Migraine

Ok, I'm sure we've discussed this before, but I'm still struggling with this. I think it's a problem that most migraine sufferers have at one time or another...

How do you decide when it's time to take your abortive?

I know that it's best for me to take my imitrex at the first sign of migraine. However, my migraines are still so chronic that I'd definitely be in MOH if I took imitrex for every one.

Right now, I wait to be "sure" it's really gonna be an exceptionally bad one...then I take the imitrex. And in recent weeks, the imitrex has not been all that effective...probably because I'm taking it too late in the migraine process?!? Also, I get so few each month that I want to save them for the times that I really need them.

Last week the nurse at my doc's office asked me "How do you decide it's time for the imitrex?" I didn't really know what to say! I explained the stuff I just shared above and we agreed that imitrex does work best if taken early. But we never really came to a definite conclusion about when I should be taking it!!

So I'm wondering if I'm going about this all wrong?

How do you decide it's time for your abortive??

jenny

Taking it as soon as you know "oh, migraine!" is of course your best bet.

But I see what you are saying about MOH and cost too. I'm the same way.

This is what my doctor and I just discussed on Tues. It may be a little different for me since most of my migraine seem to, at least recently, start out TTH.

Heres what I do, But I'm not saying try this at home. This is what my doctor and I have decided works for me now in my current cycle of migraines:

If I'm total TTH - it's muscle relaxer.

If I'm between a 1-2/3 then it's muscle relaxer - if in an hour it's either worse or the same - then I take a Frova.

Anything above a 3 - it's a Frova off the bat.

I know this probably does not help at all, right??!??

Millsy you are the opposite of me!

I usually get some sort of stomach symptom first, be it indigestion or nausea - then the head starts hurting. Yeah, I'm backwards.

In the past, I've considered any pain under a 5 "background noise." I'd only treat the pain if it reached 5 or higher.

I've got some sort of head pain almost every day. I started seeing a new specialist in December, and she said that all my head pain is migraine, even the stuff that I've been thinking is tension-type headache.

A lot of my pain starts in my neck and at the base of my skull. When the pain is between 1 and 3, I'm to take a Skelaxin, a muscle relaxer that I can use daily, if necessary. When it gets to between 4 and 6, I'm to hit it with 2 Anaprox DS (total of 1100mg of naproxen) plus Imitrex. Repeat the Imitrex in an hour if necessary. I can only do the Anaprox/Imitrex thing three times a week. I've got hycodan to take if the Anaprox/Imitrex cocktail doesn't work.

I don't always do the Anaprox/Imitrex at 4. Since I'm GOING to avoid MOH, I try to gauge whether I think the pain will progress. I'm more likely to take the meds later in the week. Earlier in the week, I tend to hoard them in case I have worse pain later in the week.

I don't know if this helps at all. My pain is as frequent -- 27 or 28 days a month. But the intensity is down. A 7 is rare, and 6s are declining. I'm taking the Skelaxin almost daily -- I usually wake up with head pain -- but I'm sticking to the 3 times a week restriction on Anaprox/Imitrex.

Gretchen in Mississippi

Thanks, guys!

Sometimes it's nice to just run my thoughts past people who understand...

Of course your responses are helpful!

I've got a very weird migraine pattern. My nerve blocks relieve my migraine pain/symptoms completely for 10 days (maybe more this time ).

Once the nerve block wears off, I have daily migraine. Millsy and Eileen, with me, the pain, nausea, visual/sensory aura all come at once! Sometimes I'm even throwing up before I realize that I'm having a migraine at all. And I have a few days of 3-4 pain but I still often get to the 7-8 level, too.

Gretchen, I think I am quite a bit like you with regard to my migraine frequency. When my abortive provides no relief and I am able to fall asleep, I usually wake the next AM with (what I believe to be) the same migraine. It's really tough to know where one migraine starts and the other ends! AND I feel pretty certain that my imitrex is not particularly helpful when I take it too late into the migraine...

But it's so tough to know what to do! I don't want to experience MOH--never had it and NEVER EVER want it!!! So I stick to my 2-3 migraines per week use of the imitrex. But right now it seems to me like it's a guessing game to decide when to take it and when to just try to stick it out.

It just seems like there should be a better way of deciding what to do...Maybe I'd respond better if I just went ahead and took the abortive earlier?!?

Eileen, you have a nice, clear plan for deciding what to take and when. I'd LOVE to have something like that for myself so I'd be sure I'm doing the right thing at the right time!!

Thankfully, I do have rescue options. For the longest time, I had imitrex as my ONLY option and that made my treatment nearly impossible! But with the rescues (used only 1-2x/week), I am at least confident that some relief will come...

I guess i'm just still confused about this whole question!

Oh, and I really think the main issue is that I still do not have an effective preventive regimen. My doctor and I are working HARD at that because, in the end, the prevention is MUCH more important than relieving migraines that have already started!!!

Just thinking out loud, I guess...
jenny

I still don't have a good answer to this question, so this is generally what I do.

