Work and migraines..

I'm new here and wondering how others manage to stay employed when experiencing migraines a few times a week....

I'm currently only working part time and wondering how to manage full time employment later on. I've recently started o a med that works well (my migraines aren't severe) but there is still the related fatigue and other symptoms All this week, for example, I've been getting frequent auras with vertigo and visual disturbances (it's hard to type and read right now) it can be a pretty ovrewhelming.

thx

It can be difficult. I managed to stay employed as an engineer for 15 years with migraines. Zomig, and before I was diagnosed, lots of Aleve, Advil and Motrin. If you get insurance as a full time employee, find a good Psychiatrist/neurologist and get an Rx for Imitrex or Zomig. That will help a lot.

Zomigman,

I am glad it is working for you, but many drugs also produce side effects for many of us. Zomig gave me a serious bout of chronic rhinitis. It made me suddenly allergic to everything, including my husband. It took a couple of months to figure out the problem. Once I stopped taking it all the mysterious allergies went away. My headaches did not improve at all.

So the sad truth is none of theses drugs seem to work for everyone, just a small subset of them. Many cause side effects ranging from annoying to life threatening. It's good to try new things, but always do so with caution.

I manage to get through my weeks (about one sick day every 2 weeks at the worst), but unfortunately get nailed on weekends and a lot of weekends end up being a write-offs because I am stuck in bed. It's almost like I just barely hold off the migraines until I am off work. I have on pain killer (percocet) that can get me through a good chunk of a day with minimal side effects while still allowing me to function at my job. That's usually enough to get me home and take Maxalt or Frova. It's pretty tough for me to take either of those and function at work though. I have tried, but I am better off just going home as I can't function properly. You may be able to, everyone is different. I do know some people who can function on those meds at work. You really only know by trying.

The 'weekend migraines' a horrible situation because I want to be able to work because I feel useless if I can't... but then my personal life takes a beating being sick on when I am off work all the time.

On the bright side, I have been having some success with Topamax. If your migraines are that frequent, you may want to see a specialist and go the route of a daily med like that.

Hmm...I have a job that gives me some flexibility and I work w. people who are largely understanding (several of whom suffer from migraines themselves), but even so it is tough. And some tasks/events are absolutely fixed; I have to be there and be functional.

When I MUST be alert and even lively -- public presentations etc. -- and have a very bad migraine, I take Fiorenal; the caffeine in the drug tends to help make me functional especially as I rarely otherwise take caffeine. (For regular coffee or cola drinkers it may not work the same way.)

But Fiorenal has to be taken w. some care as it can cause rebound headaches etc. You certainly should not take it every day and probably should not take it more than 2X a week. Same with non-prescription drugs w. caffeine like Excedrin for Migraine.

Maxalt which is my general 'go to' drug for migraines can make me sleepy, but I have used it at work. I sometimes find that when I absolutely have to be functional a certain amount of adrenaline kicks in despite headache pain and drug side-effects.

And I do occasionally get through a stressful series of work days w. no headache...and boom--on weekend I get one that I think is going to KILL me.

I honestly don't know what I would do if I had a very, very fixed eight-hour days w. no flexibility--I know very well that most jobs do and it's hard to advise people except to say that a good preventive drug is probably the best option. It may take a few tries to find one that is just right for you. Best of luck.

At my worst, I was getting 3-4 migraines a week, each lasting 4-10 hours. Luckily, at least one was on the weekend( I often had migraines ALL weekend!). My employer would let me flex my hours, so I would make up lost time from one day over the next two days, or work weekends if I wasn't too sick.

Still, I would take a sick day every two weeks at the worst. I thought I was going to have to go on disability before I finally found a preventative that worked and keeps migraines down to a few a month.

-Peter

Migrainegirl wrote:Zomigman,

I am glad it is working for you, but many drugs also produce side effects for many of us. Zomig gave me a serious bout of chronic rhinitis. It made me suddenly allergic to everything, including my husband. It took a couple of months to figure out the problem. Once I stopped taking it all the mysterious allergies went away. My headaches did not improve at all.

