When Triptans Don't Work

Hi Folks~
I haven't posted in a long time but do check the boards regularly since I am still suffering like all of you. The good news is that my migraines tend to come in cycles these days. I am having better stretches - just came off of an 11 day stretch with little head pain and no migraines- YAY! So, the Topamax does help some.

Then, of course, my good stretch ended on Saturday and I'm back in a bad cycle again (hormones play a BIG role). I am currently trying my third triptan - Amerge, since Imitrex and Maxalt have not worked for me. They've been partially effective maybe 25% of the time, if that. I cannot rely on that at all.

My migraine specialist prescribed these three because they come in generic and are therefore affordable and covered by insurance.

Today, I woke up with a doozy and took the Amerge (generic equivalent) and once again, it has hardly done anything. I took a second a couple hours after the first, but to no avail.

I have asked my Dr for another plan since I think I must be one of those people for whom triptans just don't work well on but she just wants me to try another triptan. I know there are 4 more triptans to try but I am frustrated and don't really want to try them. I need something to help me when the migraines hit and I don't see my Dr until February (it's a two hour drive and appointments are hard to come by.)

So, I find myself taking Midrin for the milder/moderate migraines that I can catch in time, though that will not work if I wake up with one, which happens often during my bad cycle. Otherwise, I am desperate and take ibuprophen, and as a rescue Tylenol 3 if cannot sleep and am in agony.

I am acutely aware of MOH and also worried about it...to the point of deliberating sometimes for a half hour before I take anything. Anyway, I guess I am looking for advice and other's experiences (and I am also venting too....)

Thanks all and peace and pain-free days too all of us.... Jane

Your story is much like mine. I feel ya. Not sure if you have tried Treximet. That one works great for me. I do have to say that sometimes you have to be carefull with the generics, as the formula for the drug is not 100% of the original one. Take that into an account. Don't wait to long to take your meds, that can cost you in the long run as these type of meds only work in taken in the first signs of a migraine. Once the migraine gets past a certain point, no help from the meds, sad to say. I have learned this the hard way. Have you talked to your doctor about a med for your hormonal migraines?

I take naproxen 2 days before my cycle and once and sometimes twice a day during my cycle. It helps a lot. Also don't know if you take magnesium. I would look into it if you have not already. once I learned about now magnesium can help migrainers, I starting taking it. Still talk to your doctor. Start of on a low dose first. You can up the dose during your cyle time. I noticed a huge difference for me.

Sad to say but we do have to be carefull with how often and how close together we take these meds, too much, and then we run the risk of them not working very well.

Look into herbs and others treatments to try. Don't give up. And you might need to think of finding a doc closer to home.

Check out my blog http://throughthewordsofchronicpain.blogspot.com/

Thanks Chrissy~

I tried the Naproxen route last year for the menstrual migraines. That did not work, unfortunately.

As far as herbals and supplements, I've tried magnesium, feverfew, riboflavin, butterbur and others that I can't think of right now. All worked for a time and then stopped working eventually. I currently take 75 mg of Topamax daily and it is helping, but as you know preventatives don't have a 100% effecacy rate, hence I still get migraines, though fewer on the Topamax.

Yeah, I hear ya about waiting too long to take the meds, but what to do when I wake up with the migraines, which happens often.

That is interesting about the generics, but the insurance will only pay for the generics so that is a conundrum!

I really like my Dr - she is a Neurologist who heads a Headache Center in Boston. There is one Headache specialist who is a bit closer than that to me, but not enough to change Drs at this point. I live in a rural part of Mass.

Thanks for replying though. I am glad I am not alone in having problems with Triptans.

Peace!
Jane

Since you say you often wake up with a migraine have you thought of seeing a sleep doctor. You may need to do a sleep study. Have you looked into what you are eating. I have been living with headaches and migraines for over 25 years and I just recently started to get real serious about what I was putting in my body. I found that I CAN NOT have any caffeine, cheese, MSG, artificial sweenter. I just started to eat more clean. Stoped process foods and things that did not come from the ground or a tree. I saw a huge difference in just that.

I kind of look at it like this. Even if I try something and it works only a little, I am going to hold onto that little and keep useing it. I hear ya about having a good doctor. Just don't give up on trying new things.

Peace as well

I have talked to my Dr about maybe needing a sleep study and that may be my next step. But I'll have stretches when my sleep is fine and then periods when it is not good. I also have been diagnosed with Fibromyalgia which can have unrefreshed sleep as a symptom (though I do feel that is a wastebasket diagnosis IMHO...)

As far as the foods, I eat only whole foods, no processed foods whatsoever and I have been a vegetarian for nearly 20 years. No artificial sweeteners or MSG either. My body cannot stand any of it. It makes it challenging to go out to eat or attend parties, but I manage. I have also recently managed to take off alot of weight, and though that has definitely improved my health, it hasn't changed my migraines at all.

