Migraine management and Triptans

Brain and nerves
1

Hi there

i have been taking different triptans for over 20 years. Right now I have Almogran (Alomtriptan) but it's become less effective so for e.g I have just had a migraine for three days and had to take 4 Almogran over that period.

they used to take away the pain and sickness quite quickly and sometimes it would not return or at least the pain would be kept in check for approx 12 hours before i had to take another one and so on. Now the tablet lasts only up to 6-8 hours and sometimes don't work to ease the pain at all unless I take something like ibruprofen on top.

Over the years I have had imigran and maxalt melt, the imigran side effects were too severe and I had to stop the maxalt when I started taking propranolol.

Anyone out there that can recommend another triptan that works for them? I am going to GP tomorrow morning so any recommendations would be helpful

many thanks

 

2

Good Morning Tezes

i take Rizatriptan ODT on the onset of a headache or even if I start with sinus like issues or if my eyes start to have pressure....these are all triggers for me to let me know a migraine is coming on and to take the Rizatriptan....I also need to lay down and close my eyes for a bit if I am able.  I use to use the Maxalt a certain brand but I believe they discontinued it so I have been on the Rizatriptan and if the migraine is bad I take a nausea medication as well and try to sleep.  How often are your migraines?

keep us posted.

have a good day

Wendy.

3

Hi Wendy, thanks for your reply,

whats the ODT is that the nasal spray?

i get an episode of migraine on average once a month (used to be period related but I'm post menopausal now). Sometimes I have two a month but as they can and usually last up to three days each it's dibilitating.

I get the usual side, effects from the  Almotriptan, aching jaw, tingling, tiredness etc and if I can take one and lay down somewhere quite it does help but I work so just have to take them wherever I am and carry on.

prob is they don't take it away altogether it comes back when the tablet wears off worse that ever, the nausea is awful too.

my triggers are lack of sleep and stress, I don't drink alcohol as that  brings it on too.

i think it's time to try a different triptan but don't know which one to ask for I was thinking the nasal spray might work better/quicker ??

4

Hi

I believe the ODT just means it melts on the tongue.  It seems to work quicker than a tablet......similar to the Maxalt.  I am post menapausal as well and varies with the migraines between once or twice a month as well.  When I got really bad I had to go into the ER as I became so sick.  I now take the nausea medication with the Rizatriptan when I know it's going to be a bad one.....it helps.

5

Hi, I suffer from Chronic migraines...

I take Naratriptan, for me I think as soon as they wear off, the pain is back

I also tried Frivotriptan last's longer in our system recomeneded by Migraine clinic in London.

That worked I was taking less .. but the the withdrawel from Narartriptan was too difficult to manage and my Dr said the Frivotriptan is more expensive even though I pay for my medicine they went back to Narartriptan

Hope this help#s

6

Hi my name is Jennifer, I have had Chronic Migraine for over 5 years. The two triptans that have worked the best is Relpax and Emerge. I'm sure you know to drink plenty of liquids and take the meds at first sign of migraine. Good luck!

7

Hi, thanks for that it's interesting that Frivotriptan is longer lasting. Strange that your GP said its more expensive as according to the BNF it's a lots cheaper than Naratriptan.

i think I will ask For a prescription Frivotriptan tomorrow and try that one x

8

have just looked up Rizatriptan, it is the same drug, maxalt is the brand name. I can't take it because it's contraindicated with propranolol, never mind.

9

I take Sumatriptan, which I think is the same as Imigran, without any side effects but I have been told I can only take 12 a month due to the risk of stroke. Are you on any preventative meds? If not, that might be something to look into.

10

Oh...I'm so sorry I didn't know.

Jennifer mentioned Relpax....I heard that one is good too.  Maybe it's a good idea to switch every now and then so our bodies don't get use to the same medication and stops working....just a thought.

please let us know what your doctor recommends and what you ended up with.  Such a blessing to have some of these meds......migraines are NOT fun!

Best,

Wendy

11

Hi kath

i tried imigran years ago but the side effects I got were quite severe and frightened me.

i take propranolol which is used as a preventative, thanks

12

Oh.. yes that is odd, that is what he said to me, I will spek to him have appt 3.5

let me know how you get on Frivotriptan

I think it's good to keep switching

 

13

Well I didn't get them GP said she couldn't prescribe them ?

