Alternatives to Triptans

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Alternatives to Triptans

Post  Cookie Monster on Sat Jun 15, 2013 5:35 pm

Hi everyone,

It's been a while since I've posted anything on this forum, mostly because my day-to-day life with somewhat less migraines got wonderfully full for a little while there.  In January, I started on Cipralex and that, combined with a wonderful new chiropractor really did wonders for me, for a while.  I think my body has adjusted to the med now though so the migraines are gradually climbing again.

That's not what this email is about though.  What I am wondering is, for those of you have tried to get pregnant/been pregnant while dealing with regular migraines what did you do when you couldn't take triptans? I have tried to go without triptans on a number of occasions but each time, the after effects, not to mention the migraine itself, have been really awful.  I am left exhausted and with my whole body sore from the muscle tension.  With a minimum of 4 migraines a week, I can't imagine subjecting myself to this for 9 months plus who knows how many months prior to this while trying to conceive.

I am on a wait list for a consultation with an obstetrician/gynecologist but I don't know how long I will have to wait for an appointment.  I will be seeing my family doc in a couple of weeks, so any info I could bring to that appointment would be helpful.  Any insight any of you have would be greatly appreciated.

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Re: Alternatives to Triptans

Post  Seaine on Sat Jun 15, 2013 7:17 pm

I have found that taking 4-5 Ibuprofen pills every 4 hours will usually prevent my migraines.  I don't think this is a good solution for 9 months of pregnancy, though...  I'm not sure there is any alternative to triptans, aside from preventative meds which I have never found to be helpful.  I do cut my 100mg Imitrex into quarter pills which is enough most of the time.  Not sure if you can take any when pregnant but maybe if you really need it you could try that.

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Re: Alternatives to Triptans

Post  dcook60 on Sat Jun 15, 2013 7:53 pm

seaine, this is an insanely huge amount of ibuprofen.  i take this when i have trigeminal neuralgia pain (like now, from an unsuccessful root canal), or really unbearable fibromyalgia pain.  it doesn't touch my migraine pain, no matter how much i've taken.  but never more than 2400 mg. per day.  if a person takes as many as you said, that would be 4800 or MORE mg/day, since each pill is 200 mg.

i got my information about maximum dosage from a pharmacist.  advil/ibuprofen is an NSAID, and like all the rest of them, increases bleeding time.  dangerous, especially for pregnant women.  it is NOT a drug which should be taken on a regular basis.  it damages the kidneys. 

yes, i know, tylenol damages the liver and the NSAIDS do the same to the kidneys.  one cannot win.  but one can be prudent about taking it only when absolutely necessary.  i have no pharmacological training, but have a medical technology background.  please be careful, is all i'm saying; i don't mean to be an alarmist.  dianne

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Re: Alternatives to Triptans

Post  Seaine on Sun Jun 16, 2013 8:21 am

Yes, I know.  I don't really care due to the amount of pain I am in.  I have chronic sciatic nerve pain and take 4 Ibuprofens every 4 hours for usually one day per week.  You can tell me all you want about kidneys and stomach bleeding but it won't change my mind when I'm in so much pain I can barely function.  I found out this prevents my migraines from taking it for the sciatic pain.  If I already have a migraine it won't do anything, but it will prevent one from occuring that day if I wake up with the sciatic pain and start taking it in the morning.  I have been given a prescription for the equivalent of 4 pills before anyways by a doctor.  The only treatment for sciatic pain is high dose pain meds.  My mom will take 10 pills at once sometimes because she has RSD, and she was also told by a doctor to take that treatment.  The maximum dose is not set in stone, you will not automatically get stomach bleeding if you take more than a certain amount.  The higher the dose, the higher your risk.  However, sometimes the risk is outweighed by the benefit when your life is ruled by pain.

Like I said in my first post, I don't think this is a good solution for 9 months of pregnancy. Wink

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Re: Alternatives to Triptans

Post  Platypus on Sun Jun 16, 2013 10:25 am

Does the OP even respond to NSAID's? I've tried mega-doses of Aspirin and Ibuprofen and they might as well have been M&M's. Opiates are out obviously. I didn't know triptans were contraindicated during pregnancy. It's your choice of course, but I assume you are aware that migraines are genetic and passed maternally. Not to mention how much fun pregnancy/screaming baby/child raising will be with chronic migraines.

-Platy

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Re: Alternatives to Triptans

Post  Seaine on Sun Jun 16, 2013 10:54 pm

On triptans and pregnancy, I found this:
http://www.medscape.com/viewarticle/720686

Basically it seems that triptans are not contraindicated for pregnancy, but there have not been enough studies to say they're safe for sure.  On the other hand, there is no evidence that they do harm.

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Re: Alternatives to Triptans

Post  dcook60 on Mon Jun 17, 2013 8:41 am

i lost track of what i scribbled it on, but there is a promising new drug in the drug pipeline, for migraine treatment.  it works not-at-all like triptans.  this would be terrific news for those of us who live on triptans, if it pans out.

does anyone have info on this?  of course we have to remember that most of those new drugs touted as "the miracle cure" either don't get FDA clearance, or aren't really as good as the news reports tell us.

we're all waiting for the perfect drug and i don't suppose it exists, does it?  dianne

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Re: Alternatives to Triptans

Post  WitsEnd on Mon Jun 17, 2013 1:14 pm

In my part of the world they will not let you take triptans if pregnant. My understanding is that they would reduce the blood flow to the baby.

