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May 2013
Migraine is Not Just a Bad Headache
“There is no condition of such magnitude - yet so shrouded in myth, misinformation, and mistreatment - as migraine.”
Joel R. Saper, MD, Chair, Migraine Research Foundation Medical Advisory Board
Migraine is an extremely debilitating collection of neurological symptoms with severe recurring intense throbbing pain on one side of the head, although in about 1/3 of attacks, both sides are affected.
Attacks are often accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.
In 15-20% of attacks, other neurological symptoms occur before the actual head pain.
Attacks usually last between 4 and 72 hours.
Migraine remains a poorly understood condition that is frequently undertreated. Migraine affects nearly 1 in 4 U.S. households and the majority of migraine sufferers do not seek medical care for their pain. Nearly half of all migraine sufferers are never diagnosed. Even with the correct diagnosis, treating migraine can be very challenging. Combinations of various medications and other modalities are often the most effective therapy.
Our compounding professionals will work together with patients and their health care providers to customize the most appropriate medication for each individual.
Researchers previously believed that dilation and constriction of blood vessels in the head were the primary source of migraine pain, and this was the focus of early medical therapy. Researchers now believe that migraine is a disorder involving nerve pathways and neurotransmitters.
Estrogen adversely influences the brain receptors that play a role in migraine development. About half of affected women have more than one attack each month, and a quarter experience 4 or more severe attacks per month. More severe and more frequent attacks often result from fluctuations in estrogen levels. 10-14% of American women get menstrual migraine. The vast majority of these women also have migraine at other times of the month. Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after menstrual onset. It is usually more severe and harder to control than other types of migraine.
Migraine triggers include alteration of sleep-wake cycle; missing or delaying a meal; medications that cause vasodilation; medication overuse (which contributes to the progression from episodic migraine to chronic migraine); bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.
Approximately one-fifth of migraine sufferers experience aura, the warning associated with migraine, prior to the headache pain. Visual disturbances such as wavy lines, dots or flashing lights and blind spots begin from twenty minutes to one hour before the actual onset of migraine. Some people will have tingling in their arm or face or difficulty speaking. Aura was once thought to be caused by constriction of small arteries supplying specific areas of the brain. Now we know that aura is due to transient changes in the activity of specific nerve cells.
If patients have frequent migraine attacks and do not respond consistently to migraine specific acute treatments, or if specific migraine medications are ineffective or contraindicated because of other medical problems, then preventive medications should be taken to reduce migraine frequency and improve response to acute therapy.
Management of migraine involves elimination of triggers, preventive (prophylactic) therapy, and pharmacologic or complementary therapy that should begin at the first sign or symptom of a migraine. For optimal therapy, the following factors must be considered:
- Severity of the migraine
- Side effects
- Efficacy
- Most appropriate route of administration (For example, oral meds would not be best for someone with symptoms of nausea and vomiting; sublingual and nasal preparations have a faster onset than oral meds.)
The goal of acute therapy is to stop or reduce the pain and other symptoms associated with the migraine while minimizing adverse drug effects and ultimately restoring the patient’s ability to function normally. Compounded medications and nutritional supplements such riboflavin, coenzyme Q10, cyanocobalamin, folate, and pyridoxine may help to prevent or improve migraine with minimal side effects.
Ask us for more information about therapies for migraine. Our compounding pharmacy can customize medications and also has many unique delivery systems that can enhance patient compliance.
References
http://www.migraineresearchfoundation.org/fact-sheet.html Accessed 4/24/13
Int’l J of Pharm. Compounding. July/Aug 2012; 16(4):270-4
Int’l J of Pharm. Compounding. Sep/Oct 2006; 10(5):344-350
Pharmacotherapy: A Pathophysiologic Approach. 5th ed. McGraw-Hill; 2002:1119-1135.
http://www.headaches.org/education/Headache_Topic_Sheets/Migraine Accessed 4/24/13
http://www.umm.edu/patiented/articles/what_specific_drugs_remedies
_treating_a_migraine_attack_000097_7.htm#ixzz2RQaHKVsc
Cephalalgia 1994 Oct:14(5):317
Neurology March 1997; 48:A86-A87
Continuum (Minneap Minn). 2012 Aug;18(4):796-806.
