Treximet

Summer Newsletter 2015

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Hello Everyone,

I hope this finds you enjoying your summer. In this newsletter, I would like to share with you a new treatment we now offer for migraine and cluster headache. In addition, I will review & update current treatment options.

Sphenopalatine Ganglion Block
The SPG is the largest group of neurons (nerve cells) outside the brain and can be reached via the nose. In the past, Q-tips were used and after being soaked with a numbing (anesthetic) medication were inserted far back into the nose to try to reach the SPG. However, this process caused nasal discomfort and was not precise in getting to the SPG. As a result, SPG blocks did not become common in a headache practice.

Dr. Tian Xia, a pain specialist and anesthesiologist, has invented the Tx360. It is a patented device that inserts into each nostril and contains a small, flexible, soft plastic tube that is advanced into the nose and is able to reach the SPG. It delivers a precise amount of anesthetic medication (Bupivacaine .3 cc) to each SPG. It is overall well tolerated and can be performed in 5 minutes in the office setting. By blocking the SPG, the migraine path can be blocked and the patient can get relief from their migraine. To see an animation of the SPG procedure, go to www.tianmedical.com.

It would not be necessary for anyone to drive you to the office. You can drive yourself after the procedure, as it is non-narcotic and non-sedating. This procedure can help to treat a bad headache and can also be done as a preventive treatment. For best results for prevention, it would be necessary to come in 2 times per week for 3-6 weeks.

Eye-Brain Update: For a limited amount of time, the Eye Brain Medical Center has agreed to treat our patients at no charge. Candidates include patients having daily lowgrade headache that worsens as the day progresses and is aggravated by prolonged reading or working on the computer. In addition, dry eyes and sensitivity to light are common symptoms that cause what has been termed “Eye-Graine”. This type of headache is not the same as migraine; the cause is felt to be from the eyes not working well together. If a patient is screened and felt to be a candidate for treatment at the Eye Brain Medical Center (located in Orange, CA), then they are fitted with NeuroLenses (glasses with prisms in them to help the eyes work better together). For more information, go to www.eyebrainmedical.com

CGRP Clinical Trial Available: CGRP Monoclonal Antibodies for migraine prevention appear to be very promising and were discussed in the last newsletter. This treatment is only available through clinical trials until FDA approved. If interested, call the following research coordinators: Mark Gonzalez 714-774-7777 (Anaheim) or Shelly Asbill 562-304-1759(Long Beach)

Cefaly Headband: This FDA-approved device for migraine is working well for many of our patients. We now offer a free 20 minute demo if interested. In addition, we have 3 units available to rent. For more information, see the description in our last newsletter and visit www.Cefaly.us

Treximet: This acute migraine medication is a combination of Sumatriptan and Naprosyn and works better than either medication by itself. Through a special program with Newport Lido Pharmacy, it is now available to most of our patients for $20 or less for 9 tablets. Newport Lido will ship to you at no charge.

Sumavel Dose Pro: Sumatriptan 6 mg injectable needle-free is now available through Newport Lido as well for a reasonable cost for most patients. This needle-free injection is a great way to rescue a severe migraine or cluster headache. Trokendi XR: This name brand Topamax does not cause the mental sluggishness/word retrieval problems that generic Topamax causes. It was discussed in the last newsletter. It is now available through Newport Lido for as low as zero co-pay for many patients.

Wherever your summer travels take you, I wish you a very pleasant rest of your summer. I look forward to seeing you to review your current headache management plan!

Sincerely,
Susan Hutchinson, MD Director-Orange County Migraine & Headache Center

New Treatment for Migraine

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The FDA just approved a new medication for the acute treatment of migraine. It is called Treximet and is a combination of Imitrex (a migraine specific medication) and Naproxen (an NSAID: Nonsteroidal anti-inflammatory medication). Treximet is the first drug of its kind on the market and represents an advancement in the acute treatment of migraine. It is now available in pharmacies.

Why was this combination brought to market?

