Migraines…preventatives and abortives

[Deleted]

Looking for some advice. After years of bad headaches, I finally went to see a doctor. Both ENT and Neurology feel that they are likely migraines, so I started a preventative and an abortive this week. Like Tuesday. Of course yesterday a headache came on. I tried the abortive (Imitrex) and the first dose didn’t do much. Went to bed and woke up with a splitting headache and took another Imitrex and felt like absolute death for an hour, fell back asleep, and woke up feeling much better. Imitrex wore off and now the headache is back. Or I guess it was always there the whole time and I just didn’t feel the pain? Anyway, I don’t want you to take another one because I already did two doses in 12 hours, and I don’t have an unlimited number of these things. What’s the point if the headache just keeps coming back and I can’t take enough doses to be pain-free until it finally goes away? And the side effects were…:not great.

I’m still not convinced that these are actual migraines instead of sinus issues, and the ENT was pretty dismissive. But ultimately I don’t really care what they are if I can make them stop or at least not be in pain.

Any advice?

ETA: the preventative is propranolol. So far I’m not impressed.

[luckystar2]

Since you mentioned sinus issues - do you have allergies? Are you taking allergy med? I’ve had headaches/migraines on and off throughout my life. I realized that they were worse when my allergies have been worse (my allergies have been better and worse at different points in my life). I was really in a bad place with my headaches/migraines a few years ago. I happened to switch allergy meds to xyzal and the difference has been amazing! I didn’t realize how congested I was all the time (was just my normal). I sleep better, breathe better and overall my headaches/migraines have decreased a TON! If I get one I take an extra half pill of the allergy med at night and am better the next day.

As for the abortive - you may need a higher dose of imitrex. What did they start you with? I was put on 50mg but it never works just one pill. You can take a second pill if you still have headache after 2 hours. I would always be taking the second pill. So I just started taking 2 at a time. I had to have my Dr increase my script eventually to 100mg.

You might also need a different abortive. Unfortunately headache/migraine options aren’t one size fits all. And it can take a lot of trial and error. I tried one preventative and absolutely hated it. I was given a couple alternative options but honestly they all sounded awful. There are a lot of side effects. I was going to start trying other abortive when I switched my allergy med and then didn’t need them hardly ever anymore. But I kind of really disliked imitrex. It always made me feel worse before I felt better. And I generally always needed to sleep after taking it. Not really feasible during work etc. my neurologist gave me some trial pills for some of the newer abortives. Generally you need to fail using the older styles first. And the newer ones can be pricey.

[mlkgls]

First off, I’m sorry. I know how debilitating and miserable they can be. Do you know what any of your triggers are or do you have any early warning signs? 

Imitrex absolutely did not work for me when it first came on the market and then my neuro cautioned me against ever taking tryptans for my specific type, so I can’t help there. For an abortive, I have had really good luck with Excedrin Migraine, as long as I take it the moment I sense an aura. I tried Ubrelvy on Sunday, but the jury is still out on that one. It definitely helped with the pain, but I was incredibly loopy and I’m not sure if it was from the migraine or the med.

I’ve tried gabapentin in the past as a preventative, but I don’t remember it helping much. Aimovig has been offered, but it was a little too $$$ on my Rx formulary. Honestly, making sure I drink a metric ton of water helps about as well as anything.

[lilypad1126]

I take amitriptyline as my preventative (20mg/day). It's the 3rd that I tried, and it's my miracle drug. So first, just know that it may take a couple different meds to find the one that works for you. But also, it took a couple weeks for my the preventative to really start working and my headaches (and bounceback headaches from living on ibuprofen for so long) to subside.

Next, imitrex has never worked for me. Actually, now that I think about it, no rescue med has done much for me. I'm better off taking 1 ibuprofen and 1 tylenol when I have a breakthrough migraine.

Finally, I thought for years my headaches/migraines were sinus related, until about 2018 when I had like a month long headache and went to a neurologist. She was confident it was not my sinuses and that's when we started trying preventative meds. So while yours could be related to your sinuses, I do think it's worth trying preventative/rescue meds until you find the right combo.

