Migraine

I can't get into my neuro til May 26. In the meantime, I need to try a new Triptan.

I was on Imitrex, but can't do the side effects. I have been using Relpax about 3X a week since September, and I think I have become resistant to it. It doesn't seem to work anymore, and I find myself reaching for the rescue meds more and more often.

So, I am going to go to my PCP to get an Rx for a new triptan. I want to try Maxalt next because it's the last "preferred" medication on my insurance list I haven't tried, so it is cheaper than any of the others.

Does anyone know if there is a reason a doc would prescribe one triptan over another? Or is it just try each one in turn and see what works?

Any imput would be greatly appreciated!

Hi Kat,

I am sure someone who has more knowledge in this will come along shortly. But what I understand is each triptan is formulated differently, and works on recepters in the brain. That may make a difference on which one works for each person. I am not sure how the docs decide though. Hope that helps a little.

Dar

When I was discussing triptans with my neuro, he tried me on one he know was supposed to be faster acting.

Example: I currently take Frova but we were looking for a cheaper one so he tried me on Axert. It is supposed to work in a 1/2 hour as opposed to Frova's 1 to 2 hours and help the same symptoms (nausea,dizziness).

I tried the Axert and it was like eating an M&M. It did nothing for me. So we stuck with Frova.

I think that drs. go by what you've tried and what in line, would be "better" then the last thing you've tried. As I said, for me Axert since it should have worked faster then Frova.

Does that help?

Why not ask for samples of the few you have yet to try? See which works best then see if once you know which one works best for you, you can let your doctor know and he/she can call in the script for you?

Other than the cost issue, which is a biggie, I always suggest people try options that have the fastest delivery mechanisms, such as Imitrex injections or Zomig nasal spray. If they work for you they give you much faster relief than something in pill form (in my experience).

Diana

I'm a big advocate of asking for samples til you know they work. Is your neuro close for that?

Zomig, Axert, Frova.. You're not getting into MOH are you? Three times a week every week......ummmmmmm

quote:

Originally posted by Katinthecorner:
I can't get into my neuro til May 26. In the meantime, I need to try a new Triptan.

I was on Imitrex, but can't do the side effects. I have been using Relpax about 3X a week since September, and I think I have become resistant to it. It doesn't seem to work anymore, and I find myself reaching for the rescue meds more and more often.

So, I am going to go to my PCP to get an Rx for a new triptan. I want to try Maxalt next because it's the last "preferred" medication on my insurance list I haven't tried, so it is cheaper than any of the others.

Does anyone know if there is a reason a doc would prescribe one triptan over another? Or is it just try each one in turn and see what works?

Any imput would be greatly appreciated!

well, the 3x a week is kind of a generalization. But, yeah for the most part it has been the case because I get lots of migrianes.

I am 99.9999% sure it isn't MOH, because I always get all the other migriaine symptoms with them, not just the HA. My migs always come with the light/sound sensitivity, severe nausea, coordination problems, visual aura, etc.

I have read and reread the MOH article a few times just to be sure, and it says that MOH usually doesn't come with migraine symptoms, just the HA (Actually, I don't take anything for an HA anymore just in case it is MOH)

I am definately going to see if my neuro has any samples when I go at the end of may, but I doubt my PCP will. I'll ask. Sometimes he doesn't get samples, just coupons... but I'll see... I have also been looking online for coupons, Zomig has a good one that I'm going to see if DBF will print up for me....

Besides, at this point I'm pretty used to shelling out cash for medicines that don't work for me!

Kat you might be surprised - your PCP might have lots of samples - the drug reps walk in & hand them out. I got two pills when I asked for samples at the neuro, 20 from my PCP!

Good luck & let us know how it goes.

- megs

Good info about the different receptors for triptans. I always thought I was 'allergic' to ALL the triptans because I had reacted badly to several of them. However, last fall when I had a super-duper doozy of a Migraine, in desperation I took a sample of zomig I still had hanging around. None of my rescue meds had fazed this nasty thing. So, with great trepidation, I took the zomig and lo and behold, it worked. Eureka! I was stunned and amazed. The relpax, imitrex, and maxalt had made me feel worse than the Migraine had. This one actually helped. (Oh yeah, some migranal had also made me feel worse.) All of those things gave me nausea which is usually NOT a symptom for me. I am NOT willing to have nausea instead of pain--I HATE NAUSEA--and that is SO not a symptom I am willing to trade for the pain: Ick, Bleck, and Yuck.