Vitam Horm. 2004;69:297-312.
Headache. 2012 Oct;52 Suppl 2:81-7.
J Assoc Physicians India. 2011 Aug;59:494-7.
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April 2013
Vulvodynia: A Painful Female Condition
Vulvodynia is chronic, unexplained pain or discomfort, characterized by burning, stinging, irritation, or rawness in the
area
around the opening of the vagina (i.e., the vulva). This is a poorly understood and under-researched pain syndrome for which
optimal treatment remains unclear. The pain, burning or irritation associated with vulvodynia can make women so uncomfortable
that sitting for long periods of time is tortuous and sexual intimacy becomes unthinkable. The condition can go on for months or
years.
Vulvodynia's onset is most commonly between the ages of 18 and 25. Sadly, 60% of symptomatic women need to see an average of
3 different providers to receive the diagnosis of vulvodynia, and 40% of symptomatic women remain undiagnosed. Other causes of
pelvic pain can include interstitial cystitis, endometriosis and urethral syndrome. It is important to work with health care
providers who are experienced in the treatment of vulvodynia.
Some women experience pain in only one area of the vulva or genitalia, while others experience pain in multiple areas. If you
have vulvodynia, don't let the absence of visible signs or embarrassment about discussing the symptoms keep you from seeking
help. Treatment options are available to lessen the pain and discomfort of vulvodynia, ranging from topical therapies to oral
medications, physical therapy and biofeedback. A physical therapist trained in treating pelvic floor muscle dysfunction can
provide strengthening exercises that can be very helpful.
Medications can be applied topically, directly on the vulva, taken orally or injected. Here are a few options:
- Topical anesthetics that contain lidocaine can be applied 30 minutes prior to the problematic activity to numb the affected area (avoid topical corticosteroids)
- Estradiol cream
- Antidepressant (topical amitriptyline) and anti-seizure medications that are known to have pain-reducing properties
- Trigger-point injections of steroids or Botox®
- Topical gabapentin 6% cream. Researchers evaluated the clinical efficacy and tolerability of topical gabapentin 6% cream, and found that after a minimum of 8 weeks of therapy, pain was significantly reduced and sexual function improved. Patients applied a small amount of cream (approximately 0.5 mL, equivalent to the size of a small pea) three times daily. Common adverse effects of oral gabapentin - including dizziness, somnolence, and peripheral edema - were not reported with topical therapy because the amount of active drug in topical preparations is significantly less than that administered orally, and the topical route of delivery reduces systemic absorption of the medication. The conclusion: "Topical gabapentin seems to be well-tolerated and associated with significant pain relief in women with vulvodynia."
- Topical nitroglycerin 0.2%. At UCLA Medical Center, 34 women used a compounded low dose topical nitroglycerin 0.2%. The study concluded "Topical nitroglycerin is safe and effective in providing temporary relief of [painful intercourse] and vulvar pain in women with vulvodynia." Side effects associated with commercially-available higher strength nitroglycerin ointment, such as headache, are much less common with the lower dose.
Copyright 2013, Storey Marketing - Compounding News. All rights reserved.
