Herbs, Headache Meds Could Be Dangerous Combination

Some herbal remedies can also cause or worsen headaches, study says

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

THURSDAY, June 19, 2003 (HealthDayNews) -- Combining some popular herbal remedies with common migraine medications could cause dangerous interactions, new research contends.

And several herbal remedies may cause or worsen migraines, say the researchers, who will present their findings June 21 at the American Headache Society's annual scientific meeting in Chicago.

The researchers, from the University of Utah Health Sciences Center, based their conclusions on a review of more than 20 studies looking at herbal remedies and possible interactions.

But the head of a non-profit group devoted to educating people about the responsible use of medicinal plants dismisses the study as "speculative" and based on anecdotal evidence.

Ginkgo biloba, ginseng, echinacea, St. John's wort and large quantities of garlic can interact with migraine medications -- including triptans -- used to treat migraine pain, and tricyclic antidepressants, which are used to prevent migraines, the researchers report.

These herbs can interact with liver enzymes that metabolize the two migraine medications, which can cause a toxic interaction, says researcher Carla Rubingh, a clinical pharmacist specializing in headache and pain management at the Utah Health Sciences Center.

The reaction could be fatal with the combination of a tricyclic antidepressant and St. John's wort, the researchers say.

Many patients don't tell their doctors or pharmacists they're taking an herbal remedy, Rubingh notes, adding that herbs should be recognized and regulated as drugs.

"Unless we specifically ask, they don't tell us," she says. "People see them as natural, and people continue to take them, but don't tell doctors."

The researchers' review of studies found no deaths caused by drug-herb interactions, Rubingh says. She acknowledges she had no statistics on interactions, saying the researchers looked at "mechanisms of action" for herbs and side effects. She added that reports of interactions are often "subjective" and "anecdotal."

The researchers found studies that some herbal remedies -- ginkgo biloba, ginseng, St. John's wort and valerian root -- also may cause or worsen migraine or cluster headaches in people prone to them, the researchers say.

But other studies showed St. John's wort and valerian root could ease headaches, the researchers found.

Ginkgo biloba is taken to improve memory, ginseng for energy, echinacea for colds, St. John's wort for depression, valerian root as a sleep aid or to ease anxiety, and garlic for prevention of cancer or high blood pressure, the researchers say.

Mark Blumenthal is founder and executive director of the American Botanical Council, a non-profit group created to educate the public about the responsible use of medicinal plants. And he's highly critical of Rubingh's study.

"It's totally speculative, and it's irresponsible in the sense that it's not based on pharmacology," Blumenthal says.

"We find that a lot of the information on herb-drug interactions is speculative," he says.

Blumenthal also notes the research has yet to be published in a peer-reviewed medical journal.

In other findings being presented at the American Headache Society meeting:

  • The anti-wrinkle medication Botox proved effective in preventing headache pain among chronic sufferers. Eighty percent of 271 headache patients said their headaches occurred less frequently or were less intense after taking Botox, researchers at Kaiser Permanente in San Diego report. Their study, which they called the largest to date on Botox for headaches, also found fewer side effects for Botox than more traditional medications.
  • Women with severe premenstrual syndrome and migraines associated with periods had worse headaches during their periods. In the study, 21 women with migraines kept headache diaries and rated pain levels. Those who had the severe PMS, called premenstrual dysphoric disorder, had migraines about 20 percent more severe than those without the disorder, say researchers from the University of Cincinnati Medical Center.
  • Researchers at Albert Einstein College of Medicine in New York City say three simple questions can help determine whether you suffer from migraines: Has a headache limited your activities for a day or more in the last three months? Are you nauseated or sick to your stomach when you have a headache? Does light bother you when you have a headache? If you answer "yes" to two of the questions, there's a good chance you suffer from migraine headaches, the researchers say.

More information

For more on the risks of mixing herbal remedies and medications, visit the American Academy of Family Physicians. To learn more about headaches and their treatment, check with the National Headache Foundation.

SOURCES: Carla Rubingh, Pharm.D., clinical pharmacist, headache and pain management, Utah Health Sciences Center, Salt Lake City; Mark Blumenthal, executive director, American Botanical Council, Austin, Texas; June 21, 2003, presentation, American Headache Society's annual scientific meeting, Chicago

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