Many pharmaceutical companies are researching completely new compounds to attack headaches from different angles. Merck & Co., Inc., announced that a Phase III clinical trial showed that a new compound called telcagepant (formerly known as MK-0974) significantly improved relief of migraine pain and associated symptoms comparable to the triptan zolmitriptan, but with fewer side effects.

Positive results of the latest study of Zelrix® are giving hope to manufacturer NuPathe that the triptan patch treatment will be on the market soon. Zelrix is a novel way of taking sumatriptan (Imitrex®): it delivers the active ingredient through the skin via a transdermal patch. The patch, which was designed for migraineurs who experience nausea, allows sumatriptan to take effect without having to go through the gastrointestinal system.

Q. I suffer with cluster headaches and over the years verapamil has been effective for me. Recently, due to an insurance change, I had to get my prescriptions from a new pharmacy. Unbelievably, the pharmacist would not fill my prescription, saying my dose of 960 mg was “dangerously too high.” No amount of reasoning could change his mind, not even my prior usage of many years. I ultimately went to a different pharmacy. Is this dose of verapamil dangerous?

All questions answered by: Richard Wenzel, PharmD Diamond Headache Clinic Inpatient Unit St. Joseph’s Hospital, Chicago, IL The number of medications that work on the body’s neurostransmitters has increased dramatically in the last few decades—bringing relief for millions of people with a range of conditions. Recently, though, concerns have been raised about the possibility of a reaction to combining these drugs, leading to a rare condition called serotonin syndrome. Neurotransmitters are the chemicals your body uses to communicate mood, pain, anxiety, temperature, pressure and numerous other sensations. There are many different neurotransmitters, but arguably the most important is serotonin. Research suggests that a dysfunction in serotonin is involved in migraine, anxiety, depression, sleep disorders, eating disorders and several other illnesses. Therefore, prescribing medications that help the body better utilize serotonin often provides relief. To alleviate migraine pain, the triptan medications work on specific serotonin receptors in the central nervous system. The selective serotonin reuptake inhibitor (SSRI) medications, such as Prozac®, Celexa® and Lexapro®, help raise serotonin levels throughout the body and can improve mood, depression, anxiety and chronic headaches. There are numerous other serotonin-raising medications. With millions of people taking these drugs, it increases the chances that someone will experience a rare side effect, such as serotonin syndrome. This is a situation that arises from over-stimulation of the body’s serotonin system. Since this is an unusual reaction, most healthcare professionals and patients are unfamiliar with how to identify and treat it.

Cafergot is a brand name of the combination of ergotamine and caffeine. It is currently available only in the suppository form for the acute treatment of migraine attacks. There are generic oral tablets with the same amounts of caffeine and ergotamine as were in the former Cafergot tablets. Ergotamine works for migraine by constricting blood vessels and effecting brain receptors such as serotonin.