[lab7979]

I take Imitrex. I rotate taking Imitrex and 2 Excerdin Migrane. I try not to take more than three Imitrex in one week and Excedrin Migraine says on the label not to take more than 2 a day. Usually I can spread them out pretty far so I'm taking Imitrex one day and Excedrin Migraine the next. I'm one of those medication hoarders though. I'll wait until it gets unbearable and then I'll take it so that I can stretch out the time between doses. I try not to take medication several days in a row because I do feel like if you continue to take Imitrex it starts causing rebound headaches. If I'm having days of back to back headaches, I'll go one day toughing it out without medication to try and break the cycle. I think my migraines are hormonal but I do have sinus issues as well. Sinus medication doesn't help the pain though. It's like once my sinuses trigger the headache the pain just takes off. I do incorporate sinus medication or allergy medication if I feel like it will be helpful. It's not usually helpful just on it's own. I've never been prescribed a preventative. Not sure why. I'm fine with that though. I prefer to take as little medication as I can get away with.

Edited to say: I was originally prescribed 50mg Imitrex and it did not help me at all.  100mg works for me.

[dove]

I also take a higher dose of imitrex. I recently gpt samples of nurtec. It works fine as well but is super expensive. not worth it for me since the higher dose of imitrex works well enough.I also do Botox for migraines. Botox has been such a game changer for me.

[Deleted]

Sept 12, 2024 11:55:24 GMT -5 luckystar2 said:

Since you mentioned sinus issues - do you have allergies? Are you taking allergy med? I’ve had headaches/migraines on and off throughout my life. I realized that they were worse when my allergies have been worse (my allergies have been better and worse at different points in my life). I was really in a bad place with my headaches/migraines a few years ago. I happened to switch allergy meds to xyzal and the difference has been amazing! I didn’t realize how congested I was all the time (was just my normal). I sleep better, breathe better and overall my headaches/migraines have decreased a TON! If I get one I take an extra half pill of the allergy med at night and am better the next day.

As for the abortive - you may need a higher dose of imitrex. What did they start you with? I was put on 50mg but it never works just one pill. You can take a second pill if you still have headache after 2 hours. I would always be taking the second pill. So I just started taking 2 at a time. I had to have my Dr increase my script eventually to 100mg.

You might also need a different abortive. Unfortunately headache/migraine options aren’t one size fits all. And it can take a lot of trial and error. I tried one preventative and absolutely hated it. I was given a couple alternative options but honestly they all sounded awful. There are a lot of side effects. I was going to start trying other abortive when I switched my allergy med and then didn’t need them hardly ever anymore. But I kind of really disliked imitrex. It always made me feel worse before I felt better. And I generally always needed to sleep after taking it. Not really feasible during work etc. my neurologist gave me some trial pills for some of the newer abortives. Generally you need to fail using the older styles first. And the newer ones can be pricey.

It definitely could be allergies. I’ve been taking Claritin and Flonase for years but it might be time to change those up.

50mg Imitrex for now.

[Scout'sHonor]

I have a script for Maxalt and zofran. The zofran is because I get super nauseous when the migraines come on and I can't keep down advil. The maxalt has helped a ton to keep them from getting worse as long as I take it at the first sign.

[dirtyred]

Excedrin and Excedrin Migraine are the exact same formulations--same drugs, same dosages.  Don't pay extra for the migraine labeled one.

[lavenderblue]

I know what you asked specifically, but I got my Tragus pierced. I have only gotten one migraine since I've had it done and it was way more mild than the ones I have gotten historically. It's been two years (nearly) migraine free and is amazing.

[mommyatty]

dirtyred- I think Exedrine Migraine has caffeine in it. That’s the only difference, I think.

Imitrex doesn’t do jack for me except give me heartburn, make my blood pressure spike, and make me feel like I’m going to vomit even more. I take Relpax and it’s a lot better for me. But, about 2 years ago, I learned that if I put an ice pack on the back of my neck where my head and neck meet, and take some Aleve, it works as well as Relpax. I had always put a heating pad on my neck, and I guess that was actually making it worse. I also drink some coffee because caffeine is supposed to help migraines.

[mpc]

I've had migraines since I was a kid. I take Imitrex (100 mg) and it works about 90% of the time. I do feel odd afterward, loopy. I've tried various preventables - Aimovig, Emgality, nortriptyline - the difference has been minor. About 6 months ago I started doing Botox and I can't believe how many fewer headaches I have had. Migraines are the worst, I hope you can find something that helps.

[estrellita]

Imitrex did nothing for me. Then they tried a variety of triptans that made it worse for me (my neck would feel extremely tense/stiff). I have Nurtec now which only sorta works.

For preventative, I'm on propranolol, which helps but I still get daily headaches. They can increase your dose, assuming they started you on a low dose (and they will before trying other things). After trying Emgality (self administered injection), now I'm doing Botox every 3 months and it has helped a ton. Still getting the daily tension headaches but the migraines are vastly improved.

