April 8th, 2012
Well, not literally. Not that it would be unheard of in the Migraine world, many of us have banged our heads at times when the beast has settled down upon us. It’s a kind of counter-irritant, I guess. Something, anything, to try to break the repetitive throbbing. Or a distraction, some surface pain to focus on instead of the hideous rending inside the head. I’m really glad I don’t have many Migraines that get that bad any more.
Last Monday I woke up after a rough night, sleepy and with a mild ache on the left side of my forehead. Technically I’m sure it was a Migraine already, but I thought of it, as I often do, as more of a maybe-migraine, a migraine wannabe. My first impulse (so often the right one) was to call in to work, take my sumatriptan and go back to bed. And then the thought entered my mind of the budget for the month, and of the sick leave hours I try to budget too, and how since my Migraines have become less frequent I sometimes have a little headache that doesn’t turn into a full-blown Migraine. So my little headache and I went off to work, and chose to focus on the less mentally taxing of the tasks on my desk, and did most of my thinking out loud to help me focus, and took a walk at lunch, and did all I could to keep the beast at bay.
But I was talking about head-banging. Which I wanted to do before the night was out. I got home and tried to focus on all the stuff I try to focus on after work, like visiting my on-line world, Migraine related and otherwise, and helping Adam manage his homework, and imposing some kind of order on the chaos that is my home, and trying to build up and work on some of my free-lance work, and I found all I could do was go take a sumatriptan and lie down.
I set the alarm for about an hour and a half, rolled a pillow under my aching neck and dosed off, hoping the pill would do its job. And woke up groggy when the alarm went off, groggy and in pain. Groggy and nauseous and hungry and in pain. It was not yet two hours from the time I took the triptan, so I couldn’t do another dose, and the pill had had no noticeable effect. So I had to wait 15 minutes or so, and I needed to eat something for my blood sugar which was dropping (contributing to the Migraine). The head had started throbbing, one of those times when I imagined I could specifically feel each dilated vein around my brain pulsing and stretching and shoving against my skull.
So did I hit myself upside the head? In a sense. I didn’t actually feel like head-banging this time, though it was the worst Migraine I’ve had for a few months. Probably about an 8 out of 10 this time, the kind that makes me cry. I knew I had to bring out the big guns this time. I had to give myself a sumatriptan injection. A highly effective way to abort the Migraine, but which I put off and avoid as long as I possibly can. Why on earth would that be, you ask? If you have to ask you have never had one of these injections, or you are lucky enough not to experience them the way I do. First of all the injection itself hurts. It’s a spring-loaded injector; you shove it hard against your arm and hold it there, pressing until it injects. It’s not a jab, it’s a SLAM-STAB, and you have to keep pushing that thing in for 30 seconds to make sure all the medicine goes in, I do it while breathing hard through my gritted teeth.
Then you need to take your sore and aching arm and get yourself prone as quickly and smoothly as you can, so you can be lying down as still as can be when the real head slam comes. For me, and I understand for many others, the injection causes a “surge” of increased head pain before it begins to work. So the only thing, sometimes, that will make the pain go away, is a short-term, extreme increase in the pain. When I say short-term, it’s not an agonizing 30 seconds like the injection torture. It’s a good five to ten minutes of the front of my head feeling like it’s being hit with a tire iron, from the inside.
The only thing that gets me through to the other side is lying on my back as still as I can, doing my relaxation breathing. I have to go into the pain, be with the pain, and visualize my breath carrying the pain away, out with each exhale. And eventually I fall asleep, and usually in that sleep the pain goes away.
This time it took a long time, almost until morning, before the pain lifted. If I’d followed my original impulse and taken a pill in the morning before the pain was much of anything, I probably wouldn’t have needed the injection. If I’d taken the injection right away when I got home I probably would have been pain free in two hours. But I couldn’t bring myself to hit myself upside the head. Until there was no alternative. If you’ve been there, you know what I mean.
- Megan Oltman
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!
Patchwork quilt image courtesy of LePetitPoulailler.
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
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