To answer this question we need to look at what occurs during a migraine attack. Migraine is a neurovascular event and involves the release of neurochemical transmitters such as CGRP and Substance P. These neurotransmitters cause inflammation and vasodilation of blood vessels surrounding our brain. The triptans (Imitrex; Relpax; Maxalt; Axert; Zomig; Frova; Amerge) prevent the release of these neurotransmitters and in turn, prevents the involvement of the blood vessels. They are most effective in taken early in this process.

We have now discovered another pathway involved in migraine that consists of the production and release of prostaglandin. The NSAIDs (nonsteroidal anti-inflammatory medications) inhibit prostaglandin production and release and include medications such as Motrin, Aleve, Advil, and Naprosyn.

Therefore, it makes sense to combine these 2 drugs to attack the multiple pathways involved in migraine. The combination should potentially be more effective than either agent alone.

Why not just take an OTC NSAID like Aleve or Advil with a triptan?

Taking the NSAID such as Aleve with the triptan may not be as effective. From extensive research studies and clinical trials, a unique pharmacokinetic profile is seen with the combination tablet. The Imitrex portion of the tablet reaches peak levels quickly, providing important initial relief; the Naproxen component of the tablet is delayed and reaches peak levels of concentration later than if given separately. This delayed release of the Naproxen provides the important headache prevention needed as the Imitrex begins wearing off. Therefore, most patients experience initial headache relief within 1-2 hours followed by sustained pain-free results for 24 hours.

Additionally, the combination tablet is convenient and eliminates the need to carry two separate medication bottles. Treximet will be packaged in a quantity of #9 tablets and is in a small container that will easily fit into a woman’s purse, e.g.

Who should not take Treximet?

Anyone who has established coronary or peripheral vascular disease should not take Treimet which contains Imitrex, a triptan medication. If an individual has cardiac risk factors such as high blood pressure of high cholesterol, they should be screened prior to triptan use. Anyone with a history of an allergic reaction of any of the triptan medications should not take Treximet. Anyone with a history of an allergy or contraindication to NSAIDs such avoid the use of Treximet which contains Naproxen, a NSAID. Contraindications would also include gastric ulcer; gastritis/esophagitis; history of gastric by-pass; and someone on Coumadin or other blood thinners. Pregnant women should avoid the use of Treximet. Full prescribing information is available at www.treximet.com.

How do I know if I should switch to Treximet? Answer these migraine treatment questions.*

  1. Do you want more relief from your migraine medicine?
  2. Do you ever need more than one dose of your current medicine to treat your migraines?
  3. Do you ever take more than one medication to relieve a single migraine attack?

If your answer was “yes” to 1 or more of these questions, then you may benefit from Treximet. It may provide more complete relief for your migraine headaches. In addition, you may be less likely to re-dose or rescue compared to your current acute headache treatment. Complete relief of head pain and associated symptoms such as nausea within a 2 hour time period is a reasonable expectation followed by sustained pain free for at least 24 hours.

*Migraine Treatment Questionnaire developed by GlaxoSmithKline Pharmaceutical and recognized by the National Headache Foundation as an effective way to initiate dialogue between healthcare professionals and patients regarding treatment effectiveness. Printed with permission from GSK Pharmaceutical.

How do I know if Treximet better than my current triptan or other acute headache medication? Answer the following questions.

  1. Are you headache free in 2 hours and back to full function?
  2. Are there any side-effects on the medication?
  3. Do you need to re-dose within 24 hours?
  4. Do you have to rescue with another medication?
  5. Does the headache stay away completely for at least 24 hours? (Sustained pain-free)

In summary, Treximet is the newest prescription medication on the market for the acute treatment of migraine with or without aura in adults 18 and older. The combination of Imitrex/Naprosyn represents the most migraine specific medication now available. Schedule an appointment with Dr. Hutchinson or your primary care provider to see if Treximet would be right for you.

Sincerely,
Susan Hutchinson, MD Director-Orange County Migraine & Headache Center