March 2013
Testosterone Therapy for Women: Debunking the Myths
Testosterone therapy is increasingly used to treat symptoms of hormone deficiency in pre and postmenopausal women. Testosterone is essential for physical and mental health in women as well as men. Although frequently thought of to increase libido, testosterone's role in sexual function is only a small part of its physiologic effect in women. Receptors for testosterone are located in almost all tissues including the breast, heart, blood vessels, gastrointestinal tract, lung, brain, spinal cord, peripheral nerves, bladder, uterus, ovaries, endocrine glands, vaginal tissue, skin, bone, bone marrow, muscle and adipose (fat) tissue. Testosterone declines gradually with age in both sexes. Pre and post-menopausal women, and aging men, may experience symptoms of androgen deficiency including anxiety, irritability, depression, lack of well being, physical fatigue, bone loss, muscle loss, changes in cognition, memory loss, insomnia, hot flashes, rheumatoid complaints, pain, breast pain, urinary complaints, incontinence as well as sexual dysfunction. According to an article by Rebecca Glaser, MD and Constantine Dimitrakakis, MD, PhD published in Maturitus in February 2013: testosterone is not masculinizing and does not increase aggression or cause hoarseness; testosterone does increase scalp hair growth, is mood stabilizing, and is cardiac and breast protective. A source of confusion concerning the safety of testosterone therapy in both men and women is the extrapolation of adverse events from high doses of oral and injectable synthetic anabolic steroids to therapy using the bio-identical form of testosterone in doses that simply restore normal physiologic levels (bio-identical testosterone is the same substance that is naturally produced by the human body). In England and Australia, testosterone is licensed and has been used in women for over 60 years.
Ask our compounding pharmacist for more information about testosterone and other bio-identical hormones.
Copyright 2013, Storey Marketing - Compounding News. All rights reserved.
February 2013
Fighting off the Flu by Strengthening Your Immune System
Influenza spreads mainly from person-to-person through coughing or sneezing of infected people. It's possible for
healthy people to develop severe illness from the flu so anyone concerned about their illness should consult a health care
provider. Treatment with antiviral medications is recommended as early as possible for any patient with confirmed or suspected
influenza who is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications.
Persons at higher risk for influenza complications in whom antiviral treatment is recommended include children younger than 2
years of age, adults 65 and older, persons with certain medical conditions, pregnant or postpartum women, American Indians and
Alaskan Natives, and residents of nursing homes and other chronic-care facilities.
Proper nutritional support can strengthen your immune system, and help to reduce the risk of infection, as
well as reduce the duration of symptoms if you do get the flu or a cold. The following may help:
o Vitamin C
o Zinc
o Echinacea
o Goldenseal
o Astragalus
o Beta 1,3 glucan
o Coenzyme Q10
o Vitamin D3
o Probiotics
o Elderberry extract
In addition to fortifying your immune system, take everyday actions to stay healthy, such as washing your hands often, and not
touching your eyes, nose and mouth which promotes germ spread. Cover your nose and mouth when you cough and sneeze. Ask our
pharmacist or professional staff to recommend the most appropriate type of immune support for each member of your family.
Copyright 2013, Storey Marketing - Compounding News. All rights reserved.
January 2013
Nail Lacquers for Treatment of Fungal Nail
Problems with thick, ugly toenails? It is probably fungal nail - clinically known as onychomycosis. Traditionally, this problem has been treated with oral antifungal medications that require frequent laboratory monitoring due to potential liver toxicity. These medications are also costly which is problematic for those patients who do not have prescription coverage.
The reason that oral medications have been used is because it is difficult to penetrate the thick nail with topical medications. For example, topical antifungal medications used for problems like jock itch, athlete's foot and ringworm won't help fungal nail.
Here is the good news! Studies have shown that when ingredients such as urea that soften the nail or otherwise increase the penetration of the antifungal medicine are added to topical antifungal nail "lacquers", these preparations can produce excellent results.
A randomized, double-blind study enrolled 70 patients with onychomycosis of the finger and toenails. Clinical and
antifungal effects as well as safety were assessed monthly for a maximum of 6 months of treatment. Results indicated topical
treatment of onychomycosis with a combination of fluconazole 1% and urea 40% was more effective (82.8%) than fluconazole 1%
(62.8%) nail lacquer alone in treatment of dermatophytic onychomycosis. Fluconazole was well tolerated and side effects were
negligible. At the end of therapy and the end of the 6-month follow-up, fluconazole 1% and urea 40% demonstrated statistically
significant superiority in clinical and antifungal responses compared with fluconazole 1% alone.
Ask our compounding pharmacist about the advantages of topical therapy for fungal nail.
Reference: J Dermatolog Treat. 2012 Dec;23(6):453-6. Link to http://www.ncbi.nlm.nih.gov/pubmed/21781012
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