If something isn't working, give it a few tries/weeks, and follow up. You may have to try several things before you find something that works, and insurance will make you try things before you move on to the more expensive treatments!

[mrspez07]

I’m sorry.
I do agree that allergy meds can sometimes help. I will do that and Advil if it feels more sinus than migraine.
Mine have been hormone related. Not always consistently the same point in my cycle, except one (day 18). I can almost call that one every month. I complained that Advil wasn’t working for me and my Dr gave me two samples, and I really liked ubrelvy as an abortive. I didn’t want something I took daily when they were infrequent and inconsistent. Then, I couldn’t get the prescription because I had to try the “other less expensive options” before. I’ve been able skirt around that with additional samples, etc. but would recommend that one. I usually only take one and it starts working about 1-2 hours and headache doesn't come back.

[sadlebred]

You may need to try several combinations of migraine meds before you find what works for you. Some of the triptans, like Imitrex, are short acting. Others like Amerge are longer acting. You can combine the two. Take an Imitrex at the FIRST onset of the migraine--not first onset of the pain. Then about 2-3 hours later take an Amerge. That should cover a larger period of time. Of course, you should always ask your doctor about your situation.

Another preventive that many doctors don't talk about is prednisone. 10-20mg at first onset along with the triptan can help. Then 10mg morning and 10mg night til the headache goes away and 10mg one time after it's gone. You don't want to stay on it for more than a few days. Something to ask the neurologist about.

Same with a preventative. You may need to try several. Nortryptaline worked well for me for years. So did a calcium channel blocker called verapamil.

Thankfully with the new heart problems migraines are rare.

[trissie18]

I am not able to take preventative meds for my tension headaches/migraines due to my liver freaking out so I do botox every 12 weeks and it has been a game changer. I maybe have 2-4 headaches in the 12 week period compared to the daily ones I had before. For abortive, none of the over the counter meds work. My dr recently prescribed Nurtec and it is amazing! My headache/migraine is gone within 30 minutes of taking it. Definitely talk to your dr about trying different meds if the current ones aren't working.

[dirtyred]

Sept 12, 2024 12:57:07 GMT -5 mommyatty said:

dirtyred - I think Exedrine Migraine has caffeine in it. That’s the only difference, I think.

They are exactly the same.  The package insert is the only thing different between the two

[rooster222]

Propranolol was amazing for me and I took it for several years with minimal side effects. I previously used imitrex as a rescue med but I needed more than what they'd prescribe. My Drs tried to put me on all kinds of crappy preventatives that made me feel awful. I had to ask to be put on propranolol and it was a life changer for me.

I don't take it anymore but have considered going back on it but lifestyle wise I have my migraines pretty under control.

[luckystar2]

Sept 12, 2024 12:33:07 GMT -5 @villainv said:

Sept 12, 2024 11:55:24 GMT -5 luckystar2 said:

Since you mentioned sinus issues - do you have allergies? Are you taking allergy med? I’ve had headaches/migraines on and off throughout my life. I realized that they were worse when my allergies have been worse (my allergies have been better and worse at different points in my life). I was really in a bad place with my headaches/migraines a few years ago. I happened to switch allergy meds to xyzal and the difference has been amazing! I didn’t realize how congested I was all the time (was just my normal). I sleep better, breathe better and overall my headaches/migraines have decreased a TON! If I get one I take an extra half pill of the allergy med at night and am better the next day.

As for the abortive - you may need a higher dose of imitrex. What did they start you with? I was put on 50mg but it never works just one pill. You can take a second pill if you still have headache after 2 hours. I would always be taking the second pill. So I just started taking 2 at a time. I had to have my Dr increase my script eventually to 100mg.

You might also need a different abortive. Unfortunately headache/migraine options aren’t one size fits all. And it can take a lot of trial and error. I tried one preventative and absolutely hated it. I was given a couple alternative options but honestly they all sounded awful. There are a lot of side effects. I was going to start trying other abortive when I switched my allergy med and then didn’t need them hardly ever anymore. But I kind of really disliked imitrex. It always made me feel worse before I felt better. And I generally always needed to sleep after taking it. Not really feasible during work etc. my neurologist gave me some trial pills for some of the newer abortives. Generally you need to fail using the older styles first. And the newer ones can be pricey.

It definitely could be allergies. I’ve been taking Claritin and Flonase for years but it might be time to change those up.

50mg Imitrex for now.

