New Migraine Drug Shows Promise

An experimental migraine drug seems to work just as well as migraine medicines currently on the market, a new study has found. The new drug, called telcagepant, also seems to cause fewer side effects than current medications.


What do we know already?

Roughly 6 million people in the UK get migraines. The pain of these headaches can last for several days, often accompanied by nausea and unpleasant sensitivity to light or sound. Research by the World Health Organization found that migraines are one of the most disabling long-term conditions you can have.

Ordinary painkillers such as aspirin and ibuprofen can help with the pain of a migraine. But you can also take specialised migraine drugs, called triptans. You can get these from your doctor, and one, called sumatriptan, is available over the counter.

Although triptans work well for many people, they’re not suitable for everyone. You can’t take them if you have a heart condition, as there’s a risk they could make it worse. A few people get chest pain as a side effect.

Researchers have been looking at new migraine drugs that work in a different way to triptans. A medicine called telcagepant has just been tested in a large trial of over 1,300 patients.

What does the new study say?

During the study, when people got their first migraine, they were given either telcagepant, a medication for migraine called zolmitriptan or a dummy (placebo) treatment. They then kept a diary of how much pain they got.

Telcagepant worked better than a dummy treatment, and just as well as zolmitriptan. It also had fewer side effects than zolmitriptan.

The study looked at both high and low doses of telcagepant. The high dose worked best, and helped 38 in 100 people have less pain. For 18 in 100 people, their migraine cleared up completely. This was about the same as zolmitriptan, which helped 36 in 100 people and got rid of the migraine for 13 in 100. Both drugs worked far better than the placebo. Only 15 in 100 people taking a placebo got less pain, and only 4 in 100 found their migraine went away.

The high dose of telcagepant caused side effects for about a third of people. Half the people taking zolmitriptan got at least one side effect. However, people were given the maximum recommended dose of zolmitriptan, which is double the usual starting dose. People taking a normal dose might get fewer problems.

Common side effects from the new drug included a dry mouth, feeling sleepy, feeling dizzy or feeling sick. Chest pain was less common for people taking telcagepant than for people taking zolmitriptan.

How reliable are the findings?

The study was large and carefully done. However, there are a few things to notice. The researchers believe that telcagepant will be safer for people with heart conditions than triptan drugs because it works in a different way. But people with heart problems weren’t allowed to take part in the study, as there was a chance they’d have been put in the group taking zolmitriptan. So, the study can’t tell us whether the new drug is really safe for people with heart disease.

Over 8 in 10 of the patients in the study were women. So, there’s not much information about how well telcagepant works for men.

Some people taking telcagepant had the option of taking a second dose if they wanted to. People taking zolmitriptan couldn’t do this, as they’d already been given the maximum dose. So, people taking telcagepant might have ended up taking a higher dose, which might make the drug appear more effective.

The study only looked at how well telcagepant worked for one migraine attack. There’s no information about how well it works or how safe it is in the long term.

Where does the study come from?

The study looked at people in the US and the UK. It was published in a journal called The Lancet, which is owned by a company called Elsevier. The study was paid for by Merck, which hopes to market telcagepant. It’s quite common for manufacturers to fund research of their own products. In this case, Merck also helped to design the study, and most of the researchers work for the company.

What does this mean for me?

At present, telcagepant is not approved for use in the UK or elsewhere in the world. A drug can’t be used in the UK until it’s been approved by either the British or European drug safety watchdog. So, we don’t know yet whether or when telcagepant will become available.

The study of telcagepant was a phase 3 trial. These are late-stage studies looking at how well a drug works in a large number of people. If a drug company wants to get a new product approved, it submits information from this type of trial to the drug safety regulators

What should I do now?

Ordinary painkillers and triptans are the main treatments for migraines at the moment. Learning to recognise the signs of a migraine and taking treatment early might mean your medicines work better. For people who get migraines a lot, there are drugs that can help to stop them happening so often.