Then told me that Zolmitriptan is commonly being recommended by neurologist so advised I try that one first.

odd well I'll try them but if they are no better I will go back and ask for the Frovatriptan again, I'll let you know, thanks

14

Oh no ... these Dr's

At least you can say you tried and you want to try Frivotriptan

when I see my Dr next I'm pushing ffor Frivo as well

let us know how you get on...

15

Hi Tezes,

I am sorry to hear that you are struggling right now. It can be truly debilitating and sometimes others that haven't experienced migraines just aren't capable of understanding, ex work, because they can take a tylenol and the headache ends. Sometimes my coworkers are in search of tylenol or advil for a headache, and I've been asked because they are aware I have migraines. I have to kindly explain that I've been told I CANNOT use over the counter meds for headache (due to risk of rebounds) so I only have prescriptions, most could likely knock out a horse (lol).

I can agree that when taking triptans it seems that a resistance is developed, or it is in my case. I think I will begin alternating my most effective two so that resistance may not be such an issue. Worth a try.

I have tried quite a few triptans in several forms over the years. I have suffered with chronic migraine for about 7 years and also have been diagnoses with idiopathic intracranial hypertension, which seems to increase my number of headache days per month.

I started on Maxalt/Rizatriptan first and it was effective for the first few years. I then was changed to the oral disentegrating tablet which you put on/under your tongue and it is supposed to get into your system more quickly. It caused some odd facial numbness and I suffered aphsia, or the inability to form words or sentences. My husband was really freaked out thinking I was having a stroke, and so was I equally frightened. It was the first time I had experienced that symptom, it has happened since so probably a coincidence, but I wouldn't take it again.

I tried Zomig/Zolmatriptan oral tablet and nasal spray with no success. Again, the nasal spray is supposed to be more quickly absorbed.

Imitrex/Sumatriptan tablets were partly effective temporarily but the headache returned. For faster action tried the injectable form. I do this myself and while I have to go to bed it will do the trick most of the time, however I feel hungover the next day. If it did not competely resolve I would go for an injection of Toradol, which worked for me for several more years until recently. The combination still worked, but I had to do two rounds of the Toradol injections and oral steroids to break the 13 day pain cycle. This might have been my sign that it was time to change it up again. I developed colitis, so my neuro doesn't want me to take that any longer until I have myself checked out by a gastroenterologist... colonoscopy yay .... sad

Currently I am taking Migranal/Dihydroergotamine (DHE) Nasal Spray my first few doses were highly effective used along with Reglan/Metoclopramide for nausea and to knock me out. I am currently working with a headache clinic alongside my regular neuro, the clinic wants me to come off of some medications, Effexor/Venlafaxine, and Propranolol. The side effects of tapering all of these medications are nasty but one is increased migraines. This is why I believe the last dose of the DHE nasal spray did not work, as the migraine endures for 9 days while I worked through my other abbortive therapies. My neuro called ahead to the hospital emergency department to ensure they had DHE on hand for an infusion among other things she wanted me to receive. I left the hospital almost pain free.

As an aside when I received an injection of Toradol I would also receive an injection of magnesium and an injection of Reglan. Somewhere in there I would take a course of Methylprednisolone steroids to try to break the pain cycle, I am not quite sure which was first off hand, this was during periods of migraine that was lasting longer than 24-72 hours. The hospital also gave me the magnesium, reglan, solumedrol, benedryl and fluids alomg with the DHE infusion. It took a really long time to get all of that in me, they said they had to wait certain amounts of time, and you may require two IV lines. They decided not to do a second one on me thankfully, but it may have slowed down my treatment time a bit due to having to wait certain times between pushing the next med.

I have a friend at work who takes Relpax with success. I personally have not tried it (yet lol). There are more out there to try as well. I realized that I have tried a lot of all sorts of migraine preventatives and abortive therapies but not ALL options when asked to fill out a questionaire with a list of about every medicine one could think of for migraine.