We are also strongly advised not to take ibuprofen. Paracetamol, paracetamol, paracetamol is what they advise. Which is useless to most migraine sufferers. I believe they will allow codeine if absolutely necessary, but OP, please don't just take my word for that.

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Re: Alternatives to Triptans

Post  Platypus on Mon Jun 17, 2013 9:44 pm

dcook60 wrote:i lost track of what i scribbled it on, but there is a promising new drug in the drug pipeline, for migraine treatment.  it works not-at-all like triptans.  this would be terrific news for those of us who live on triptans, if it pans out.

does anyone have info on this?  of course we have to remember that most of those new drugs touted as "the miracle cure" either don't get FDA clearance, or aren't really as good as the news reports tell us.

we're all waiting for the perfect drug and i don't suppose it exists, does it?  dianne

Are you thinking of Levadex? That is the inhaler version of DHE which is already available as a nasal spray (Migranol) and an injectable. The pharma company that owns the rights is Allergan, same folks who make Botox, which they have made huge dough on, and they are expecting to make huge dough on Levadex, except they can't get the FDA to approve it. And who really gives a shit? If you're one of the few who DHE works for you can use one of the other versions. Allergan is all about ripping off migraineurs with crappy products and making huge money doing so. How many people do you know who Botox works for?

-Platy

P.S. The quote feature on this board is broken :/

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Re: Alternatives to Triptans

Post  WitsEnd on Mon Jun 17, 2013 11:20 pm

Forumotion have released an update. To change back to how the quote function used to work, click the icon right at the end of the tool bar. The one that looks like a sheet of paper.

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Re: Alternatives to Triptans

Post  Mini on Tue Jun 18, 2013 3:31 am

It is always a good idea to be very cautious when it comes to pregancy, so you are right to be seeking advice from your gynecologist/obstetritian.
However I have never heard it mentioned that Imitrex is not advised in pregancy (I am also in UK), but even if what Wits End is saying is the case, you are as yet not preganant, so at this stage it is not likely that you would be affected.

But of course, in the end taking any medication is a serious risk.

I really understand that the high levels of pain can drive you insane and you just want it to stop, almost at any price, but taking Ibuprophen in any dose, let alone in such high doses presents a very high risk not only of  getting a chronic stomach inflammation, but also more serious complications such internal bleeding, anemia, ulcers and damage to the oesophagus, which can all have bad consequences.

YOu really need more advice about your pain control from a neurologist.

Taking high doses of Ibuprophen might leave anyone with damaged stomach  and possible anemia during  pregnancy.

Taking all this into account, until you get better advice from both a good neurologist and obsetrician, about any drugs and pregancy, Imitrex does not seem like the worst option, since Imitrex  might not have such lasting effects.


It would be good to know what is the source of the information about use of Imitrex  during pregnancy mentioned by Wits End, unless this is just hearsay or an opinion of just one doctor.

I am sure we have all been given wrong, or alarmist imformation by some doctors in the past, so it is best to check as many sources as possible, to plan the best pain control during pregancy which might work for us, well indavance - just as you are doing Cookie M.

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Re: Alternatives to Triptans

Post  Seaine on Tue Jun 18, 2013 7:40 am

Mini wrote:I really understand that the high levels of pain can drive you insane and you just want it to stop, almost at any price, but taking Ibuprophen in any dose, let alone in such high doses presents a very high risk not only of  getting a chronic stomach inflammation, but also more serious complications such internal bleeding, anemia, ulcers and damage to the oesophagus, which can all have bad consequences.

YOu really need more advice about your pain control from a neurologist.

If you were speaking to me, since I'm the one who takes high dose Ibuprofen, then unfortunately I must say as usual doctors do not help in this matter. The medication is not for my migraines, it's for sciatic nerve pain. From specialists, the only advice I've received is that there's nothing wrong on my lower back MRI scans and therefore it's all in my head. From my GP, who is not a moron, I've received prescriptions for 800mg Ibuprofen pills. Obviously I've researched this and been to many doctors trying to find a cure. As there is none, the only treatment is pain medication.

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Re: Alternatives to Triptans

Post  WitsEnd on Tue Jun 18, 2013 8:15 am

I never said imitrex, I was talking about triptans in general (I don't even know if imitrex is a triptan scratch ).


Yes, it came from a doctor, but it stands to reason that a drug to counter-act migraine restricts blood flow, and restricted blood flow to a baby can surely only be a bad thing...

Like I say, I don't know what imitrex even is, I replied in answer to the thread subject, which says triptans.

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platypus

Post  dcook60 on Tue Jun 18, 2013 8:47 am

no, it was a completely new drug, not some variation on an old one, just so the drug company can make more big bucks.  wish i could remember where i read this; i read lots of magazines when i drive my clients to doctor appointments and wait for them, so it could have been in an office mag.  if i find it again i will post.

yes, imitrex was the very first triptan invented.  i believe it came on the market around 1992.  the other 6 triptans were after that time, and there hasn't been a breakthrough since.  (only a couple of variations in form of delivery).   dianne

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Re: Alternatives to Triptans

Post  Sara79 on Tue Jun 18, 2013 10:22 am

The only alternative to what's been mentioned that I know of is ergotamine (caffergot), which is 100% pregnancy unsafe.  The ergot that the med is derived from causes miscarriages and hallucinations.  It just also seemed to stop migraines for some at specific dosages.

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