Some people find particular things trigger migraines, like being hungry or not getting enough sleep. Keeping a migraine diary can help you spot these triggers and avoid them.

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Know Stroke Symptoms For Quick Treatment

People who have strokes are reluctant to get medical help, because they hope their symptoms will go away, researchers have found. But delaying vital treatment even by a few hours can make a big difference to your chances of recovery.


What do we know already?

Time is crucial after a stroke. During a stroke, one of the blood vessels supplying the brain gets blocked with a blood clot. The blockage means that blood can’t flow to part of the brain. Without a blood supply, the brain cells start to die. This damage to the brain is what causes disability after a stroke. The type of disability depends on which area of the brain is affected. Some people have problems with speech, or with moving one side of the body.

The faster the brain’s blood supply is restored, the less damage there will be to the brain. This means people are likely to have less serious disability, and are more likely to recover. Medical treatments, including drugs, can help restore the supply of blood to the brain, so the faster you get treatment, the better.

Without treatment, the damage is more likely to be widespread, and permanent. Getting treatment quickly may make the difference between whether someone is left with a slight disability or more serious damage.

Previous research on people who have had strokes has found that almost 80% call the GP when they get stroke symptoms, rather than an ambulance. This suggests that, even if people recognise that something may be wrong, they do not recognise stroke as a medical emergency.

What does the new study say?

The researchers interviewed 400 people who’d had a stroke or a mini-stroke (transient ischaemic attack) and been treated in hospital. They found that:

  • Less than half of the people had thought their symptoms meant they were having a stroke
  • The most common reason for delaying getting help was people thinking the symptoms would go away. Also, some people had difficulty getting to hospital, or had no one to help them.
  • People took on average three and a half hours to get medical help. But some took as long as 8 days
  • Only half of those interviewed thought it was important to get treated quickly.

Where does the study come from?

The study was carried out by researchers for the Mayo Clinic in Minnesota, USA. It was published in the Emergency Medical Journal, which is owned by the British Medical Association. The research was funded by the Mayo Clinic.

What does this mean for me?

If you think you might be having a stroke, it’s really important to get medical help quickly. It’s a medical emergency. These are some of the symptoms of stroke:

  • Suddenly feeling numb, weak or unable to move your face, arm or leg. This is usually on one side of the body only
  • Suddenly finding it hard to speak or understand what people are saying
  • Suddenly getting double vision, blurred eyesight or being able to see less well
  • Suddenly feeling dizzy, losing your balance, or not being able to co-ordinate your movements
  • Sudden, very severe headache that feels like a ‘bolt from the blue’. You may also get a stiff neck, painful face or pain between your eyes.
  • Feeling confused and finding it hard to remember things, see or hear things.

These symptoms usually come on without warning. They may happen very quickly, or get worse over several hours. If you get these symptoms, you should get emergency medical help.

Sometimes, you get symptoms like these, but they go away. This may be because of a mini-stroke, or transient ischaemic attack (TIA). If you have a mini-stroke, the blood vessel to the brain was blocked, but only temporarily. However, it’s still an emergency. People who have a mini-stroke have a very high risk of getting a full stroke within days or weeks. Prompt medical treatment can stop you from going on to get a full stroke, so it’s very important to get medical help at once.

What should I do now?

Take note of the symptoms of a stroke, and be aware of them. If you or anyone you’re with gets symptoms and you think they might be having a stroke, get medical help straight away. Call 999 for an ambulance, or go straight to the hospital.


Breathing Exercises May Help Asthma Symptoms

Breathing exercises may help people with asthma, according to new research. But exercises aren’t a substitute for medicines. It’s important that people with asthma use the inhalers prescribed by their doctor.


What do we know already?

Asthma is a common condition that causes breathing problems. It’s treated by breathing in drugs called corticosteroids, and by taking ‘reliever’ medicine that helps the airways in the lungs to relax. Generally, these treatments work well. But some people still get symptoms of breathlessness or wheezing.

