Migraine

I would love to hear any feedback any of you might be able/willing to offer about Triptans. I have tried all of the following with basically zero results:

Axert
Frova
Maxalt
Imitrex (p.o. and IM)
Zomig (p.o. and nasal spray)

I had the best luck with the Zomig nasal spray, but even that only worked about 1 in 4 times. I've also tried:

Midrin
Ultram
Toradol (ha!)

Anyone else had similar problems finding a triptan that worked? I clearly have migraines and not tension HA (unilateral, throbbing, variable onset time, nausea common, phonophobia but no photophobia, and no aura.

Hi, Todd (I hope that's right!)

The search for an effective abortive can be horrid!

Since each of the triptans bind to different combinations of serotonin receptors, it's well worth trying them all to see what works best for you. Keep in mind though, that triptans just don't work for some people. The last research I read indicated that triptans are effective for 80 - 85% of Migraineurs.

Imitrex was my triptan of choice until I had a heart attack (NOT related to the Imitrex). After that, I switched to Axert since the newer triptans are supposed to be "gentler" and have a somewhat lower potential side effects profile.

On the Imitrex -- did you mean to say IM. Imitrex injectable is meant for subcutaneous use only. It says as much right at the very top of the prescribing info. If you did indeed inject it IM, I wonder if it would do better if you injected it subcutaneously?

There's a new drug coming out next month, Treximet. It was called Trexima in trials, and you may have read out it. It combines sumatriptan and naproxen. We'll have an article about it up tomorrow.

If you end up not finding a triptan, have you considered DHE injections or Migranal Nasal Spray?

Hope this helps!

Hi Jay,

I've only tried Imitrex and Frova so far, but what I have discovered with both of them is that they do not work at all unless I take them with ibuprofen. This is per my doctor's suggestion. He has me take them with 400 mg of ibuprofen - I also have the option of Aleve. As Teri mentioned above, Treximet will be coming out next month, which has actually proven in clinical trials to be more effective than combining Imitrex and naproxen in separate tablets.

I will also be trying Relpax soon - I have a script waiting for me to pick up. I notice you haven't tried that one yet, nor have you tried Amerge. Since all seven triptans work differently, you really do need to give all seven a try.

Hope this helps - good luck to you. Finding effective treatments really can be awful. Good luck to you.

aww I was going to recommend you Relpax and then MJ did it in the post before me.

Well Relpax really came through for me, it was the first one I had that really worked.. and what a relieve I tell you. i did "wear it out" after a while though, now I get mainly side effects and little effect when I take it. Not meaning that will happen to you. even if it does, if it helps you for a year or two while you find something else that is a more long term solution, that will make it worth a try, no?

I REALLY hope you find something that works. It really is a fight to find the right one

To tell you the truth, I didn't know imitrex was sub-Q; I tried the inject-a-pen gizmo couple of times and I guess I thought it was IM cuz that little *bleep* hurt! I went through just about my whole profanity vocabulary, plus some in Spanish!

I haven't tried Relpax yet, I couldn't remember if I have tried Amerge, so I didn't put it on the list. My neuro mentioned Relpax at my last visit, so I'll ask her about it when I go back this week. Of course, there is always the not-so-small matter of insurance; I'll have to check to see if it's covered. Luckily, my wife has a great job with pretty good insurance, but as I'm sure many of you know, that doesn't mean a given med will be covered.

My neurologist called out some of the Zomig nasal spray for me a couple of weeks ago - it was $166.00 after insurance! For six of them! I am actually in my first year of medical school and - believe it or not - we don't get any health coverage through the school! I'm paying them 25 grand a year to attend a medical school at the largest medical center in the state and we get zero health benefits. Unbelievable.

There is always student health, which is free, but if you have labs, x-rays, or need a specialist, you are on your own. No wonder we have a health-care crisis in this country - medical schools don't even take care of their students! At least, mine doesn't. You can bet the Treximet will cost a pretty penny, too. Sorry for the rant.

Kirsti, I'm curious to know what kinds of side effx you had?

