cardiovascular disease than the general population. “For reasons that are not yet clear, people with migraine—particularly those with aura—may be more likely to present with risk factors associated with cardiovascular conditions,” said lead author Ann Scher, PhD, of the National Institute on Aging in Bethesda, Md. “It is known that migraine with aura increases the risk of stroke before the age of 45, although the reason for this is not yet clear.”
Men and women with migraine were 1.78 times more likely to have a mother with a history of early heart attack. Whether migraines “cause” cardiovascular problems or vice versa is still very much in doubt. The research shows simply that there may be a shared predisposition toward both migraine and heart disease, said Lenore Launer, PhD, also of the National Institute on Aging and the senior author on the study.
By contrast, a study reported only two months earlier in the same journal indicated that while people with migraine headaches report more angina (chest pain), they do not seem to be at higher risk for heart disease. The study was conducted at the
University of
North Caroline , where researchers looked at the medical records of 12,409 individuals.
According to the report: “After adjusting for factors such as age, race, hypertension, smoking and total cholesterol, participants with a history of migraine or other headaches with aura were three times more likely to report a history of exertional chest pain that those without a history of headaches. “No significant association was seen between headaches and verified coronary heart disease.” (Emphasis added).
Additional research into the possible link between migraine and heart disease is ongoing and the results will be published here.
[SOURCES: For the study, see Neurology, February 2005. For the
University of
North Carolina study see Neurology, December 2004. Neurology is the scientific journal of the
American
Academy of Neurology: www.aan.com ]
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Combination Drug Suffers Setback
A possible new combination drug received a setback recently when the Food and Drug Administration asked the manufacturer, Pozen, for additional information. If approved, Trexima will combine the triptan drug Imitrex with naproxen, an older non-steroidal, anti-inflammatory drug, or NSAID. This should not be a major event for migraineurs, however, as physicians are already free to recommend their patients combine the over-the-counter naproxen with the prescription drug Imitrex.
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NEW PRODUCTS
Pozen and GSK pharmaceutical companies have begun sale of Trexima. It is a combination drug of sumatriptan and naproxen. FDA studies showed for some people the relief is more complete when naproxen, a generic anti-inflammatory drug, is added to sumatriptan.
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