Researchers are looking again at a type of treatment that was used before the drugs became available. This involves being taught ways of breathing that help avoid breathlessness. These include breathing through the nose instead of the mouth, not breathing too quickly, and using the right muscles to control your breathing. The training is usually done by a physiotherapist.

There’s some evidence to show these exercises can be helpful, but the research isn’t clear. Researchers ran a new study to see what effect breathing training had on people who were taking medicine but were still troubled by asthma symptoms.

What does the new study say?

People who had breathing training had a better quality of life, six months after the training, compared to people who did not have the training. They were less anxious, had fewer symptoms of asthma, and were better able to get on with activities.

However, they still needed to use their inhalers regularly. The breathing training didn’t stop their airways from getting inflamed and reacting to allergens such as pollen.

How reliable are the findings?

The findings are likely to be fairly reliable. This was a randomised controlled study, which is the best type of study to see if a treatment works. However, quite a lot of people dropped out of the study, or didn’t fill in the questionnaire after six months. So we only have results from 63 people who did breathing training, and 66 people who did not. A bigger study might have been more reliable.

Where does the study come from?

The study was carried out among patients at GP surgeries in Leicester. It was overseen by doctors at the University of Aberdeen in Scotland. It was published in Thorax, a medical journal owned by the British Medical Association. The charity Asthma UK funded the study.

What does this mean for me?

The study means that some people with asthma may benefit from having breathing training from a physiotherapist. However, breathing training isn’t a substitute for asthma medication. You’ll still need to keep using the inhaler prescribed by your doctor.

What should I do now?

If you have asthma and you still get symptoms like breathlessness or wheezing, make an appointment to talk to your GP or asthma nurse. You may need to have your medicine adjusted. You could also ask about breathing training with a physiotherapist.


Does Anything Help With Jet Lag?

Travelling across time zones can leave you feeling wide awake when you’re supposed to be asleep, and sleepy when you should be up and about. It can spoil the first few days of your holiday and make it hard to get back to your normal routine when you get home. We look at what you can do to feel better faster.

What is jet lag?


Jet lag is a side effect of long-distance air travel. It can make you feel tired, irritable, and generally unwell.

When you travel by plane across several time zones, your body clock gets left behind in the place you started from. It takes a few days to catch up with you in your new time zone. So, for a while, your body acts as if you’re still in the time zone of the country you travelled from. You may feel wide awake at night and sleepy during the day.

In general, the more time zones you cross, the worse jet lag gets. And flying east (from the UK to India or Thailand, for example) seems to be harder than flying west (from the UK to the US). When you fly west, you gain extra hours in your day. This kind of jet lag might not be as bad because most people find it easier to stay up later than go to sleep earlier.

What can I do to help myself?

Most people with jet lag feel better after a few days. But some things might help your body adjust more quickly to a new time zone. We don’t know for certain whether the following things will help, because there’s no good research, but some doctors advise that you:

  • Get plenty of rest before you travel
  • Set your watch to the time at your destination before you leave
  • Drink plenty of fluids – but not alcohol – during the flight. Alcohol can make you feel worse
  • Try to sleep on the plane if it’s night time at your destination
  • Stay awake until it gets dark, when you arrive after a long trip going west. Get up when it gets light after a long trip going east
  • Sleep and eat at the correct times for your time zone
  • Avoid alcohol, and caffeinated drinks such as coffee and tea, for a while. They may stop your body adjusting to the new times
  • Take some light exercise, such as walking or sightseeing, during daylight. Natural light may help your body adjust to the new routine.

What about drug treatments?

Melatonin is a natural hormone that controls your body clock and helps you sleep. There’s quite good research to show that a synthetic form of this hormone can help with jet lag. You take it at night (destination time), usually for three or four days.

In the UK, melatonin (brand name Circadin) is only available on prescription from a doctor. But it’s not usually prescribed for jet lag. It’s recommended for treating sleep problems in people over 55.