I have daily, constant migraine pain. It never gets below a 2-3 anymore. A typical day I max out around a 5-6, so I don't usually even think about treating until the pain gets above a 5. I average a 7-8 usually once or twice a week. Sometimes, if the vertigo and nausea (also very frequent) are severe even if the pain isn't, I'll treat. My abortives are Imitrex or Frova, both taken with 400 mg of ibuprofen per my specialist's recommendation. I've found that the combo is key for me - without the ibuprofen the abortives don't touch my pain.

I'm not happy with this, though. My preventives aren't doing their job yet (still playing the waiting game to see if the Topamax will work). I usually max out my abortives most weeks, and I'm rather sensitive to MOH so I tend to under-treat. I don't have any rescue meds. So I plan to discuss this with my specialist in-depth when I see her next week.

I'm not sure if this has helped you any, but I did want you to know that you're not alone in your confusion on when to treat. I struggle with that question every day.

I guess I'm kind of the odd duck here. My migraines usually wake me up so it's immediate Zomig NS for me. On the days that it starts during the day (like Friday) I use Maxalt as long as I haven't used either one two days that week.

I can usually tell if it's a migraine by my auras like whether or not I had a lot of energy the day before, heard sounds that didn't exist or smelled something burning. The downside is that I don't always get an aura.

Long short for me is, the sooner I feel my migraine senses tingling the sooner I take the abortive. Did that even help?? LOL

Hi MJ and Laura,

MJ, I still find it ridiculous that you have been left without rescue meds! I know that my last HA specialist was very strongly opposed to using rescue meds. She kept telling me to work on the preventives--that was the key to migraine management in her book. She refused to prescribe any rescue meds...

I agree completely that a good preventive regimen is critical!! But it can take many years to find that regimen! In the meantime, a migraine sufferer needs something that will put her to sleep and stop the pain--even if it's only for a short time!

I am fortunate that my new HA specialist is in agreement with my belief--I now have 3 different rescue options. I use rescue only 1x/week (at most) to be sure I don't have MOH issues, but at least I have something that works for the really awful ones!

You deserve rescue options, too!!!

Thank you for assuring me that I'm not alone with the "when to treat" issue! Sometimes it just helps to know that I'm not nuts!

Yep, Laura, your reply was great! I think you're taking your abortive the way I'd like to...at the first real sign of migraine. I think the abortive has a better chance of pushing the migraine out if you take it early. With my current frequency, though, I just can't do it without risking MOH...Hopefully, my preventives will start REALLY working so this will be less of in issue for me!

Thanks girls!

jenny

Jenny, I agree with you, and also think it's ridiculous I don't have any rescue meds. This is question #1 for when I see my specialist next Monday. I never even had any abortives available to me until the beginning of January - to think I just put up with all that pain! I think that's a lot of the reason that my pain levels have gone up. It is true that preventives are key to good management, but in the meantime we need relief!!

I'm glad that your new specialist agrees with you and has found good rescue options for you. I do plan to push this issue with my specialist. I think she'll be willing to work with me on this. I'm just sick of living in pain every day while I'm playing the waiting game with preventives.

And you really aren't alone in the "when to treat" issue - I think a lot of us struggle with that, if not for MOH reasons then for insurance reasons. Or sometimes both!

quote:

Originally posted by jennyc:
Hi MJ and Laura,

MJ, I still find it ridiculous that you have been left without rescue meds! I know that my last HA specialist was very strongly opposed to using rescue meds. She kept telling me to work on the preventives--that was the key to migraine management in her book. She refused to prescribe any rescue meds...

I agree completely that a good preventive regimen is critical!! But it can take many years to find that regimen! In the meantime, a migraine sufferer needs something that will put her to sleep and stop the pain--even if it's only for a short time!

I am fortunate that my new HA specialist is in agreement with my belief--I now have 3 different rescue options. I use rescue only 1x/week (at most) to be sure I don't have MOH issues, but at least I have something that works for the really awful ones!

You deserve rescue options, too!!!

Thank you for assuring me that I'm not alone with the "when to treat" issue! Sometimes it just helps to know that I'm not nuts!

Yep, Laura, your reply was great! I think you're taking your abortive the way I'd like to...at the first real sign of migraine. I think the abortive has a better chance of pushing the migraine out if you take it early. With my current frequency, though, I just can't do it without risking MOH...Hopefully, my preventives will start REALLY working so this will be less of in issue for me!

Thanks girls!

jenny

Jenny,

I can't wait for your preventatives to work their magic too!


MJ,

Yep, insurance is usually an issue for me each month too. Grrrr!! But, one day soon, my treatment plan will fall into place and I will get the right combo and *poof*, no more insurance worries!

quote:

And you really aren't alone in the "when to treat" issue - I think a lot of us struggle with that, if not for MOH reasons then for insurance reasons. Or sometimes both

Jenny, I also wrestle with the question of "should I take Imitrex now?" for the same reasons you mention.

I allow myself two weekly, to avoid MOH. The first one I take as soon as I can. The second I'm usually more conservative. I also add Aleve with the Imitrex if I can tell it is going to "one of those."

The next time I stand with my Imitrex in my hand debating if I should or shouldn't go ahead and take it, I'll remember there are others who are having the same conversation with their medication.

Liz