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    Migraine Community  Hop To Forum Categories  MyMigraineConnection  Hop To Forums  Questions and Answers    Fioricet + Imitrex : ok to combine? (fighting a progressing headache, please answer)

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Fioricet + Imitrex : ok to combine? (fighting a progressing headache, please answer)
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Hi. I'm new here, my name is Leah. I have a quick question for anyone that happens to be on right now - I have taken 2 Fioricet (the butabital/acetaminophen/caffeine combo, NOT the aspirin one) and I'm scared it's not going to work. It's kind of hit or miss with Fioricet. I have imitrex, but my doctor advised me not to combine one with the other. I asked him why, and he said it just isn't a good idea. it's been slowly progressing, and I JUST took the second Fioricet so in another... 30 minutes or so, I'll know for sure if it's going to work or not.

My question is: is there anyone here who has combined these two drugs before, and have you experienced anything alarming? I understand that nobody here can give me official medical advise, but I would just like to hear your personal experience. I have scoured the internet and cannot find any known interaction between the two, but if this headache continues it will turn into a migraine and it will be too late for me post this because I will have to lay down... I'm just being cautious before I start popping more pills. Wink I would appreciate anything you guys have to share about these meds.

****a little rant about my doc, looking for opinions, sorry so long***

To clarify, my doctor is a general practioner (osteopathic) NOT a neurologist, so it isn't like he's given me a CT scan or MRI and has any reason to think my brain may have something wrong with it that would make me unable to handle the drugs. I have no thyroid condition or heart condition and my blood pressure has been normal every time it's been taken.

He's been treating my headaches with a low dose anti-depressant (Desipramine 25mg) and Fioricet and Somas to be taken as needed. Once a month he gives me a slight 'adjustment' much the same way a chiropractor would, and that does help a lot... for about a week. I just got the Imitrex and I've only taken it once before, and I heeded my doctor's warning about not combining it with Fioricet.

However. He said something during our last visit which has made me think maybe it's time for a new doc. I mentioned to him that I cut out the 3 most common migraine triggers from my diet - MSG, tyramines, and sodium nitrates. I also told him that I added riboflavin and magnesium supplements along with my fish oils, because of the studies I'd found online that support their use in preventing migraines. His response was that there are so many preservatives in food that finding one's triggers is almost impossible, and that he "does not support the idea of taking extra supplements to treat headaches because he doesn't believe they can help". To give him credit, he did encourage me to continue with my experiment because if I "think" something might make me better then I should by all means pursue it.

I wasn't sure how to take that. There have been so many studies and articles where sufferers have reported feeling better by cutting out these 3 very common triggers, and the same goes for the supplements - I even read articles where neurologists claimed they have given their patients magnesium injections to relieve the pain, and it worked. The fact that my doctor was aware of these things (he said he's heard about them) but never brought them up after more than 6 months of seeing him, makes me wary. Isn't ANYTHING worth a try? Especially something so harmless as a diet change?

I really, really like my doctor otherwise. He's very open to my questions and ideas, never rushes through our appointments or acts condescending like other doctors I've tried to talk to about my pain. But I'm starting to think maybe I should see him only for my 'adjustments' and perhaps visit a neurologist for the headache problem. On the other hand, during my perusal of migraine message boards, I've seen many a post from sufferers who say they've had all types of brain scans and never found anything wrong with their brain. So I kind of feel like those tests might be a waste of time and money.

This is incredibly long, my apologies. I got caught up in it, and it's takes my mind off of the pain. In fact, it took me about 20 minutes to type this, and I'm starting to feel relief. I think the Fioricet may have cut this headache off before it could progress. (hopefully I didn't jinx myself by typing that!)

Thank you to anyone who took the time to read my rambling.

-Leah
 
Posts: 2 | Registered: 02-16-2009Report This Post
Guru
Picture of MaxJerz
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Hi Leah, and welcome. The moderators will come by to say hello and give you some links (probably in the morning), but I wanted to welcome you in the meantime.

Not being a doctor and not knowing your medical history, I can't tell you if the Fioricet and Imitrex are ok for you to combine. None of us will be able to. But, what you can do is call your pharmacist and ask. (Even if your pharmacy isn't open 24 hours, you can find one that is and talk to the pharmacist on duty.) You could also try calling your doctor's office. Even after hours, he should have someone on call who may be able to help you. Either way, I would highly recommend you contact your doctor first thing in the morning to get a real answer on why he doesn't want you combining the two meds.