In some countries, such as the US and Thailand, melatonin is sold as a supplement and is available over the counter in health food shops. It’s also available on the internet. But these supplements won’t have gone through the same safety checks that apply to medicines in the UK, and the exact ingredients can vary. Scientists have found impurities in the melatonin tablets sold by some companies. It can be difficult to know which companies to trust.

There hasn’t been much research on the possible side effects of melatonin. But doctors say it is not suitable for people with epilepsy, or for people taking drugs to stop their blood clotting, such as warfarin.

Taking sleeping tablets at bedtime for the first few nights after you arrive in a new time zone may help you sleep better. But you may get side effects from sleeping tablets, such as a headache, a runny nose or diarrhoea. The sleeping tablets that have been studied for jet lag are zolpidem (brand name Stilnoct) and zopiclone (Zimovane). You can only get these on prescription from your doctor.

We don’t know if sleeping tablets reduce other symptoms of jet lag, such as poor concentration. There’s also the problem that sleeping tablets can be addictive. This means it can be hard to stop taking them. They also stop working as well after you’ve been taking them a little while. This is because your body gets used to them. You should only take sleeping tablets for a short time.

Sleeping tablets can sometimes make you feel drowsy the day after you take them. You should be careful about driving if you’re taking this treatment.

Taking sleeping tablets and melatonin together increases your chances of side effects. These can include sickness, confusion, a headache, sweating, a dry mouth and dizziness.

To learn more see our information on jet lag.


Long-term Study On Medicines For Heartburn

Medicines called proton pump inhibitors (PPIs), which are commonly used for heartburn and peptic ulcers, have been linked by researchers to a slightly higher risk of fractures. But the risk only increases after several years.

If you’re worried about the possible side effects of medication, don’t just stop taking it. It’s best to discuss your concerns with your doctor before making a decision.


What do we know already?

PPIs are a common treatment for people who get frequent heartburn (called gastro-oesophageal reflux disease) or who have peptic ulcers. You need a prescription for most PPIs, but one called omeprazole is available over-the-counter.

PPIs work by reducing the amount of acid that your stomach makes. This means there’s less acid to cause heartburn or irritate an ulcer. But by reducing this acid, PPIs may make it more difficult for your body to get calcium from foods. And too little calcium can cause a condition called osteoporosis, where your bones are thinner and more likely to break.

Two previous large studies have found that using PPIs for one year or longer slightly increases the risk of a broken hip and other bone fractures. Now researchers have focused on what happens when people take these medications for up to seven years.

What does the new study say?

Researchers looked at the health records of more than 63,000 men and women aged 50 and older from a government database in Manitoba, Canada. Over eight years, nearly 16,000 had been treated for a broken bone related to osteoporosis.

Like the previous studies, the new study found that people who had used PPIs for a long time were slightly more likely to have broken a bone. But unlike the previous research, the new study found that people had a higher overall risk of a fracture only after taking these drugs for at least seven years, rather than just one year. When researchers looked specifically at the risk of a broken hip, they found that people had a slightly higher risk after taking PPIs for five years, and the risk got higher after seven years.

Where does the study come from?

The study was done by researchers from the University of Manitoba. It was published in CMAJ, which is a medical journal produced by the Canadian Medical Association. It was funded by a grant from the Canadian Institutes of Health Research.

How reliable are the findings?

This was a large study and it was well done. But this type of study (called a cohort study) can’t prove that taking PPIs for a long time can lead to broken bones. It can show only that there may be a link. And researchers can’t be entirely certain about this link. Perhaps there was something else about people taking PPIs that made their bones weaker and more likely to break. The researchers did a good job of taking into account other illnesses and prescription drugs that might have weakened people’s bones, but they could have missed something. Also, they didn’t have information on any over-the-counter treatments people were using. Notably, they didn’t know whether people were taking calcium or vitamin D supplements, which can strengthen bones.

Finally, the researchers can’t be sure that they knew about all the people who had broken bones. Fractures in the spine, for example, can happen without causing noticeable symptoms.

