Common heartburn drugs taken by millions ‘increase the risk of agonising brain attacks’
HEARTBURN drugs could increase your risk of agonising migraines, a study shows.
People who take acid reflux meds are more likely to suffer severe headaches than those who don’t, US researchers found.
The drugs linked to the painful symptoms include omeprazole, esomeprazole, cimetidine, famotidine and antacid supplements, they said.
Dr Margaret Slavin, of the University of Maryland, said: “Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation.
“These drugs are often considered to be overprescribed, and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia.”
Heartburn — also known as acid reflux — is a burning feeling in the chest caused by stomach acid travelling up towards the throat.
Up to a quarter of British adults suffer the condition, according to Guts UK.
Proton pump inhibitors (PPIs) like omeprazole — sold as Prilosec and Losec — and esomeprazole — sold as Nexium — are commonly taken to alleviate symptoms.
Some 72million PPIs were prescribed in Britain in 2022, according to official NHS figures.
Previous research has linked the drugs to a greater risk of dementia.
The latest study, published in Neurology Clinical Practice, looked at how they and other heartburn drugs, including H2 blockers, affect people’s risk of migraine.
Researchers looked at prescription drugs in their study, tracking data from 11,818 people.
A quarter of people who took PPIs had migraine or severe headache, compared to 19 per cent of those who were not taking the drugs.
Another quarter of those taking H2 blockers had severe headache, compared to 20 per cent of those who were not taking those drugs.
And 22 per cent of those taking antacid supplements had severe headache, compared to 20 per cent of those not taking antacids.
Dr Slavin said: “It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions.
“People with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue.”
How is migraine treated?
Often the only way to get rid of a migraine is to take painkillers and sleep it off.
Sufferers normally rest up in a dark room until it has passed – which can be up to 72 hours.
There are many options for migraine that can be tried – some help at the point of migraine and others are preventative.
And there are new treatments coming onto the market that are not just repurposed drugs for other conditions.
Triptans
Triptans reduce the pain and sickness of a migraine attack at the time they are taken.
Naratriptan and frovatriptan usually take longer to reach their maximum effect but their effect lasts longer.
But if a patient’s attacks peak quite quickly, a triptan such as sumatriptan, zolmitriptan, eletriptan or rizatriptan may be more appropriate.
Two doses of any triptan are allowed in 24 hours and they should not be used more than 10 days in a month.
Analgesics
This is medication that treats the pain of a migraine attack at the time they are taken and includes paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Prophylactics
Prophylactics are preventative medicines for migraines taken every day.
Most preventive medications currently available are repurposed from other conditions.
They include:
- Angiotensin II blockers (for hypertension)
- Anti-convulsants (for epilepsy)
- Anti-serotonergic drugs (for depression)
- Beta-blockers (for hypertension)
- Calcium channel blockers
- Tricyclic antidepressants
- CGRP monoclonal antibodies (described below)
Botox injections
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. It was discovered that those who had the cosmetic injections had fewer headaches.
Botox is approved for use on the NHS for the treatment of chronic migraine – at least 15 headache days a month – in adults who have tried other treatments.
Doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.
CGRP monoclonal antibodies
Calcitonin gene-related peptide antibodies (CGRP) monoclonal antibodies (mAbs) are a new type of treatment for migraine.
CGRP mAbs are the first preventive medicines specifically developed for the treatment of migraine.
Several are now available on the NHS. This includes erenumab (brand name Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti).
The drugs target CGRP, released by the nerves and blood vessels during a migraine attack. It is thought to cause pain.
The new drugs target CGRP to prevent migraine developing.
All of the medicines are taken by injection, either monthly or every few months.
Gepants
Gepants are like the tablet form of the injectable CGRPs antibodies described above.
There are currently three gepants – ubrogepant (not yet on the NHS), atogepant and rimegepant – and others in development. They are CGRP receptor antagonists.
Gepants bind to the CGRP receptors on nerves and block its effects. Gepants (unlike triptans) do not constrict or tighten the blood vessel. They prevent them from dilating.
This makes them safer for people with heart issues and they can be used in people with cardiovascular disease.
Early indications suggests that gepants may be the first acute treatment not associated with medication overuse headache. Due to this, they may also be used as a preventive treatment.
Greater Occipital Nerve (GON) block
There are injections which contain small doses of local anaesthetic and/or steroid which is injected around the greater occipital nerve – which travels up each side of the back of the head.
Evidence suggests a GON block can provide short-term benefit to some people with migraine, reducing how often migraines occur and their severity.
Around one in three people do not see any benefit from a GON block.
Lifestyle measures
If none of these treatments help a patient’s symptoms, or they’re getting worse, a referral to a specialist may be made.
A GP may also recommend making changes to lifestyle to help manage migraines, such as eating at regular times and drinking less caffeine.
These include:
- Eat meals at regular times
- Exercise
- Get plenty of sleep
- Manage stress
- Drink plenty of water and less alcohol and caffeine
- Limit trigger foods, such as spicy food
Sources: NHS and The Migraine Trust