So the sad truth is none of theses drugs seem to work for everyone, just a small subset of them. Many cause side effects ranging from annoying to life threatening. It's good to try new things, but always do so with caution.

Sorry that Zomig did not work for you. I seem to tolerate it well, for whatever reason. I do not tolerate many drugs very well either. I also have many allergies, and I can no longe take Aleve/naproxyn as I was on it for too many years for severe back pain. I am also allergic to several antibiotics and beef, and I have to avoid a ton of foods that have tyramine in it to reduce the number of migraines. When I first went on Zomig I cut the 2.5mg tablets into quarters to test it, and ramped my way up to a 2.5mg dosage.

I would have to disagree that drugs like Zomig and Imitrex only work for a small subset of migraine sufferers though. I know (and have known) a lot of people that get migraines (I am in a large family with many cousins that get them, as well as friends), and all of us take either Zomig and Imitrex and get relief from using them. While that is my own limited perspective, looking online there are studies with lots of statistics of migraine cases that are improved using the half dozen or so Rx Triptans available out there, including: Amerge® (naratriptan), Axert® (almotriptan), Frova® (frovatriptan), Imitrex® (sumatriptan), Maxalt® (rizatriptan) , Relpax® (eletriptan) , Treximet® (sumatriptan + naproxen sodium), and Zomig® (zolmitriptan). Bottom line is that Triptans greatly improve migraines in about 60% of cases compared to placebo. 80-90% of tested cases improved in at least one in 3 migraines. That is not a small subset.

I would appeal to you to try some other Triptans if Zomig did not work for you. Many people have different results from taking different Triptans for migraines. While I agree that Triptans are not for everyone, and they certainly have their associated side effects and dangers, the benefits outweigh the risks in my view. I would also warn people that Triptans are not to be taken as a daily preventative, as they have the potential for heart valve scarring and other risks. That said, I simply cannot function with a migraine, never mind the intense pain and dismal feelings that I get when I have one. Zomig does not always work for me, though it does about 80% of the time. So I take it. It is not cheap either. I get mine in the UK for cheaper than in the US, but it is still expensive. I found that a lot of pharmacies do not always have it in stock either, and when I was in the hospital last year they did not have it. I took Imitrex there instead and that that worked the same for me as Zomig did.

Here are two detailed studies available online of the Triptans listed above with statistics on results, toleance and all kinds of tests vs. placebo:

http://ferran.torres.name/download/shared/ejemplos/migrana%20metaanalisi.pdf
http://www.meduniwien.ac.at/user/juergen.messner/Migraine.pdf

ZomigMan wrote:

Migrainegirl wrote:Zomigman,

I am glad it is working for you, but many drugs also produce side effects for many of us. Zomig gave me a serious bout of chronic rhinitis. It made me suddenly allergic to everything, including my husband. It took a couple of months to figure out the problem. Once I stopped taking it all the mysterious allergies went away. My headaches did not improve at all.

So the sad truth is none of theses drugs seem to work for everyone, just a small subset of them. Many cause side effects ranging from annoying to life threatening. It's good to try new things, but always do so with caution.

Sorry that Zomig did not work for you. I seem to tolerate it well, for whatever reason. I do not tolerate many drugs very well either. I also have many allergies, and I can no longe take Aleve/naproxyn as I was on it for too many years for severe back pain. I am also allergic to several antibiotics and beef, and I have to avoid a ton of foods that have tyramine in it to reduce the number of migraines. When I first went on Zomig I cut the 2.5mg tablets into quarters to test it, and ramped my way up to a 2.5mg dosage.

I would have to disagree that drugs like Zomig and Imitrex only work for a small subset of migraine sufferers though. I know (and have known) a lot of people that get migraines (I am in a large family with many cousins that get them, as well as friends), and all of us take either Zomig and Imitrex and get relief from using them. While that is my own limited perspective, looking online there are studies with lots of statistics of migraine cases that are improved using the half dozen or so Rx Triptans available out there, including: Amerge® (naratriptan), Axert® (almotriptan), Frova® (frovatriptan), Imitrex® (sumatriptan), Maxalt® (rizatriptan) , Relpax® (eletriptan) , Treximet® (sumatriptan + naproxen sodium), and Zomig® (zolmitriptan). Bottom line is that Triptans greatly improve migraines in about 60% of cases compared to placebo. 80-90% of tested cases improved in at least one in 3 migraines. That is not a small subset.