What does this mean for me?

Hearing that a drug you take regularly may cause serious side effects can be alarming. But there’s no need to panic. Researchers say any bone changes related to PPIs appear to happen slowly. The question is how slowly: does the risk of fractures increase after one year, seven years, or somewhere in between? Unfortunately, we don’t yet know the answer.

Although the study found only a small increase in risk, this may still be worrying if you are older or already at risk of fractures for other reasons. But bear in mind that we still don’t know for sure that using PPIs for a long time can affect your bones. More studies need to look into this issue.

What should I do now?

Until we know more about the link between PPIs and broken bones, there’s nothing you need to do. Still, if you’re worried about possible fractures, you and your doctor might want to consider these findings when you weigh up the benefits and possible risks of using PPIs for a long time. Some people may be able to take PPIs for a shorter amount of time or use a lower dose.

If you are free from symptoms for long periods, you may be able to take this medicine only when you feel you need it. Doctors call this intermittent treatment. You may also wish to discuss with your doctor alternative treatments for heartburn such as H2 blockers.


Moisturiser study: your questions answered

You may have seen alarming stories in the newspapers about a link between moisturiser and skin cancer. But these stories all come from a study that looked at mice specially bred to get skin cancer. We take a close look at the study, to see whether the alarm is justified.

What do we know already?

A type of skin cancer caused by too much sunlight, called squamous cell carcinoma, is the most common cancer in the UK. It’s rarely fatal, and people who get it can usually have it removed in a small operation.


We know that this type of skin cancer is more common in people who tend to get sunburn, such as people with pale skin, fair or ginger hair, or lots of freckles or moles. And we know that using sunscreen and avoiding getting too much sun can lower your chances of getting squamous cell carcinoma.

But we don’t know what else might be linked to the chances of getting squamous cell carcinoma. To find out more about what causes skin cancer, and what protects against it, researchers have been working with mice specially bred to be at high risk of getting skin cancer. These mice have very thin skin, no hair, and are albino (have no melanin pigment in their skin).

In one experiment, researchers wanted to make a cream they thought might protect the mice against skin cancer. To make the cream, they planned to use a particular type of moisturiser as a base. But first they needed to do an experiment to check whether that moisturiser, or other common types of moisturiser, had any effect on the mice’s chances of getting skin cancer.

What does the new study say?

The study found that some common types of moisturiser seemed to increase the amount of skin cancer that the mice got.

It’s important to remember that these are mice that already have a very high chance of getting skin cancer, and are treated with UV light deliberately to trigger skin cancer. There’s no reason to think that these creams would have the same effect on human skin.

Tell me more about the study’s findings

The mice were treated with UV light (the cancer-causing rays in sunlight) for 20 weeks, then treated daily with applications of moisturiser or water for 17 weeks. Almost all of the mice got skin cancer, whether they were treated with water or moisturiser. But the mice treated with moisturiser had bigger patches of skin cancer, and more of them. Mice treated with water had an average of 4.5 patches of skin cancer. Mice treated with moisturiser had from 6 to 9 patches of skin cancer.

The moisturisers tested were Dermabase, Dermovan, Eucerin and Vanicream. The researchers also had a special moisturiser made up, without any mineral oil or sodium lauryl sulfate. The researchers thought these ingredients might be to blame for the increased skin cancers. When they tested this specially made moisturiser, the mice had the same amount of skin cancer as the ones treated with water.

Where does the study come from?

The study was carried out by researchers from The Cancer Institute of New Jersey, in New Jersey, USA. It was published in the Journal of Investigative Dermatology, which is owned by Nature Publishing Group.

How reliable are the findings?

The findings are not a reliable guide to the effect of moisturisers on human skin. Human skin is much thicker than mouse skin and is much less susceptible to skin cancer. Remember that almost all the mice in the study got some patches of skin cancer, whether they were treated with moisturiser or not. That shows how different these mice are from humans.