If you have any questions let me know. I hope that you find something that works for you. Don't be discouraged from other people's lack of results from medications, what works for me may not work for you. If your doctor isn't willing to help you, or only pushes a one size fits all treatment it is time to move on.

Jenn

16

Gosh you are going through the mill as we say 

i too too have tried lots of therapies, acupuncture, massage, cranial osteopathy etc and many types of triptans some with horrible side effects and one combo I collapsed with !

just now I have been given zomig, to replace Almogran, as the GP said they couldn't prescribe frovatriptan but I do know frovatriptan has a 26 hour half life as apposed to 3-4 hours of most triptans. In theory that should mean you end up taking less over a migraine episode.

i also have two forms of dystonia and take clonazepam and propranolol for that, I will have to take these for life or as long as they work but then I'll have to go on alternatives. taking the propranolol has not prevented or reduced the migraine attacks unfortunately.

i wish I didn't get them at all as I am post menopausal and was always told I wouldn't get them anymore but that's not happened (-although  a friend of mine is now migraine free having gone thru the menopause)

i do do worry about strokes and heart problems that may occur from taking triptans but nothing else relieves them 

what at can we do ?? It's depressing and yes people often think it's 'just' a bad headache, they have no idea

 

17

I would give a word of warning about taking any Triptans for more than 3 days as it can cause addiction. I speak from experience as I am just coming out of rebounds due to overuse of Sumatriptan. (I've used Rizatriptan also and this didn't work for me but can still cause addiction) the fact that you are finding them less effective is exactly what happened to me and so I used more, the GPs upped my prescription to 24 a month and I would easily get through the whole pack in 30-35 days.

Coming off them is even worse as you still have the pain and no over the counter meds helped me, in fact Asprin in particular made it even worse. I am coming out of it now and will probably never take another Triptan as a result. I am looking into alternative methods, including Mindfulness for Health which you can buy a book/cd of. Might be worth a try.

I'm surprised that Propranalol is not helping as a prophylactic, it could be the dosage? It stopped working for me and I gained weight so I came off it. When I went to a neurologist, who suggested I go back on it short-term to help with the withdrawal, she told me the dosage can be altered to increase it's strength but I totally understand this might not be possible if you are taking it for other conditions...

I have tried Amitriptyline and Topiramate, neither of which helped me and both caused awful side effects. I wish I had some other advice for you. Migraines are the worse!

18

Thanks for your info, I wasn't aware that triptans can be addictive, I know the clonazepam is but then I will have to take that forever so it's not an issue.

i have put on weight since I started the meds, I take the propranolol 80mgs slow release for tremor and at first I did have fewer, less intense migraines but two years in I think my body has got used to it. The combo of clonazepam and propranolol still work to manage my dystonia symptoms though. 

I tapered off  sertraline recently after being on that for two years, maybe that's related to the increase in migraine and my system will settle down over time.

ive tried all the alternative possible to reduce migraine, regular massages helped a little but really nothing else has had any lasting effect unfortunately.

im hoping when I've retired from work that will help as I always have less migraine when I've been off work for any period of time,

good luck with your quest to relieve yours, they are very debilitating that's for sure X 

19

Hello Tezes, I just want to clarify something..I have had chronic migraine for over five years.  Triptans are the only med that helps me, and I have tried everything under the sun.  Triptans are not addictive, however, you can become dependant on them for pain relief.  I get 27 Naratriptans a month and sometimes have to take them daily when I am having a bad spell.  But addictive is not the right term, this was told to me by my Neurologist. The key is to identify your triggers, try to find a preventative that works, stay hydrated, get plenty of sleep.  Also try and keep your stress level down.  But like me if OTC meds work but for that really bad headache or migraine triptans have saved my life.  Good luck

20

Hi Jennifer, that is interesting, I keep being told my migraines are down to medication over use ...

I probably have 1 Naratriptan a day, as soon as I get the symptons I take half in the hope that that will be enough..

if the pain comes back I take the other half

If it is medication over use, last year I went 3 week's without a Triptan, so what triggered the pain for me to be on them every day since

latest specialist said I have Psychological problems with the Triptans , gave me striod injection to help me come off the Triptans nut no luck

I'm trying to stay positive