I would appeal to you to try some other Triptans if Zomig did not work for you. Many people have different results from taking different Triptans for migraines. While I agree that Triptans are not for everyone, and they certainly have their associated side effects and dangers, the benefits outweigh the risks in my view. I would also warn people that Triptans are not to be taken as a daily preventative, as they have the potential for heart valve scarring and other risks. That said, I simply cannot function with a migraine, never mind the intense pain and dismal feelings that I get when I have one. Zomig does not always work for me, though it does about 80% of the time. So I take it. It is not cheap either. I get mine in the UK for cheaper than in the US, but it is still expensive. I found that a lot of pharmacies do not always have it in stock either, and when I was in the hospital last year they did not have it. I took Imitrex there instead and that that worked the same for me as Zomig did.

Here are two detailed studies available online of the Triptans listed above with statistics on results, toleance and all kinds of tests vs. placebo:

http://ferran.torres.name/download/shared/ejemplos/migrana%20metaanalisi.pdf
http://www.meduniwien.ac.at/user/juergen.messner/Migraine.pdf

The thing is, if you are getting very frequent migraines you may be better looking into preventative options and not relying on constantly taking Triptans. It took me awhile to find a daily preventative that was effective with tolerable side effects, but I already feel a million times better than when I was just taking Triptans multiple times a week now. Even the most tolerable Triptans (for me) generally gave me a 'medication hangover' for a day after taking them. Yes effects vary from person to person, but I have yet to meet someone in person who takes those drugs who doesn't describe the side effects as harsh. It's not that they don't work, it's just that they can be brutal on the body if you are taking them frequently, which you pointed out yourself. If someone was looking for a solution to get through a working life with really frequent migraines, relying on Triptans would not be what I would personally recommend. I would see a specialist/neuro and see what you can do as far as a preventative treatment as well.

Been there and done all of that. I have had a really good psychologist/neurologist double specialist for 7 years and we went though the gambit of Rx meds for my migraines. He was the first one to accurately diagnose them; several other neuro specialists mis-diagnosed me with cluster or stress headaches and gave me some terrible Rx meds for them. One was so bad I was contemplating suicide and I threw them away. Men are more commonly mis-diagnosed, as women are 2-3 times more likely to get them.

As for side effects, Zomig really gives me few if any side effects. No more than Advil, really. Non-issue for me. Also the so called side effects are commonly not not due to the Rx, but rather than to the migraines themselves. Triptans aleviate the pain of the migraines, but they do not get rid of the migraine, as it were. The thing will run its course if you take Triptans. I have never found a bullet proof preventative for migraines, and I am not aware of any out there for my type of them, other than avoiding triggers as much as possible (in my case, that is mainly tyramine in food and opiate meds). My cure as it were is to take Triptans when I get them, and right now that is Zomig and it is very effective for me with little or no side effects.

I am not saying that Triptans for migraines is the cure-all for everyone with migraines. There are different types of migraines and different causes for them in different people. However, looking at the medical staistics and the results, it is hard to argue that Triptans are not an effective medication for a majority of us. I advocate that my "solution" is one that is available, and one should consider it if they are in continued pain and suffering from migraines, as many here obviously are. And so again, my response to the original question is that Zomig is how I get through the work week as an engineer... with migraines.

I do take a triptan - Frova, which sometimes works if I take with an oxycodone. It's pretty hit or miss really. But no luck with preventatives for the most part. They all seem to produce one weird side effect or another, sigh....

But back to your question on working. Your best bet is a job with flexible hours. I work from home and can generally flex around the really bad ones. It's about the only reason I've been able to keep going the last 5 years.