I was also using claritin and Flonase. I have side effects with all other allergy meds in past. Claritin is very mild and while no side effects it doesn’t do a lot for my allergies. Xyzal is a newer allergy med I hadn’t tried so figured I’d give it a go and it was amazing. It does make me tired so I take before bed. But it doesn’t make me groggy the next day like Zyrtec did.

[Nonny]

My main migraine trigger is hormones, and my second biggest trigger is lack of sleep.

So, one big help to me is continuous use of my nuvaring (which both my neuro and gyn are fine with) - but my body forces a period every 3-4 months, so it only works so well.

I also take 25 mg topiramate, 200 mg gabapentin (which in theory also helps with my IBS, and with the fibromyalgia my neuro insists I have but that I'm dubious about), and 1 mg of melatonin.

Finding 1 mg tablets of melatonin is ridiculously hard BTW, people take way too high of doses, and I used to have to buy 3 mg tabs and cut them in half. The melatonin really does help though; I cut it out once when I thought I was getting enough sleep due to the gabapentin, and within a week started having more, and more intense headaches.

If you want to fall down the melatonin/migraine rabbit hole, start with this article from the Cleveland Clinic, then follow the links to the NIH PubMed and Neurology India who actually did the study. I know it's anecdotal, but I'm convinced. I also used to take amitriptyline for something else (before I got on the topiramate and gabapentin) and it did nothing for my headaches. 

I used to have rizatriptan (Maltax) as my abortive, but I didn't think it worked very well and if I took it during the day it made me feel high. So I'd wait until bedtime, and then it worked even less well because I wasn't taking it early enough.

My neuro switched me to Ubrelvy this summer, which I've taken exactly once. It worked OK-ish, but made me feel really sleepy. It's also expensive AF, and went through some really confusing things with my insurance, and getting enrolled into the AbbVie savings card to pay my co-pay. I ended up getting it for free, but I'm not entirely sure how that happened (I think it was only because I'd hit my deductible for the year).

TL;DR - it took a lot of trial and error to land on a treatment I'm content with. I still get headaches, but it's random and occasional, rather than non-stop, so I'm happy enough.

[mommyatty]

Nonny- I take the melatonin gummies for my kids. They are 1/2 mg! I just eat 2.

[Nonny]

Sept 12, 2024 15:11:43 GMT -5 mommyatty said:

Nonny - I take the melatonin gummies for my kids. They are 1/2 mg! I just eat 2.

I've considered that, but generally I brush my teeth and put in my retainer about 30-60 minutes before I actually take my handful of bedtime pills. Having a tablet is a lot easier for me for my bedtime routine.

[joy]

I’ve done all the things for migraines.

Imitrex works for migraines but not other kinds of headaches. Imitrex also isn’t for everyone. There are different abortives (ubrelvy, fiorcet, etc) and even different triptans (sumitriptan is imitrex) you can try. Call your neuro and say this is not working, what else ya got?

Imitrex side effects for me are sleep, skin pain and joint aches. But it gets rid of my headache at the 100 mg dose so okay!

Propanolol just made me dizzy and my blood pressure so low that doctors asked if I was okay. 🤣 I tried topomax but the injectables work best for me (with Ajovy being my favorite).

Definitely tinker more with your neuro.

[gemini79]

Imitrex is the first triptan abortive that Dr's will give you and insurance approves. As others mentioned its fast acting and it's also short lasting. There are other triptans like Relpax and Frova that only come in pill form (so they take a little longer to kick in) but they last for 12-18 hours. My migraines can last for that long and so I need a blaster that keeps going and I really prefer Relpax. It also is a lot more gentle on my system.
I also tried propanolol and like Joy it didn't really work for me and it lowered my blood pressure so much that when I was working out at Orange Theory they had to keep customizing my HR monitor lower and lower and lower so I could get an accurate reading. It also impacted running--as in I had literally no giddy up at all and it was awful. Eventually I got off it.

I used the CGRP injectables--first Ajovy (LOVED) and then Emgality (Fuck you, I hated it). And now I get Vyepti every three months and she's the queen bee. I'm a super responder to the CGRPs--as in my headache days were like 15 and went to 1 or zero on them and my migraine with aura days were 6 and went to zero--and the medicine reduces intensity and increases abortive effectiveness.

