Migraine

I know, sounds silly - you take it at the beginning of the migraine. Problem is, I don't have specific migraines. I get "bad headaches" that wax and wane in intensity and usually last about 3 days. Back in Oct I saw my doc b/c they were up to 7-8 on a scale of 10 and we increased my topomax and he gave me a variety of triptan samples (I only had fioricet before) and he told me they sounded like cluster HA. (But I don't have that searing eye pain like I've read about - much more generalized and actually, now I'm thinking they might be more like cervical headaches with some weather related and hormonal thrown in for fun - hehe, just like the tea cups after a huge meal with botulism!)

Since then, they have been better, more on a scale of 2-3 in general, with some 4-5 thrown in. BUT now it seems the nausea factor has tripled in the last couple months for some reason. So when I get a headache, the nausea kicks in and stays for 3-4 days. I did call and get some phenergan. (Used to use ginger during the day and dramamine at night).

So my question is, if the nausea comes first, then a mild headache for a day then say I'm at work and it cranks up and becomes unbearable and fioricet is not working, will the triptan be any use? I don't want to "waste" any of my 9 triptans if it just turns out to be a "3-4" headache.

I ask b/c Tues I was fine, very mild HA during day, no big deal, didn't even take anything. Then nausea started around 11 and by 11:45 I felt awful, I was in bed already and got up and took a phenergan and went to sleep. Woke up feeling better w/o a HA even. But by about 11am a moderate HA (3-4) started w/ nausea and by 2pm I took "work" meds and no one knew any different. (I am pretty tough when it comes to pain unless I am puking). By 3pm I called my doc and asked them to call in a real RX for a triptan since I only had one sample left and my headache wasn't abating. At 4pm I took another fioricet and chanced the phenergan, figuring by now I'd had enough caffeine in 2 fioricet.
But I took the Imitrex when I got home, ate dinner and went to bed. My headache is still around this morning, albeit better after a restless nights sleep (more advil and phenergan during the night since I didn't go by the pharmacy).

I hope this makes sense. I am still learning! I have learned that the phenergan can chase the headache, which I think helped stop the start of this headache. But then a big weather change was coming (the one that spawned the tornadoes, then it headed north of us so we missed the damage but got the wind and temp drop -just enough to mess up my brain. Or who knows, could have been anything - my back/neck have been killing me since Monday. I'm going mattress hunting today!

Thanks bunches!
Diane

I get what you are saying.

The best time to take a triptan is at the first onset of symptoms. If you know your aura - you mentioned nausea. As soon as your symptoms for telling you are getting a migraine pop up - thats when you would take it.

I hear what you mean by not wanting to waste them - I feel the same way because they are exspensive, but if you don't take them, you feel icky - so I guess its not really worth it not to.

My sister has migraines that come on more like yours. She has worked out with the help of her doctor the order and timing of the medications she takes. Unfortunatley I cannot remember what she takes, other than it's not Imitrex. There are 2 or 3 drugs. Like you, it often starts with nausea and if she can nip that in the bud, she can stop the whole thing from happening for days on end.

Again, it's a very specific order and if the first doesn't work in a certain amount of time, she is to take the next medication. As always, the sooner a migraine attack is treated, ususally the better response to treatment I get.

Good luck.

Cindy

I don't know how much help I'll be, other than to say that I'm still trying to figure out the same thing.

I used to have chronic daily headache with weekly severe migraines. Since November I've had moderate daily migraines, with weekly severe migraines (sometimes twice a week). It's only recently I've started using triptans. I asked my HA specialist about how I should treat, since I have migraines every single day. She suggested I treat when the pain/symptoms are bad enough that I wouldn't go to work. It's still a lot of trial and error for me - some weeks I take 3 days' worth of triptans, some weeks I forget and don't take any. I hear you on the nausea, too - mine is often worse than the migraine pain. Who knew nausea could be so debilitating?

My best suggestion to you is to ask your doctor. Explain your symptoms and ask how you should treat. Triptans can be really tricky - even when you find one that works for you, it doesn't always work every time.

I think - or at least I hope - that we play the "do I or don't I" game more when we are still figuring out our preventive programs. Which is also why we are still migraining so often. Because we are still trying to find what works for us.

Once we have that under control, the migraines will be less frequent so then it will be a lot clearer when to take a triptan, because we will have migraines less often.

At least this is what I'm hoping!!!!!

I'm hoping for a "Teri ticker" one of these days!!!! It would be sheer joy to go a month or 2 without a migraine - but even so - she had to work very hard with her team and for a long time to get to that point - but it goes to show you that a good preventive regimin will work, once you find one that is right for you. All we can do is keep trying until we find it.

My BCBS insurance will cover multiple triptans. For example, for several years, they paid for a package each of Imitrex NS, Relpax, and Frova. You can't mix triptans and have to wait 24 hours between them, but it was wonderful to have the extra doses.

My new specialist has switched me to exclusively Imitrex. BCBS pays for a package of each: 9 Imitrex tablets, 6 Imitrex NS (nasal spray -- I love it!) and 2 Imitrex injections. I pay 3 $25 co-pays, but it beats the fool out of paying out-of-pocket for extra doses.

Like you, I have almost-daily head pain. It's hard to tell when the daily pain is going to morph into a migraine attack. With my worst ones, I'm awakened at 5am with a #8, but usually a migraine attack isn't that sudden.

To avoid rebound -- medication overuse headaches -- I didn't treat anything below a 5. I figured that was just "background noise."

I started seeing a specialist in December. She's given me an entirely new strategy to treat my head pain. When the pain is between 1 and 3, even if I wake up with it, I'm to take a Skelaxin, a muscle relaxer. At 4 to 6, I'm to hit it with a whopping dose of prescription naproxen and a dose of Imitrex. I can repeat the Imitrex in an hour, and the naproxen and Skelaxin 6 to 8 hours later, up to 3 times a day. If that doesn't work, I have hydrocodone as a rescue.

I can take the Skelaxin every day, but the naproxen and Imitrex are limited to 3 days a week. Treating early with the Skelaxin has kept the intensity down. So has taking the naproxen/Imitrex cocktail at #4.

I'm much luckier than you are. I only get nauseated once or twice a year. I've actually thrown up only 4 or 5 times. I have Phenergan (promethazine) for that, and it helps. I feel so sorry for y'all that have to deal with the nausea often.

Triptans help when I wake up with a full-blown monster. It takes longer, and it takes 2 doses, but I usually feel much better a couple of hours after the second dose. I often feel wiped out, but virtually pain-free. I understand not wanting to "waste" a dose, but the Imitrex is there to treat your pain.

Ask your doctor about multiple triptans or different forms of Imitrex.

Weather is a big trigger for me, too. The worst storms were a couple of hours north of us. Oxford, the home of Ole Miss (Eli's alma mater), got hit pretty hard. My brother is a senior manager at the Miss. Emergency Management Agency. He'll probably be in Oxford for the next month or so. At least when he's not on the Coast supervising temporary housing to get people out of FEMA trailers.

I'm just like Gretchen, my specialist has me treating depending on the "type" of migraine I have; starting with my Zanaflex, then Naprelan and Reglan. This is a completely new treatment plan for me and so far so good.

I use my Zomig NS when I wake up with a migraine and Maxalt for day time onsets.

But, again, it is my treatment plan coordinated with my migraine specialist and everyone is different.

If you take the triptan when you are having nausea, will you be able to keep it down? If you have concerns about that, you may want to ask your doctor about the triptan nasal sprays. Imitrex and Zomig come that way. If your doctor approves, it can help make sure the medication gets into your system even if you are throwing up.