I have lots of migraine questions

[Chaswick]

Hi Nathan;

1) Mz. M. is right. You do need to discuss this with your Dr. before you deviate at all from the instructions that were given to you when you had the Rx filled.

Having said that, a 'rule of thumb' for abortive medications is that they be taken a maximum of 2 days per week. Anything more than that and you run a higher risk of developing medication induced headaches (rebound) and more side effects.

Your Dr. may have different experiences from the norm.. There are some patients that are taking this type of medication daily and getting good results, but it isn't something that should be done without speaking with your Dr. There have not been any good studies done giving results of daily triptan use. It is a pretty potent medication so nothing that you should take lightly.

2) When it comes to 'abortive' medications. anything as good or better than taking the pain from a 9 to a 4 are excellent results. Don't ever attempt to relieve all the pain ubsing any time of abortive medication. There are so many bad things that can happen when you do that it isn't funny. Getting your pain to a level that you can go about your daily routine is the goal when it comes to abortive medications.

You are right that taking the medication as soon as you feel a migraine coming on is the best thing that you can do. When it 'takes hold' it can be very dificult to break.

I think it is a good idea to try the different triptan medications. We all seem to react differently to them.

3) Stay as far away from Fiorinal or Fioricet (one has aspirin one has acet.) as you can. IMO, no Dr. should be Rx'ing that medication to new headache patients. There are so many better meds. for migraine than Butalbital (it is the barbituate that is in this medication) that don't carry any of the risks associated with this medication.

SO MANY patients have developed big problems taking Fiorinal it isn't funny. It is highly addictive and very easy to get dependant on it. You hear it all the time that people say that not only does it reduce their headache pain but it gives them a 'boost' of energy and makes them more social. Once addicted and/or dependant on it, it is not a medication that you can just stop taking cold turkey. You need to slowly taper off of it over a a very long period of time or risk your health big time.

In Canada, the college of physicians and surgeons came out with a directive a couple of years ago. They said that Fiorinal should never be Rx'd to any new patients and any patients that are taking it should be, if possible, shifted to another medication.

I DON"T think that someone who has taken it for many years and is taking it responsibly should not have access to it. Just that it - again IMO - shouldn't be Rx'd to any new patients.

4) I don't know about treating them like an allergy. There are medications that some people take and have success with though. Hydroxyzine, which is an allergy med. is Rx'd to many migraineurs who use it along with an abortive pain medication. It makes the pain medication more potent. Sort of like making 2 plus 2 equal 5. It's supposed to be a fairly safe medication, but then so was Oxycontin!!

5) Never heard of Percocets making migraines worse. Probably was part of a discussion about taking abortive medications daily or too frequently. Any type of analgesic (Percocet, morphine, codeine, tylenol etc. etc.) taken too often can fesult in 'Medication Induced Headaches' (rebound headaches).

What happens is that your body and brain get used to taking this medication on a daily basis and if it doesn't get it, it mimics the symptoms of your regular migraine so that you will 'feed' it.

Most h/a specialists will have their patients check to see if they are getting MIH. They will have you stop taking any analgesic medication for a period of 8-16 weeks (depending on the Dr.) and if your h/a get worse for the first couple of weeks and then start getting better, then you are getting MIH to a certain degree and your analgesics are making things worse.

If you see no change to your h/a pattern then you spend 8-16 weeks in bad pain when you have a migraine which isn't much fun. It is seen as neccesary though.

6) If you are talking about something like Ativan, Valium, oxazepam etc. then no. IMO, these are not medications that should be taken as migraine 'prevenatatives'. They can be as bad or worse than Fiorinal and it can take years and years to taper off of these medications. I'd stay away from them if I were you.


Hope this helps you a bit anyway. Any observations or questions welcome!!

Chaz

[NathanF41]

Thanks Chaz!

That was really informative. I'm going to print and save the info on there. I had no idea that fiorinal/fioricet was a barby med, and now I have zero interest in it. I'm thinking of testing out Axert to see how it works. Zomig has always mildly worked it seems. Maxalt tablets did NOTHING at all for me, in fact I believe it made my migraines worse. It makes me skeptical of Axert because I know it's a tablet, and it sounds similar to maxalt...but I've heard great results.

I ask about anxiety meds because after stopping depakote er, it seems that I was having anxiety covered up. I have physical anxiety symptoms that I want to deal with (anxious breathing...yawning, overbreathing, lots of deep breaths, etc). I've heard that some migraine preventatives are anti-anxiety meds. Are there any that you know of that don't have the withdrawal issues that ativan, paxil, and some others have, that would work as a mg preventative? I would go back to depakote, but it honestly wasn't doing much for my migraines in the summers anymore after a few years (was on it for 5 years total, and got 7 migraines last summer while on the med).

Thanks again.

Nathan

[mjewell]

Hi Nathan -

First, understand the difference between anxiety meds- there are anti-depressants and benzodiazepines - Benzos are your Ativans, valiums, xanax...Anti-depressants are your Paxils, Zolofts, Lexapros, etc. Given that, which class of meds did you hear help reduced migraines? I have taken Xanax for a couple of years for my anxiety and panic attacks, and it has been a godsend for me, but it certainly didn't alleviate my headaches in any way. I started taking also Effexor a couple months ago, which is an anti-depressant, and i have had one headache since getting on it but I was able to make it go away fast with Imitrex. This is my normal week to get migraines, so i guess this week will tell me if the Effexor is making a difference in my headaches.

My advice to you (and with your drs advice of course) is to maybe do a sample of an anti-depressant and see if it helps. Your anxiety symptoms to me don't sound like you need a benzo. Benzos are most helpful for people who have regular panic attacks. As far as withdrawal and side effects, every person reacts differnt to diff meds so its hard to say. Sometimes you have to try several differnt ADs before finding one that works. Like me, Effexor hasn't had one negative side effect for me, and sometimes I forget to take it and never experience withdrawals, but others have experienced awful effects, so you never know.

[NathanF41]

Sounds worth looking into. Thanks for the reply.