Regarding your doctor: even the kindest doctors run out of ideas sometimes. My second neurologist was wonderful; he never rushed me, answered all of my questions and was very responsive when I called his office. But he eventually ran out of ideas in my case, so I moved on to a headache specialist. Here's the thing to keep in mind: a GP needs to know a little bit of information about a lot of conditions, enough to recognize what conditions are serious, requiring outside referral, and what he can treat himself. Even a neurologist is a "generalist" in brain issues. For many of us, there comes a time when we have to get even more specialized and go to a headache specialist. It sounds to me like you may have surpassed your GP's comfort or knowledge level in treating your headaches and Migraines.

One thing you can do is see a neurologist or headache specialist for a second opinion. Second opinions are a great way to "try out" a doctor and get new eyes on your case. I'm not sure where you're located, but we have an excellent list of patient-recommended headache and Migraine specialists, which you can find here.

MRIs and CTs are typically done to rule out any organic issues. Most Migraine patients have clean MRIs, though some do show benign white matter lesions. In my experience, it's very typical for a neurologist to send you for an MRI to make sure nothing's going on, even if he doesn't suspect there's anything there.

A couple other things I want to mention. First, I hope your doctor has explained that Imitrex and other triptans should *only* be used for Migraines, not Tension-Type Headaches (TTH). Also, triptans are generally used as the first-line treatment for Migraines, rather than rescue medications like Fioricet. Second, has your doctor ever mentioned Medication Overuse Headache (MOH), also known as rebound headache? Taking medications like Fioricet, Imitrex and other painkillers (OTC or prescription) more than 2-3 days per week can result in MOH. Take a look at these articles:

Is It Migraine? Tension-Type Headache? What?

Medication Overuse Headache - When the Remedy Backfires

Types of Migraines and Headaches

Preventive, Abortive, and Rescue Medications - What's the Difference?

I know I've thrown a lot of information, but please do feel free to ask as many questions as you need after you read through it all. We'll be happy to help you out. Hopefully I haven't overwhelmed you too much! Eeker

Welcome again to our forum - we're glad that you're here and look forward to seeing you post here more often. Flower


-MJ

my blog: http://rhymeswithmigraine.blogspot.com

"What will you do, if it does not turn out how you expect?"
"I do not know. Nor shall I worry about it until it happens. I still have an action left to take; until I have exhausted it, I shall not despair." - Robin Hobb, Assassin's Quest
 
Posts: 2833 | Location: western WA | Registered: 06-01-2007Report This Post
Newbie
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Hi Leah, and welcome. The moderators will come by to say hello and give you some links (probably in the morning), but I wanted to welcome you in the meantime.

Thank you!

Not being a doctor and not knowing your medical history, I can't tell you if the Fioricet and Imitrex are ok for you to combine. None of us will be able to. But, what you can do is call your pharmacist and ask. (Even if your pharmacy isn't open 24 hours, you can find one that is and talk to the pharmacist on duty.) You could also try calling your doctor's office. Even after hours, he should have someone on call who may be able to help you. Either way, I would highly recommend you contact your doctor first thing in the morning to get a real answer on why he doesn't want you combining the two meds.

I checked my insurance providers website, caremark.com, also checked rxlist.com and drugs.com, which all have either an interaction list or an 'interaction checker' tool, so to speak. I didn't find anything to indicate a risk. I will definitely ask my doctor tomorrow though, because I think if he's going to give a warning like that he should have a reason for believing that. I should have pressed the issue at the time, I don't know why I didn't.

*snipped to save space*One thing you can do is see a neurologist or headache specialist for a second opinion. Second opinions are a great way to "try out" a doctor and get new eyes on your case. I'm not sure where you're located, but we have an excellent list of patient-recommended headache and Migraine specialists, which you can find here.

That makes perfect sense. Thank you for putting it that way, I suppose it wouldn't hurt to try and see what someone else as to say - I'll never know if I don't try, right?

MRIs and CTs are typically done to rule out any organic issues. Most Migraine patients have clean MRIs, though some do show benign white matter lesions. In my experience, it's very typical for a neurologist to send you for an MRI to make sure nothing's going on, even if he doesn't suspect there's anything there.

