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Posts Tagged ‘Migraine abortive medication’

Medication Basics

November 3rd, 2009

I’ve been getting a lot of medication questions from readers lately. Of course what we are all looking for is something that will help us feel better, without side effects that mess up our lives! I am not a medication expert. I’m not a doctor, and while I am interested in science I haven’t taken a science class since college, many years ago! What I do is help people with Migraine disease manage their lives, inside of the resources that are available, part cheerleader (you Can do it!), part manager (here’s how – here’s when – let’s plan it), part personal trainer (yes, just stretch a little further, let’s keep it going), part teacher (here’s some knowledge and information that will help).

In my view, medication is a partial solution. We have a brain chemistry that causes us to have Migraine attacks – that chemistry can be partially addressed with medication. We can also have a large impact on our nervous systems through regulating our lives – getting regular sleep and relaxation, eating properly and regularly. Learning our triggers and getting attuned to our energy levels, we can reduce our Migraines. With a combination of medication and this kind of self-knowledge, we can reduce Migraines significantly.

That said, here is some basic information about types medication for Migraine.

• Preventive Medications: These are medications that lower the responsiveness or triggerability of our nervous systems, reducing the number of Migraines we get. There are over a hundred different medications that are used as preventives. None of them were actually developed for Migraine prevention, but started as off-label uses of drugs for other conditions. They come from many families of drugs, and there are nutritional supplements used as well. The most commonly used ones fall into three categories:

1. anticonvulsants, the same kind of medications that are prescribed to treat epilepsy, such as Topamax or Depakote;
2. antidepressants, several different classes of these drugs can help prevent Migraines, generally prescribed at a much lower dose than used to treat depression; and
3. antihypertensives, again, several different classes of these drugs are effective for some people.

No preventive medicine will prevent every single Migraine, and different ones work, alone or in     combination, for different people. A very complete list of these medications is available at My Migraine Connection: Migraine Preventive Medications – Too Many Options To Give Up!

• Abortive Medications: These are medications that stop a Migraine in progress. They act directly on the nerves which are firing, causing the Migraine process. They are not pain-killers, but will stop the process that is causing the pain, and when effective they will usually work within a few hours. They include the triptans (the only readily available class of drugs that were developed specifically for Migraine treatment) as well as ergotamines and compound medications like Midrin and Treximet. The compound medications contain a pain-killer as well as an abortive agent, so be cautious when using with other pain-killers so as not to take too much at one time.
• Rescue Medications: Rescue medications are usually pain-killers, anti-nausea medications, or relaxants. They do not stop a Migraine themselves but help to mask the pain and let us relax while the Migraine runs its course. They are to be used when you can’t take abortive medications or when abortives have failed. Rescue medications which are in the opioid and barbiturate families should generally not be used more than 3 times per month, as they carry a risk of causing transformed Migraine – a condition with daily head pain and frequent Migraine attacks.

Over the counter pain medications, even if they have “migraine” in the name, do nothing but cover up the pain for a short time, and are not truly Migraine medications. They may be the only alternative for you at a particular time, if you don’t have prescription medications or you can’t take them. But several cautions:

• Some over the counter medications carry serious risks – acetaminophen (Tylenol) for instance, can cause severe liver damage and even death if taken in excess of the dosing amounts. If you take it and then vomit, you can’t know whether the medication was absorbed before you vomited – it is a severe risk to take more! It is also present in combination in drugs like Midrin (which contains a drug to widen narrowed blood vessels in the brain and a relaxant, as well as acetaminophen), Percocet (which contains a narcotic pain-reliever as well as acetaminophen) and Fioricet (which contains caffeine and a sedative as well as acetaminophen). When taking these combination drugs you must be careful not to take additional acetaminophen.
• Any pain medication taken more than 2-3 days in a week can cause rebound headaches – or Medication Overuse Headache – which can feel as severe as a Migraine. This is also true of taking triptans more than 2-3 days per week.
• It is rare but possible to develop a life-threatening allergy to NSAIDS (aspirin family – aspirin, ibuprofen, naproxen). This happened to me. If you have any signs of an allergic reaction to any medication, stop using it and seek medical help.

If you have 3 or more Migraines per month, Migraine specialists will consider you a candidate for preventive medication. Most Migraine specialists will prescribe a preventive, abortive and rescue medication for you, so that you can prevent as many Migraines as possible and treat the ones that happen anyway. If your doctor has run out of options, or you are working with a doctor who is not a Migraine specialist, you can get great information about treatment options at My Migraine Connection: Preventive, Abortive, and Rescue Medications – What’s the Difference?

– Megan

Magic pill image courtesy of [O*] ‘BharaT.

Tags: Migraine abortive medication, Migraine preventive medication, MIgraine rescue medication
Posted in Medicine | Comments (0)

Pills, Nasal Sprays, Injections, and Now a Patch?

February 27th, 2009

A clinical trial was begun this past fall, of sumatriptan delivered by transdermal patch.  Sumatriptan, the first to be developed of the triptan drugs, is a Migraine abortive, which acts directly on the trigeminal nerve to abort a Migraine attack in progress.  It was available only as the brand-name, Imitrex, until the past couple of months when the pills and the injectable form came off patent and were approved as generics.  Triptans can be taken by about three quarters of Migraineurs and are effective in aborting a Migraine, if taken early enough, roughly three-quarters of the time.

Regarding the patch, I think it’s a good idea. The injections work better than the pills for most people, me included. Bypassing the digestive system seems to limit side-effects, especially nausea, and personally I’d love to have the faster absorption like the injections without the major ouch of giving myself a shot! That said, I imagine the manufacturer is happy to have something they can patent and charge top dollar for, now that the pills and injections are out in generic. Call me cynical… but only partly!