I have done many food elimination diets too, with bananas being the only food trigger I can identify, though the latest research shows food triggers to be much less important of a trigger for the majority of migraineurs than once thought. That was a relief as I was barely able to eat anything on the elimination diets, was miserable, couldn't figure out any triggers (cause there were none!) and still had migraines.

Anyway, I have to come to the place of accepting that I have this disease; it puts less pressure on me as if I have done something wrong in not finding the right treatment since I still have migraines. The acceptance allows me to not blame myself and to deal with the pain a little better (sometimes.) And like you say, even if something works a little, its better than it not working at all!!

Here's to all of us finding some peace! Take good care,
Jane

I just came off an 8 day stretch where I took 7 triptans over that time...Relpax and Treximet. Nothing was helping so I just stopped taking them and waited it out. Sometimes a triptan will help for a few hours and then it comes back with a vengeance.

I've been taking relpax for about 6 years and just started trying treximet out...I am finding that I am liking the treximet better. The side effects are not as bad and they seem to work. My dr. said there is an anti-inflammatory apart of it, so it helps with relief more.

Anyways...good luck with the generics. I haven't tried any of them...I pay quite a bit for my brand name even with insurance covering quite a bit of the cost.

Good luck with the Amerge. It did not work for me, but that is the only triptan anyone ever prescribed for me. No idea why they never tried any of the others.

Hi Jane

Sorry you're not having much luck with triptans. I know you're not keen to try another but if they are mainly hormonal, then Frovatriptan might be worth a try. Over here, it's recommended as the triptan most likely to help with menstrual migraines and it certainly helped me, having had them for 25 years. It can take a long time to work, which isn't good if you wake with one. Unfortunately I now take them just about every day - not good but it took a few years to get to that!

I wish you luck.
Liz Is it too early for one of these yet?

I have just had a migard fail me for the first time ever.
Load of side effects, but no relief....about an hour and then back....

Does anyone else have this occur please?
Scared me, I rely on them so much,.

P

pen wrote:I have just had a migard fail me for the first time ever.
Load of side effects, but no relief....about an hour and then back....

Does anyone else have this occur please?
Scared me, I rely on them so much,.

P

Pen--I've had this problem recently too. Dianne responded to me today in the "Brain Based Therapy" forum that after awhile our bodies get used to the drugs and they stop working as effectively. My Relpax is only working about 30% of the time when it used to work 100%. Treximet works 80% of the time...but I only just started taking it.

Part of my problem though is that I've had so many migraines lately that I have been taking a lot of triptans...and I think I'm building up a tolerance...

It scares me to death too...

Kim

Pen, yes it does happen - sometimes I've no idea why, at other times it's definitely the hormones. Now I've started going through the menopause and the hormones are everywhere, it's happening quite a bit. I don't think it definitely means you're become immune, although I know it can happen.

Liz

Thanks Kim and Liz.

It was such a shock. They always work.
They can be slow and the s/e vary, but they always help.

I got a load of heavy s/e and if it hadnt been for them I would have thought I took the wrong tablet.
I even stumbled (yes really) to the kitchen to check....nope definitely Migard...

I am not well. I have no idea what is wrong.
I have stupid symptoms so I assume a bug.
I have had stomach pains which move, so I supposed gas.
I have had waves of nausea, but not bad.
My years are ringing like mad, and I feel off balance.

I did consider the doctor, but can you imagine?
So what's wrong? Well I have belly ache.
Any D&V? No none.
What else? I have a headache that wont quit.
But you have headches anyway? yes I do...
And so on....

So I havent been but have now been "crook" for 9 days.
The only thing I can think is daughter's party or hospital appointment.
I havent been anywhere else and everyone else is fine.

But my migraine.......

I've been taking Maxalt since '98. It is still as effective for me as the first time I took it. One tablet totally wipes out the migraine almost all of the time. Very rarely I have had to take 2 tablets, spaced several hours apart. Even more rarely, maybe twice, I have had to take 3 tablets in 24 hours.


Chris

Great for you Chris. They used to work for me like that....Maxalt....
But they stopped working so well as they were wearing off after about 6 hours.
So I went onto Frova and they have been better.
This is a first.

BTW I went to the dr and came out feeling patronised and humiliated.
I got no resolution, but was given a bottle of Kolanticon....
I knew it would be a waste of time....

I dont even feel reassured....
NHS, great to have, but drs not so great...

P

I always take my triptans -currently Maxalt, before Zomig - together with percocet or two, or two T3
otherwise neither will work.
Also, most often that not the initial first dose is not enough to knock the M out.
I have to take at least two hrs later the next triptan,
in case of very severe M sometimes followed two hrs with another two triptans with two P.

have you thought of trying that?

Risa

Hi Risa,

Well all I have to go with the Triptan is OTC Anadin (Excedrin).
I dont even know what Perocet or T3 are. (the only T3 I know is for thyroid)
But I will google them .....