Check out this web site for assistance with meds not covered by insurance:

www.pparx.org

Some programs may even help with copays, although most are for people who don't have prescription insurance at all.

Also, my neurologist tells me to check the web sites for the specific meds on a regular basis. Coupons for money off copays (or full pay if you don't have prescription insurance) may show up on such web sites frequently. You just have to keep looking.

Good luck. I know this is a difficult issue.

Well first let me specify these are just my experiences and might not be strictly from the Relpax.. However lately every time I take them I get this:

Cold Sweats
Extreme Nausea
Dizziness
General feelings of illness
Sleepiness that I cannot resist, I fall asleep and sleep for hours

I still take it sometimes when I struggle to sleep from a migraine, or wake up with one, as the sleep I get from it is very comfortable. I talked it over with my doctor and she agreed it was time to switch so gave me maxalt tablets.. the ones that melt on your tongue. But I see you tried them with no luck. However I can still take Relpax when I am able to sleep it off, which is better for me.. but Maxalt works when I don't have the option of laying down. However sometimes the migraine simply leaves me no choice

I keep forgetting you need insurance in America.. can't imagine having to put insurance into consideration. I had enough trouble finding a good medicine without that being an issue. Here (Norway) I pay 1/3 of the cost of the medicine (if it fulfills certain criteria which migraine medication does) which still leaves me a pretty stiff price to pay.. but the 2/3s are covered no matter what. In England (where I study) I pay £6.50 regardless, for any prescription. Even though I am not a citizen I am covered as a student. I agree it is shocking a medical facility doesn't cover you... and a little weird. Here I am covered under the NHS which the government pays, but the university has it's own surgery. When I hurt my knee they did bloodworks, doctor appointments, nurse check ups and countless physiotherapists appointments (ultrasound treatments) for free.. which I found just amazing. But me and my knee are very grateful. And look at me rambling on! I hope you find my copious amount of words useful

Thanks for the link, nut.

Yes, anyone who doesn't think that there is a health care - or, more accurately, a health-coverage- crisis in the United States is either 1) an insurance or pharma company executive, 2) rich, or 3) a Republican.

I am part of a student-run free clinic that serves the uninsured, underinsured, undocumented immigrants, etc., and every night we hold clinic we turn away more people than we end up seeing. Before I came to medical school I worked in another low-income clinic and every day was a struggle to get people the care and the medications they needed. I have insurance, and I'm still into several doctor's offices and hospitals for bills for ER visits, CT scans, and so on. It's obscene.

That's a bit off-topic, but thanks for the info/link. I'll check it out. Hopefully I'll get some more responses regarding the triptans...

Well, looks like I have to give you the same reminder we give everyone -- What were you thinking using the Imitrex without fully reading the patient info and/or the prescribing info? Had you read it, you would have seen "FOR SUBCUTANEOUS USE ONLY. The all caps is their emphasis. Unless you were careful to inject into soft tissue only and NOT muscle, you may have hit muscle. On the other hand, IMO, it's not the needle that hurts; it's the entire dose of Imitrex being injected so quickly. When I used it, I asked my doctor to prescribe the individual dose vials and used an insulin syringe to inject it very slowly. Didn't hurt that way.

Our son is a doctor. There was group insurance available, but there were still premiums to be paid. It wassn't covered in his med school fees. I know he'd agree how tough it is. His wife got pregnant during med school, and has been a stay-at-home mom since she found out she was pregnant. We took their toddler to his med school graduation with the rest of the family. Do you know what your specialty and type of practice is going to be yet? If you go into private practice, you're still going to be paying for your own insurance.

Hang in there. In the end, what you do to get through med school will be worth it.

quote:

Originally posted by JayDocTC:
To tell you the truth, I didn't know imitrex was sub-Q; I tried the inject-a-pen gizmo couple of times and I guess I thought it was IM cuz that little *bleep* hurt! I went through just about my whole profanity vocabulary, plus some in Spanish!