I have to applaud every advance in Migraine treatment, small though it may be. And though you may call me a broken record, I am still your fired up advocate here and want to point out that we have had no new medications developed for Migraine, other than the triptans, in the past 15 years. So a little yay for another way to deliver triptans.

A way bigger yahoo! would be for more effective abortives, that could be taken by people with heart conditions, AND for effective preventives without hideous side effects that are actually developed for Migraine disease, not hand-me-downs from other diseases. Call me crazy? Well, a girl can dream!

– Megan

Patchwork quilt image courtesy of LePetitPoulailler.

Tags: imitrex, Migraine abortive medication, Migraine medication, Migraine preventive medication, sumatriptan, transdermal patch
Posted in Advocacy, Medicine | Comments (0)

Take at first sign of Migraine

March 5th, 2008

If you are among those lucky enough to be able to use drugs in the triptan class, Migraine abortives, you’ve seen this advice “Take at first sign of Migraine.”  Most of us find them quite effective when we follow this advice.  But like many things in real life, following the advice isn’t easy.

Triptans were the first, and are so far the only, class of drugs specifically designed to abort a Migraine attack.  When they were first introduced in the 1990’s, they revolutionized the treatment of Migraines.  Rather than simply treating pain, or reducing the inflamation of blood vessels, they work directly to end the neurological process which is Migraine.

As described by Dr. Gary L’Europa in his excellent article last June in the Providence (RI) Journal, Stop Limiting Migraine Medicine , the migraine process includes these phases:

“Prodrome consists of fatigue, neck pain, hunger, thirst, and other physical symptoms that occur up to 24 hours before the headache.

“Aura occurs up to 60 minutes before the headache and produces a sensation of seeing sparkling lights or feeling numbness or tingling in the face and hand.

“Headache, lasting as long as 72 hours, consists of severe throbbing pain similar to that associated with meningitis. This pain is often associated with nausea, vomiting, light and sound sensitivity.

“Postdrome consists of fatigue, neck pain and lethargy that lasts 24 to 48 hours after the headache.”

So what’s the first sign of Migraine?  Most migraineurs report that triptans are not particularly effective in the prodrome phase; they wait to take them at the first sign of headache.  I can attest to the fact that my triptans are most effective if taken at the very first sign of head pain.  I haven’t tried them in prodrome, since fatigue, neck pain, hunger, thirst (and irritability) can have other causes.  Also because I am afraid to waste one of my precious triptans.  Which brings us to my main point.

Triptans tend to be very expensive.  Imitrex, which I take, retails at around $20 to $30 per pill.  It often takes two doses to end a Migraine attack.  Given the cost of triptans, many insurance companies began in 2007 to set lower limits on the number of doses per month they would cover.  My coverage went from 9 per month to 4.  This was based on some math they had done on what the “average” migraineur needed.  I guess I can take pride in being, once again, “above average!”  I have 4 – 5 migraine attacks per month.  Migraine researchers estimate that 46% of migraineurs have more than 3 attacks per month.  Do they limit the doses of insulin a diabetic can have to the amount an “average” diabetic would need?  (Maybe they do… someone fill me in… either way, it’s a scandal!)  Seems to me the reason our doctors prescribe for us, not our insurance companies, is because they treat the actual patient, not the average patient!

My insurance company politely suggests I look at having another triptan prescribed for me, as Imitrex is one of the most expensive.  I’d be happy to, but becasue of my multiple drug allergies, the neurologist I saw recently wasn’t willing to prescribe a different one at this point.

As Teri Robert pointed out in her article Doctor speaks out about insurance limiting triptan Migraine medications,

“Limiting triptans is beyond absurd. It’s counter productive, inane, and cruel. Many Migraineurs, when faced with a Migraine and no triptans, end up in the emergency room. Ever pay an emergency room bill? The cost of a reasonable month’s supply of triptans costs far less than a single ER visit. Duh! Maybe part of the problem is that many insurance plans have two parts — medical care and prescription coverage. The people managing the prescription coverage don’t care about ER payments because that’s a different budget.”

After many calls, 4 months, over $350 out of my pocket for medication (and several seemingly stress triggered Migraine attacks following calls to the insurance company,) they have now told me they will cover 9 pills per 23 days.  This comes out to almost 12 doses per month.  Which ought to be enough for my average month, but…

Can I take the Imitrex at the first sign of Migraine? Certainly not.  I have moments, or sometimes hours, of mild migraine pain up to 8 times per month.  That’s on top of my 4 – 5 “full blown” migraines.  This may be the sign of a transforming migraine pattern.  I have an appointment with a bona fide migraine specialist in early June – we’ll have to talk on this blog about the lack of qualified headache specialists another time.  For now, my attitude seems to be that the pain isn’t bad – many of you have it worse – so I save the Imitrex for when I feel a “real one” coming on.

Is this a good strategy?  Probably not.  My other alternative, I suppose is to pay out of pocket for additional Imitrex (at $26 per pill at my local pharmacy.)  I do get what samples my doctor can spare me when I see him.  But I have to say, when it comes to aborting Migraine, most of us are between a rock and a hard place.

– Megan Oltman

It’s a paradox wrapped in an enigma!

Signs of Spring photo courtesy of Just-Us-3

Hammer photo courtesy of Darren Hester

Tags: Migraine abortive medication, sumatriptan, triptans
Posted in Managing, Medicine, Rant | Comments (5)