What does this mean for me?

There’s nothing in these findings to suggest that using moisturiser increases your risk of getting skin cancer.

What should I do now?

We already know that the best way to prevent skin cancer is to avoid getting too much sun. Keeping out of hot sun, covering up with hats and T-shirts, and wearing sunscreen, are all sensible precautions against skin cancer. There’s no need to take any further action as a result of this study.


Possible link between low vitamin D and pain in women

Researchers have found evidence of a link between low vitamin D levels and chronic pain in women. But the link is far from definite and we don’t know whether taking vitamin D supplements would be any help for women with long-term pain.


What do we know already?

Vitamin D is made in your skin, after you’ve been in the sun. You can also get vitamin D in some foods, including eggs and oily fish, although most people get the vitamin D they need from sunshine.

Vitamin D is important because it helps your body absorb calcium, to make healthy bones. Previous studies have shown that people with a bone disease called osteomalacia, who often have bone pain, have very low vitamin D levels. But researchers don’t know if vitamin D makes a difference to pain in people without this bone disease.

The new study looked at 9,377 people aged about 45, who are taking part in a long-term health study. The researchers measured their vitamin D levels, then asked them to fill in a questionnaire about their health, including whether they had long-term pain that was widespread across their body.

What does the new study say?

There was no link between vitamin D levels and the likelihood of having long-term widespread pain in men. There was a possible but not definite link between vitamin D levels and pain in women. However, other things like women’s social class, and lifestyle factors like whether they smoked, made more of a difference to whether they got long-term pain than vitamin D.

Tell me more about the study’s findings

The women least likely to have long-term widespread pain had vitamin D levels of 75 to 99 nmol/l (short for nanomoles per litre, a measurement for very small amounts of a substance in liquid).

The study found that 8 in 100 women with vitamin D levels in this range had pain. Between 12 in 100 and 15 in 100 women with lower levels of vitamin D had pain.

Much, but not all, of the difference in pain at different vitamin D levels disappeared when researchers took into account other things like whether the women smoked, and what social class they were in. There was no link between having pain and whether or not women took vitamin D supplements.

Where does the study come from?

The study was carried out by researchers from University College London and the University of Aberdeen. It was published in the Annals of the Rheumatic Diseases, a medical journal owned by the British Medical Association.

How reliable are the findings?

The researchers themselves say that their findings give ‘little support’ for the idea that vitamin D levels cause long-term widespread pain. They say they cannot rule out the possibility that women with long-term pain had low vitamin D levels because they had changed their behaviour due to the pain, rather than the other way round. For example, women with pain might be less likely to spend time out of doors, so they’d get less sunlight than women without pain.

It’s odd that there was a link for women, but not for men. The researchers say this could have been because women react differently to vitamin D, because of their hormones. But equally, it could be that women were more likely to stay inside when they had pain, compared to men with pain.

What does this mean for me?

Experts say that most people can get the vitamin D they need from sunlight and food. The study does not suggest that taking vitamin D supplements can help if you have long-term pain. The researchers say that different studies are needed to find this out.

If you have long-term pain, this study suggests that other things about your lifestyle may be more important than whether you have enough vitamin D. But we can’t rule out that vitamin D may have some effect for women.

The government recommends that pregnant women, and elderly people, take a 10 mcg (micrograms) supplement of vitamin D. That’s because you may need more vitamin D in pregnancy, and older people are less likely to get enough vitamin D from sunshine. We don’t know if this is helpful for other people.

Most of the people in the study (98 in 100) were white. There’s some evidence that people with dark skins living in countries like the UK, which get less sunshine, are more likely to have low levels of vitamin D. We don’t know if the results would be different for black and Asian people in the UK.

What should I do now?

There’s no need to take any action as a result of this study.


Atherton K, Berry DJ, Parsons T, et al. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey. Annals of the Rheumatic Diseases. August 2008. Available at (accessed on 14 August 2008).