So, yeah, I was ultra glad to find that there's a medicine I can take when an ultra nasty hits that once in a blue moon I need it. Now, in the usual course of things, I can take tramadol and that eases the pain enough that nothing else is needed; not even the triptan. I don't know if that's what is recommended or not. I will ask my neuro if I should be trying harder to stop the Migraine or not. I am really unsure if it's that important. My Migraines are usually on the I'm-still-able-to-function-while-I'm-having-them level so it's okay for me. It's only afterwards that I feel wiped out like I have a hangover or something like that. It's kind of weird.

My son who has epilepsy says the way I describe it sounds just like his post-ictal or 'post-seizure' state. (Only his seizures have been far better controlled than my Migraines have been.)

Thanks for putting this info out here.
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Just a tidbit to keep in mind is that you can have MOH and migraine at the same time, overlapping each other. So, just because you have aura and all that jazz, it doesn't neccesarily mean that you have only one kind of head pain.

My thoughts? If it comes to the point that you're reading the MOH article more than once, then it bears checking out with your doctor. It's better to be safe than sorry and err on the side of caution with MOH.

quote:

Originally posted by Katinthecorner:

I am 99.9999% sure it isn't MOH, because I always get all the other migriaine symptoms with them, not just the HA. My migs always come with the light/sound sensitivity, severe nausea, coordination problems, visual aura, etc.

I have read and reread the MOH article a few times just to be sure, and it says that MOH usually doesn't come with migraine symptoms, just the HA (Actually, I don't take anything for an HA anymore just in case it is MOH)

Well, I reread the article a few times because I am a little paranoid about the idea of putting myself in more pain.

I am going to discuss w/ my neurologist.

Thanks for all your help on this guys!

I understand that. Having been through rebound at a time when I was also having severe muscle spasms in my shoulders and constant migraine activity, I've become extra cautious and diligent about making sure I never go back there.

quote:

Originally posted by Katinthecorner:
Well, I reread the article a few times because I am a little paranoid about the idea of putting myself in more pain.

I am going to discuss w/ my neurologist.

Thanks for all your help on this guys!

That MOH thing? I'm pretty dang sure it defined me with ibuprofen for literally years. Have I said that I had no idea it wasn't normal to take it every single day for years and year? Yeah. I had never even heard of over using something I thought was innocuous like good ol' ibuprofen. My neuro DID say that if I had to overuse something, at least it was that and NOT tylenol (acetaminophen) or aspirin. However, he frowns BIG time on me using ANY of the OTC products for ANY kind of headache.

He tells me to always suspect any head pain of being a precursor for a Migraine. He knows me. He said, "If it starts out on the right side and you know, suspect it of being a Migraine and try to abort it with what I've prescribed for you." Yeah, yeah--I know. I have always been reluctant to 'admit' to having these stupid Migraines. However he wants me to treat my 'holy brain'....
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This is probably a repetition of what's been said already, but in my experience (back when I was allowed to take triptans), I was also a fan of the "get samples and try them out" plan.

It was amazing to me how differently I reacted to each triptan, and honestly, I think that besides the medical research about the speed of absorption and peak concentrations, nobody can really make very good predictions about what will work for you.

Thank goodness we have more than Imitrex these days. That didn't do a thing for me, but I eventually hit on Amerge as my magic pill. After trying perhaps five or six of the triptans. But who knows? You'll just have to keep trying.

I also wanted to echo the speed of mechanism thing - as in, a preloaded shot will always work faster than a pill. However, since some of the meds only come in pills, you may not have a choice. You'll find something. It might even be a combination thing (not two triptans!). Personally, my magic combo was two Aleve and an Amerge. I don't know why they worked so well together, but they did. My husband does an Amerge and a Vistoril at the same time, and gets a bigger bang out of it than the Amerge alone. Just a thought - maybe once you find the best triptan, you can ask your doctor if you're allowed to take anything with it.

I say the above because when you're trying to avoid rebound, you're generally trying to minimized the DAYS you're using abortives, not the number of pills necessarily. I've generally been told that if I have to resort to abortives, I should keep working at the headache with whatever I am allowed to use (at the prescribed intervals) till I really feel as if I have it under the best control I can. So I'm no longer shy about using stuff in combination as long as I've been told it's OK.

I hope this helps. I just want to encourage you to ask for samples! And I think it's essential to keep a detailed log of when you take your meds and the side effects/good effects of any. It's surprising how easy it is to forget details three days afterwards.

Good luck to you.

Lynne