You know, after I posted this, I remembered a strange problem I had a few years ago. I came down with what seemed to be a sinus infection. I had intense pressure and pain in my nasal passages and behind my eyes, unlike anything I'd ever felt before. It made me dizzy and nauseous (much like a migraine will, but the pain was most certainly NOT a migraine-like pain) It was accompanied with a very bad smell... rotting, and sour. I worked in a deli at the time and I first noticed it at work - which lead to a huge search for rotting meat. I assumed someone dropped some meat under a table, or behind the oven, where it wasn't noticed and began to rot. I found nothing. I then wondered if it was somehow me. "Is my BO that bad? I showered, I swear!" LOL

The smell stayed with me for weeks no matter where I was or what I wore, who I was with, etc. Just stayed. The pain, too. The only way I could relieve it was laying on my back and hanging my head upside down and breathing through my nose for a few minutes, and I would eventually feel my sinuses "pop". (there's no other way to describe the sensation, it was like cracking a knuckle, but in my face. i would feel a tingling sensation of relief and the the pain would subside for a few hours. don't ask me how i even discovered this, i do strange things when i'm in pain.)

I finally went to the E.R. (no insurance) and the doctor told me there was nothing wrong with me, even though all he did was press on my face and look inside my ears. I insisted I must have a sinus infection, he insisted that I most certainly did not. I insisted he find out WHAT was causing it, then, because it was making me miserable, and he insisted in... blowing me off.

Eventually, it just... went away. I had it for 3 or 4 months, never diagnosed or explained. Never reoccurred. I've read that strange and persistent odors that cannot be smelled by other people often point to a possible neurological problem. I can't believe I've never made the connection before, but I'm thinking it's worth looking into. It was the strangest thing, and I had completely forgotten about it.

A couple other things I want to mention. First, I hope your doctor has explained that Imitrex and other triptans should *only* be used for Migraines, not Tension-Type Headaches (TTH). Also, triptans are generally used as the first-line treatment for Migraines, rather than rescue medications like Fioricet. Second, has your doctor ever mentioned Medication Overuse Headache (MOH), also known as rebound headache? Taking medications like Fioricet, Imitrex and other painkillers (OTC or prescription) more than 2-3 days per week can result in MOH.

Oh, absolutely, to all of the above. I had a problem with rebounds when I took Excedrin. I ended up with a bleeding ulcer in '07 because of the overuse. I was up to 10 or more a day. Ignorant of me, I know, especially since I KNEW about rebounds and I knew that's exactly what I'd given myself. I guess I just pushed it to the back of my mind because, well, I only cared about getting through the day and I just didn't want to deal with weaning myself off of them. I almost died, they had to replace 4 bags (pints, i think?) of blood in the hospital. I was forbidden to use NSAIDs in the future, and I told the doctor that even after I get over the rebounds I will still have chronic headaches, so he advised Fioricet. It just doesn't always work, even though I'm very careful not to take it too often. If I have the option of just staying in bed for a day and waiting it out, then I will, because god knows I don't want to deal with rebounds again.

I get different types of headaches, I have nicknames for them. There's my Neck Headaches, my Brain Headaches, my One-Side Headaches. They feel very different, but they all seem to have the potential to progress into migraines if I do nothing to treat the headache. I'll usually have my husband rub my neck & pressure points on the back of my head, drink a glass of water and lay down with a cold washcloth. Since I've started taking magnesium and riboflavin, that is usually good enough and the migraines are less frequent. (I'm so glad I continued the supplements, they have definitely made a difference!) That's why I've only taken my Imitrex once before - I've had the prescription for almost 3 weeks, but I won't take it for a regular headache, because I know it isn't meant for that.

I do panic if I feel like the headache might not be going away, because I'm so scared of migraines. There's nothing worse than that dizzy, pukey feeling and the pain gets so bad that I wish for a bullet in the brain. I can't talk, I can't move, I'll lay in bed and deal with any discomfort to keep from getting up. Too hot in the room? Don't care, I'll sweat to death before I get up and turn on a fan. I can't even move to take my clothes off. Gotta pee? Don't care, I'll hold it, and pray for sleep to come so I can get away from this nightmare.

Thank you again for the welcome and the articles, I am always on the lookout for new information! I suspect I've probably make the longest newbie post EVER. I'm a little excited that I've finally joined a message board. I don't know anyone else IRL that understands what I go through, and though my husband is very supportive... he just doesn't "get it", I guess. It's hard to explain this kind of pain to someone who never takes an aspirin for anything. He just ignores whatever hurts until it goes away. The extent of a headache for him is "My head hurts a little bit. It's kind of annoying. What's for dinner?" Wink
 
Posts: 2 | Registered: 02-16-2009Report This Post
Grand Wizard
Picture of Cindy
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Good Morning,

First welcome. You will find all sorts of wonderful information and support on this site. I hope we see you around alot.