I haven't tried Relpax yet, I couldn't remember if I have tried Amerge, so I didn't put it on the list. My neuro mentioned Relpax at my last visit, so I'll ask her about it when I go back this week. Of course, there is always the not-so-small matter of insurance; I'll have to check to see if it's covered. Luckily, my wife has a great job with pretty good insurance, but as I'm sure many of you know, that doesn't mean a given med will be covered.

My neurologist called out some of the Zomig nasal spray for me a couple of weeks ago - it was $166.00 after insurance! For six of them! I am actually in my first year of medical school and - believe it or not - we don't get any health coverage through the school! I'm paying them 25 grand a year to attend a medical school at the largest medical center in the state and we get zero health benefits. Unbelievable.

There is always student health, which is free, but if you have labs, x-rays, or need a specialist, you are on your own. No wonder we have a health-care crisis in this country - medical schools don't even take care of their students! At least, mine doesn't. You can bet the Treximet will cost a pretty penny, too. Sorry for the rant.

Kirsti, I'm curious to know what kinds of side effx you had?

Please, please, please leave party affiliations out of this. We can certainly debate the ISSUES all anyone wants, but bringing party affiliations into is is a sure way to start a debate that will get out of control.

Generalizing about Republicans is inaccurate, thank you. I'm a registered Republican, yet I -- as much as anyone -- realize there is a health care problem in this country and am very active in working with members of the House and Senate to initiate change.

quote:

Originally posted by JayDocTC:
Thanks for the link, nut.

Yes, anyone who doesn't think that there is a health care - or, more accurately, a health-coverage- crisis in the United States is either 1) an insurance or pharma company executive, 2) rich, or 3) a Republican.

I am part of a student-run free clinic that serves the uninsured, underinsured, undocumented immigrants, etc., and every night we hold clinic we turn away more people than we end up seeing. Before I came to medical school I worked in another low-income clinic and every day was a struggle to get people the care and the medications they needed. I have insurance, and I'm still into several doctor's offices and hospitals for bills for ER visits, CT scans, and so on. It's obscene.

That's a bit off-topic, but thanks for the info/link. I'll check it out. Hopefully I'll get some more responses regarding the triptans...

Wow. Sorry.

Hey there, JayDoc. I hope you realize I wasn't picking on yuu, offended, or anything like that. It's just that every time someone mentions a particular political party in a way that's not 100% positive, things tend to get out of control. OK?

quote:

Originally posted by JayDocTC:
Wow. Sorry.

You're right. I'm sorry. I have a tendency to try to be funny all the time, which gets me in trouble sometimes. I also tend to forget that not everyone is a raging Democrat like me. My apologies. (

Really, NO need to apologize. OK?

Humor is one of my favorite ways to deal with many things. But here, where we can't see faces or hear tone of voice, it can be a problem at times.

As for Democrat or Republican, I registered to vote affliated with the party that seemed closest to my views at the time. Now, keep in mind that that was many years ago. (I'm not telling how many! :-P

West Virginia recently changed the rule. I'm going to be headed for the court house to change my registration to unaffiliated. Once I do that, during a primary, I can choose which ballot I want.

I'm vote based on the person, not the party. Sometimes, I even get confused about which candidate is affiliated with which party, but of course not in a Presidential election.

To me, since we need the party system for our elections, the ideal situation would be to be able to remove all traces of party affiliation from the minds of those elected -- to make them work for THE PEOPLE, like they're supposed to.

Anyway, I think you now understand what I meant originally. Thanks so much!

OOPS! Guess we should really get back to discussing triptans.

quote:

Originally posted by JayDocTC:
You're right. I'm sorry. I have a tendency to try to be funny all the time, which gets me in trouble sometimes. I also tend to forget that not everyone is a raging Democrat like me. My apologies. (

My triptan story goes like this.....

Amerge, Frova, Relpax, Imitrex no go - so why bother to try others???

Was I wrong! When I finally tried Axert last year I found my "magic" pill.

Here's my point. You have two left Amerge and Relpax. Give them a go. Ask you doctor for a sample first to see if they work.