As for 2 Triptans.
I havent tried that because, great if it worked and knocked it out totally.
But:
a: the side effects are sometimes such that I wouldnt want to add to them.
b: If the second one didnt kill it, so that it didnt return the next day or day after.
I would not have enough for the month...

This is the very first time I have had a Migard not work.
It was strange. It did work a little for about an hour, but then stopped and was left with strong long lasting s/e.

I sure hope it is a one off.

Pen

Pen, it's Percocet not Perocet
I am not trying to be a smartypants, just so you not have a trouble looking it up
'anyway it's oxycodon with paracetamol and the other is Tylenol with codeine # 3.

And yeah, I get that you need to save your triptans, as for s/e - is it with every triptans the same,
have you tried each of them?

Risa

Thanks Risa, I looked it up right, but spelt it wrong...
Well its 1.30am here, I guess I should be asleep....

I found it, but it doesn't come with the paracetamol.
I am sure someone form England will correct me, but it seems it is only available for things like cancer pain?????

Now the T3, or course, I couldnt find, but thanks for explaining.
So its Paracetamol with codeine.....
I guess we have them. My husband gets Propain which has 30mg codeine with paracetamol.

I have a lot of problems with codeine. Never used to.
Took Dihydrocodeine for years, but it makes me feel very very strange now.
Dont know if that is common.

Yes i have had all he triptans Risa and Frova is the best for side efects.
They are usually not too bad, but once in a while I get them bad.

I do think because I have had a bug or something, my system reacted strangely.
Sure hope thats all it is.

Thanks for trying to help me.
Now I better sleep.

Night.

Pen

I found it, but it doesn't come with the paracetamol.

Pen, Percocet (brand name ) is a combination of oxycodone and acetaminophen (paracetamol)
http://www.medbroadcast.com/drug_info_details.asp?brand_name_id=921

Oxycodone and Oxycontin are single ingredients of other medications containing this narcotic pain reliever.
My Percocet contains 325 mg od acetaminophen (paracetamol.).

Yes it is used for also cancer, so is Tramadol.
It doesn't mean it is indeed so strong it will magically always relieve the head pain. Unfortunately it will not.
Just because it says "for cancer", it doesn't mean it's something that special, Pen. It's just a pain reliever,
you know, stronger than T3, is all.
I don't know about England but here as you see is Rx for M, too.
notice how it says:
to relieve moderate to moderately severe pain, including conditions associated with fever.

(moderate to moderately severe, Pen. not even just severe)

It doesn't specify for what kind of diseases - it says what kind of PAIN.

I'd say it's only fair, instead of deciding this patient gets it because he has cancer and this doesn't because it's just migraine.

As for T3, in Canada it contains acetaminophen 300 mg, codeine 30 mg and caffeine 15 mg, in USA just codeine
and acetaminophen. But we do have 'US version', only it's called for example Emtec 30.
That's what I was taking, to be precise, for many many years.

I have a lot of problems with codeine. Never used to.

My Dad couldn't take codeine, he got severe nausea from it, and seems like my daughter has it, too.
Also dizziness. They disliked T3 intensely.
They did well on Tramadol, though, which strangely is also opioid analgesic but perhaps works a bit differently.
Tramadol however can not be taken with triptans, as I recently found out. How unfortunate.

I hope you'll find something that will work well for you, Pen.

Risa

Thank you Risa. Kind of you to take all that time explaining for me.
When my head is a bit more with it, I will check it all our here.

Thank you.

Pen

Hi Pen,

I have said it a couple of times on this forum before, but the effect of a triptan gets enhanced by taking it together with a tiny dose of amitryptiline (5mg). Triptans don't work when I have my period and that is when my secret weapon comes out. I don't take amitryptiline daily. I would turn into a zombie, but for emergencies it works wonders for me.

Love

P.

My pleasure Pen

Petzi - but how about the serotonin syndrome? Is it that it is a very little dose of ami.. you are not worried about it?

Risa

Risa,

At this low dose I don't really worry about Serotonin syndrome. Amitriptylene was prescribed to me as one of the first preventatives to try out about 10 years ago. I took 50mg daily for a couple of weeks (as well as plenty of triptans). I could not bear the side effects and stopped taking it daily.

Now I prefer to take a triptan together with a miniscule dose of ami to knock a persistent menstrual migraine on the head instead of taking 3 triptans over the course of 3 days and spending most of those 3 days in bed. I take 5mg of ami once a month. I would not call this excessive and it works for me.

P.

Patronizing and useless doctors are epidemic unfortunately. And we don't help our cases when we cannot communicate effectively while in the office, which is often the case if not feeling well. I find it can be helpful to write out a detailed description of the symptoms (type, frequency and severity) beforehand that you can hand the doctor instead of them going off on tangents. Be sure to list the most important symptoms or issues first as they tend to anchor on the early information. They will still ask followup questions, but it gets the meeting off to a better start.