Intractable migraine

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Intractable migraine

Post  Kem10 on Mon Oct 03, 2016 10:04 am

I seem to have entered into a period of intractable migraine. Sometimes the pain is less and sometimes very severe but never gone. Sumatriptan helps a fair amount but it is a worry that if taken daily at 100mg each time, the effectiveness will decrease, not to mention the extreme cost if needed daily. It is definitely a process of learning when to take the medication for maximum benefit such as a decent amount of sleep against getting at least some things accomplished during the day. The thought of two full tabs per day scares me both for the cost and the possible ill effects to the rest of my body if taken in these amounts. Also there are some days when the pain reduction only lasts a few hours.
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Kem10

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Re: Intractable migraine

Post  tortoisegirl on Mon Oct 03, 2016 5:45 pm

Sorry you are suffering.  Have you made an appointment with your headache specialist to discuss ideas for stopping this headache cycle (a steroid pack is common), evaluating your preventative regimen (might be time to change/add), and evaluating your abortive regimen?

I might as well mention the possibility of rebound, which I think anyone going from episodic to daily pain should try to rule out. One characteristic of rebound would be the pain location and/or type changing.

A new condition starting up or a new medication or dose increase causing headache is something else to rule out. Several times I've had other meds cause a constant headache on top of my constant NDPH + episodic migraine, which wasn't easy to figure out, but was easy to fix.

So, before too much time passes, I'd try to pinpoint when this streak started and if you had any lifestyle changes during that time. It might be good to start a headache log, including diet, going forward as even if you determined in the past you didn't have any triggers (or you are avoiding them), sometimes things can change over time. Similar to how someone can develop a severe allergy overnight to a medication they took for years.

Have you tried less than 100mg of Imitrex at a time? The pills can be split. For whatever reason my doctor prescribed me 100mg, and when I was doing bad and starting running out (9/month), I cut them in half. Turns out 50mg is just as effective and lower side effects for me.

I'd try even less but the generic I get is too small to split except to halve, and I haven't even been using 9 lately. Especially mail order or using a coupon, they may be affordable even paying cash if you have insurance limits. Might as well try to get a quantity override, but most of the time they don't work (although there are higher levels of appeal to try too).

On the coupon front, just an example, but I recently used GoodRx.com to get a coupon for a med my insurance doesn't cover, and I was shocked to find to price dropped from $130 to $44. I've been paying that much (although thankfully not every month) for years without much thought besides comparing other pharmacy's cash prices.

It took just a minute to print out (no cost and it didn't even need an e-mail address) and went through without a problem. I was curious for Sumatriptan, and it shows $56.81 for six packs of 9 of 100mg (54/month), independent pharmacy. Not bad at all.

To try to put your mind at ease, some small studies of daily Triptans showed no ill effects. However, it should be a last resort, and hopefully you wouldn't need two 100mg a day. Its also something to definitely discuss with your doctor. If you can't get into your specialist for awhile, at least try your primary doctor.

If Sumatriptan is only lasting a few hours, I'd definitely bring it up with your doctor. That may mean you should try to switch to something else. Some are known to be longer lasting, some quicker acting, etc. Best wishes.

http://chicagoheadacheclinic.com/archives/daily_triptan_use.html
http://chicagoheadacheclinic.com/archives/long_term_triptan_abstract.html
http://chicagoheadacheclinic.com/archives/daily_triptans.html
http://www.nyheadache.com/blog/daily-use-of-triptans/
https://www.ncbi.nlm.nih.gov/pubmed/14756859

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Re: Intractable migraine

Post  Kem10 on Wed Oct 05, 2016 11:14 am

Thank you so much for the info and especially for the coupon info for Sumatriptan, that will really help a lot. I have evaluated a number of the things you mentioned and none seem to apply but am stopping all of my supplements for a bit to see if that helps and if so adding them back one at a time to catch the guilty party. lol My migraines seem to always be triggered by hormone fluctuations which seems ridiculous at my age but there it is. In any case, am having a much better day today and that is so very welcome.
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