Migraine

Going to my neuro on Thursday. I had to come off the zonisamide since my last visit so we'll have to come up with another preventative for me to try. The last two I told him what I wanted to try and he was open to the suggestion. Neither worked, so this time I'll let me offer a suggestion or two.

My question for the group, however, relates to what to take at the onset or during a migraine. For two years, I've been taking 2.5 mg of Zomig. And it work pretty well except I sometimes feel like hell for a couple hours after taking it. But it does alleviate the migriane usually. But with 2-4 headaches a week, I'm concerned about taking so much zomig in a short amount of time (plus it's expensive!). At my last visit I had him write me a script for midrin. I wanted to see if I could use it to avoid taking so many zomigs. Unfortunately, it did little to help. I've also taken 7.5 mg hydrocodone/APAP, and it works ok if I catch the headache very early.

What other drugs do you consider to be front-line along with your triptans? There have been weeks I ended up taking a 6-pack of zomig in one week. Not good, I know. I just need something else in my arsenal. Suggestions anyone?

I'm sort of in the same situation. I started using Frova+ 600 mg.advil. Frova is one of the slower working triptans, so I didn't get good response from it. I've changed to Maxalt + 600 mg. Advil now and seem to get a good response if I get it early. If I let it get the best of me, it takes a 2nd dose of Maxalt.

It's my understanding that the triptans work differently-some faster than others, and they will work differently on people, just like everything else does. Right now, triptans and Advil are my only front line meds.

I'm fighting right now trying to get a rescue med. My current doc doesn't believe in them and I'm having problems getting in with a new doc.

Good luck
Lynn

Jeff,

Do you get Tension headaches before migraine? I've noticed that if I take a muscle relaxer (for me right now, it's Skelaxin) when the pain is a 1/2 it can sometimes knock it out before it becomes a migraine.

If you are looking for another abortive medication, and Zomig just isn't for you - there are now 7 others you can try: Imitrex, Relpex, Frova, Treximet, Axert, Amerge, and Maxalt. Don't think that just because you react one way to the Zomig, you will react the same to the other tritpans. I didn't like the effects Zomig gave me either, but Frova works great for me.

As far as abortives go, there are the eight triptans, Midrin, and DHE, which is an ergotamine medication. Since Midrin didn't seem to do anything for you, my guess is that your doctor would reccommend trying a different triptan.

Zomig works fine for me, which is a good thing since my insurance will only cover it and Imitrex.

I'm just looking for another possible alternative as an abortive to take from time-to-time (provided it works) instead of taking 3-4 Zomigs a week. Even though I have a low co-pay to get 36 2.5 mg Zomigs a quarter, I'd still prefer to take something less expensive if I can. Plus, my understanding is I shouldnt take more than 2-3 Zomigs every seven days.

I'd just like a couple of abortives (one triptan and something else) on hand, if I can.

Of course, if I can ever find a preventative that works, this would be somewhat moot. My neuro has the 100 preventatives list in my file and we'll review it again tomorrow. I've already tried 11 of them, so 89 more to go!

Jeff, two things come to mind.

First, the guideline for avoiding MOH is 2-3 days per week, not doses. Most of us have authorization from our docs to take a second triptan dose if the first isn't enough, so the MOH guideline takes that into account.

Second, adding another triptan to your arsenal won't necessarily help the MOH guideline. The 2-3 days per week is for *all* triptans. So, if you take Zomig one day and Imitrex another 2 days, then that's the limit for the week. Because triptans all work on the serotonin receptors (I believe - mods, correct me if I'm wrong), then using two different triptans 3x each in the same week still puts you at risk for MOH.

Does that make sense?

Now, that's not to say that having an option about abortives isn't a good idea. It is a great idea. For a while I used both Imitrex and Frova (never together, of course) depending on if I was at work or at home. The Imitrex worked better and faster, but knocked me out. The Frova took longer but allowed me to stay at work. So I would use the Imitrex at home and the Frova at work. (Of course, neither of these work for me now so I'm using Relpax.)

Also, keep in mind that many of us take a combo of several preventives, so if you haven't pursued that route yet you may want to discuss it with your doctor.

Certain triptans can be taken twice in 24 hours, while others, I believe, are only supposed to be taken once. Check the prescribing info that came with your Zomig, and be sure to consult your doctor if you have any questions about how often he/she wants you to take the medication.

MJ is right. Alternating your triptans, does not change your risk of MOH.
See: Medication Overuse Headache: When Remedy Backfires.

In the ideal world, we wouldn't migraine every single day. But, when we do, the plan of attack is to alternate between your triptans and your rescue medications, which it sounds like you have both.

Your rescue is there for when you have maxed out on your abortives for the week, or, of course if your abortive fails.

Along with not taking two different triptans within 24 hours of each other, you aren't supposed to take triptans and ergotamine meds within 24 hours of each other, either. So...if you want to safely rotate meds, Midrin would pretty much be your choice.

i know you orginally asked about other abortives...but i just wanted to add that i rotate my triptans monthly. one works for a few weeks then quits. so i start the second one. and after a month i go back to the first. not saying this is a good idea for everybody but it is part of my attack.
have you tried combining preventatives? like all 89 at one time? im TOTALLY kidding, just a little migraine humor here. i take cymbalta and keppra. alone they don't do much but together they (were) pretty helpful.
JJ

And preventative number 12 is Namenda. We talked through several of the 100 preventatives listed on this site (he has it attached to my chart). He told me he had been reading lately that namenda shows some promise, but he admitted he had not used it with any of his migraine patients yet. Someone has to be first I suppose. Fortunately, he gave me enough samples to get through the first six weeks...We shall see. As always, I'm expecting this to be "the" one!

We'll hope right along with you. Go, Namenda!