I've had migraine since I was 7, and been through TONS of options. It's a chronic condition that is complex--so really you have kind of dig in and be like, "ok that didn't work but I won't give up." In the course of my life, I've really had to continually work at it, find the doctors that work best for me, keep up on the research and be willing to try things and even have them fail--but not give up. I also had to really communicate with my doctors and even my husband--I loved ajovy--but our insurance stopped approving it that's how I got on emgality. It has a super problem with wear off effect--and even when I tried to push that as a failure and a reason to get back on ajovy--my insurance did not care. My husband and I considered other insurances! But finally we realized I could do Vyepti (which is WAY more expensive than Ajovy and makes no sense but ok)--I got approved for that--but it was b/c of tenacity, and teamwork that it happened.

[felicity]

I don't have the answers but I've been trying to get my headaches (and other aches and pains) addressed and it's so frustrating.

I went to see a neck Orthopedist the other day, and he gave me some muscle relaxers to help with my neck pains while I wait to get more imaging and treatment started, and it's helping with my chronic headaches/migraines. I think one of the triggers for me is tense neck and shoulders. I don't think it's the only answer for me and I think I have other triggers as well, but it helps with some of the headaches at least.

[litebright]

I had migraines since I was a teenager. I had my wisdom teeth removed in college, thinking that might help. No difference. Imitrex didn't do anything for me that ibuprofen + an ice pack on my head didn't do. It got to a point a few years ago where I was waking up every.single.night in the wee hours with a blinding headache. I was also concerned about how much ibuprofen I was consuming regularly.

My doctor was like, you can go on a preventative or you can try acupuncture. I figured trying acupuncture couldn't hurt and if it helped me avoid meds, it was worth trying. I was VERY skeptical of the woo but also pretty much desperate.

I walked out of the first session feeling like someone HAD given me drugs. Really good ones. I slept that night with no migraine for the first time in weeks. My acupuncturist also did occipital release at the end of each session. I went once a week for a short while, then was able to go down to every other week, then eventually once a month. Headaches were vastly reduced, to just one or two around my period & those were not as intense as they had been.

I stopped going when we moved cross-country and didn't find a new acupuncturist immediately. After about six months, the headaches started picking up again in frequency and intensity. That was a lesson to me that the issue really hadn't gone away, that I needed to continue regular acupuncture to stay on top of it.

I go once a month. As long as I do that, I have very few headaches. Insurance doesn't cover it, I pay out of pocket but the improvement in my quality of life is more than worth it. I see my acupuncturist way more than I see my regular doctor, lol.

I've gone to acupuncturists who are also chiropractors & adjust me during the session, who use the needles plus electrical stimulation, who have done cupping along with acupuncture. No one has ever been as good as the first guy I went to, who tended to use a lot more needles per session. But as long as I keep up with it in some form, I'm okay.

[mpc]

Oh, I just remembered - I can't explain why, but I'm convinced that the Imitrex doesn't work for me if I take it and then immediately go to sleep. I almost always wake up and still have the headache. Usually I try to stay awake for 60-90 minutes to give it time to kick in, even if that means I'm just laying in bed miserable.

[Deleted]

Sept 13, 2024 9:43:01 GMT -5 mpc said:

Oh, I just remembered - I can't explain why, but I'm convinced that the Imitrex doesn't work for me if I take it and then immediately go to sleep. I almost always wake up and still have the headache. Usually I try to stay awake for 60-90 minutes to give it time to kick in, even if that means I'm just laying in bed miserable.

I’m not sure I could go to sleep immediately after taking it! My tinnitus has been unbearable after taking…kind of pulsating and very high-pitched.

[joy]

Sept 13, 2024 9:43:01 GMT -5 mpc said:

Oh, I just remembered - I can't explain why, but I'm convinced that the Imitrex doesn't work for me if I take it and then immediately go to sleep. I almost always wake up and still have the headache. Usually I try to stay awake for 60-90 minutes to give it time to kick in, even if that means I'm just laying in bed miserable.

Yes.. this is me, too. What is that?!

[audry80]

I have been dealing with migraines/headaches for 13 years. Like you, I swore it was sinus related but after a clear CT scan and other tests, my sinus were cleared from being the cause of the pain.

A couple years ago I finally saw a neurologist who is a headache specialist. I was on a 6 month waiting list but she has been life changing and we finally found a routine that works for me. My preventive is pronanol, my rescue med is nurtec and muscle relaxers and I get botox covered by insurance. The botox has made the most difference.

Recently I was getting bad headaches again that was different than my previous pain and nothing was working. I once again thought it was my sinuses and it was! They swabbed my nose and found a bacteria that shouldn’t have been in my nose! A round of antibiotics and the pain was gone.

I find some food trigger them as well, lots of nuts and yogurt which we have linked to Tyramine.

Headaches suck and I wish them on no one. I hope you get relief.