MJ gave you great links to provide you with further education and the possibility of finding a neurlogist.

The main reason I wanted to write is that I've taken Imitrex and Fioricet together for years. I don't take them at the same time, but after two doses of Imitrex and I still have the migraine, I take Fioricet 2 hours later. In the old days before triptans Fioricet was what I took when I got migraines. As long as I took it at the first sign (ususally when my vision blurred or those nasty lights started dashing through my vision fields) it would probably 75% of the time abort the migraine. If I didn't take it right away, it did not work as well or as fast.

But Fioricet is a nasty drug for MOH and I have to be extremetly careful.

My primary prevenative now is CoenzymeQ10, a supplement. The B2 I started with decreased the intensity of my migraines greatly. Both of these are prescribed by my neurlogist as she knows supplements usually help and are most often easier of peoples body's than prescriptions.

Good luck. Stay in touch.

Cindy
 
Posts: 2136 | Location: Fairfield, CA (San Francisco Bay Area) | Registered: 01-10-2008Report This Post
Guru
Picture of nutcracker
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Hello, Leah, welcome to the forum. We're glad you found us.

I doubt you've actually posted the "longest newbie post" in history, but even if you have, we're glad you did. Never worry about the length of your posts on this forum. It's our privilege to take the time to read them.

Take a few minutes to look at the Start Here folder at the top of the forum, so that you get the most out of your use of the forum. Then, take a look at this article:

• Learning About Migraines and Headaches - Where To Start

At this point you will probably never know what caused your sinus discomfort and that awful smell. I'm so sorry you had to live with that smell for so long. However, in many cases sinus pain is actually due to migraines:

Sinuses Giving You a Headache? It's Probably Migraine

Migraines are "chameleons." There's no one location for them, and no one way they feel. For example, while most people's migraines are one-sided, mine are usually bilateral. Yet occasionally, I get a one-sided migraine.

I'm among those who started out with a wonderful doctor, but moved on to a migraine specialist when my doctr reached the limits of her knowledge. My primary doctor ordered a CT scan of the brain, just to rule out other possibilities, and then referred me to a neurologist. I really enjoyed working with my neurologist. When she ran out of ideas, I moved on. At my initial appointment at the migraine specialist, the nurse said it was obvious I'd had a good doctor, but it was time for someone else to take a look. Good doctors usually want their patients to make the most progress possible, and that sometimes means moving on.

Take care of yourself.
 
Posts: 2510 | Registered: 09-16-2007Report This Post
Grasshopper
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That "dizzy, pukey feeling" is enough to give anyone the shakes. I sure hate it myself. Nothing's worse to me than that feeling like you're on the edge of barfing, and it won't subside and it's not bad enough to just barf and get it over with either. With me, I can hang like that for hours if I don't take something.

Thankfully there's a couple good meds they have for the nausea, make sure that you ask about them, the next doctor you see, so that they give you something to help. No sense in suffering if you don't have to. The good thing about one of them, called phenergan, is that it tends to make a lot of people sleepy, which is where I want to be - asleep - if I am not having to stay at work, in which case I take a different one called zofran.


Life gave me a bowl full of lemons... got any sugar? I'm out....
 
Posts: 47 | Location: southern US | Registered: 01-01-2009Report This Post
<Nancy Harris Bonk>
posted
Welcome to MyMigraineConnection!

Good to hear you are aware of rebound headache because no Migraine preventive medication on earth wilk work if you are in rebound! The general rule of thumb is not to take certain medications, fioricet included, more than two to three days a week.

Here's the thing - if we get more than three Migraines a month - it is time for preventives. Clearly, the regime your doctor has you on is not working. There are many more preventive medications available to treat Migraine, in fact over 100. If your doctor is a good partner in your health care, willing to work with you. Migraine Preventive Medications - Too Many Options To Give Up!

Keeping a Migraine diary is another way to see what triggers are and are not triggering an attack, what medications are and are not working and how many days you are getting a Migraine. It is easy to do and you can down load our free diary HERE

Now, having said that, if your doctor is open to "learning" about Migraine, which is a genetic neurologic disease, that is fine. Migraines DO have triggers such as foods, weather changes and dehyration. They are caused by overactive neurons in our brains and genetics (this is a condensed version.) But, in light of his statements, it may be time for a new doctor and a Migraine specialist at that. A good article to read is Migraine and Headache Specialists - What's So Special?

I've given you a lot of information, after you read over it if you have any questions, please feel free to ask away. That is what we are here for.
 
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