ZomigMan wrote:Been there and done all of that. I have had a really good psychologist/neurologist double specialist for 7 years and we went though the gambit of Rx meds for my migraines. He was the first one to accurately diagnose them; several other neuro specialists mis-diagnosed me with cluster or stress headaches and gave me some terrible Rx meds for them. One was so bad I was contemplating suicide and I threw them away. Men are more commonly mis-diagnosed, as women are 2-3 times more likely to get them.

As for side effects, Zomig really gives me few if any side effects. No more than Advil, really. Non-issue for me. Also the so called side effects are commonly not not due to the Rx, but rather than to the migraines themselves. Triptans aleviate the pain of the migraines, but they do not get rid of the migraine, as it were. The thing will run its course if you take Triptans. I have never found a bullet proof preventative for migraines, and I am not aware of any out there for my type of them, other than avoiding triggers as much as possible (in my case, that is mainly tyramine in food and opiate meds). My cure as it were is to take Triptans when I get them, and right now that is Zomig and it is very effective for me with little or no side effects.

I am not saying that Triptans for migraines is the cure-all for everyone with migraines. There are different types of migraines and different causes for them in different people. However, looking at the medical staistics and the results, it is hard to argue that Triptans are not an effective medication for a majority of us. I advocate that my "solution" is one that is available, and one should consider it if they are in continued pain and suffering from migraines, as many here obviously are. And so again, my response to the original question is that Zomig is how I get through the work week as an engineer... with migraines.

Are you suggesting a forum full of migraine suffers (many who have been suffering their whole lives) don't know the difference between the side effects from a Triptan and an migraine? The side effects of a Triptan are VERY distinctive. They are horrible. It's absolutely fantastic that you don't get them. But if you did, you would see where other people's advice is coming from. The idea of working with those side effects is pretty much impossible. And unfortunately the side effects do seem to be very common.

I personally was not suggesting Triptans don't work, as they do work for me. It's just that none of none of them with the exception of possibly Frova allow me to function even close to normally until they wear off (and even Frova is borderline). You should try everything without a doubt. What I was saying is that the OP should be prepared for the very real possibility that they may not be a solution that can get him through a work day. If you setup a poll on this forum, you'd likely find the majority of people can't not perform their job adequately on Triptans. It's fantastic that you can, but I have never met anyone in person who can and haven't read posts from very many people who can on this forum. People should use all options available to them, but that includes at least trying to see a specialist and see what they suggest as well. Especially if you are in a situation where you are concerned you can't manage being employed.

Actually, I would suggest that Triptans and other drugs taken for migraines (ie., aspirin, ibuprophen, opiates, etc.) do have some side effects similar to those of migraines. Triptans, opiates and the NSAIDs have rather complex interactions on several elements of metabolic function that could and would cause all kinds of side effects. From my own experience over 40 years of having migraines, I would suggest that yes indeed, drug side effects can and may be confused with migraine side effects. They are also commonly misdiagnosed because of side effects, and/or the effects of drugs being taken with and/or for them. Its all part of the signs and symptoms stew that the medical profession has to wade through, as it were.

What exactly are all the side effects of a migraine? Mild to blinding mind-splitting headaches; slight stomach upset to entire gastro-intestinal shut-down; mild to massive bloated gas effects; a high blood pressure response to tyramine (in my type of migraine) that can result in a hypertensive crisis that in itself be confused with anything and everything from dizzy spells to anxiety attacks; visual auras that vary in intensity and effect;... yadda yadda. Now what are the side effects of common drugs taken for headaches? Take aspirin for example. That also gives me stomach upset. But so do most of my migraines. Opiates give me all kinds of side effects, including a splitting migraine the next day after being given dilauded and morpheme. Which has me wondering why people take synthetic opiates for migraines (seems to me that they would just be setting themselves up for more migraines, which would be the result in my case anyway).

I am somewhat befuddled with these replies about the terrrible Triptan side effects. Maybe it is more the case here that people that do not have issues with Triptans do not seek help from a forum like this one, as they have a remedy for their migraines? I do not believe that Triptans would have ever been FDA approved if the majority of people had terrible side effects from using them, as you suggest. Also published clinical trial results of side effects of Triptans simply do not support the claim that the side effects for the majority are extreme. That is why I posted them here in my earlier replies. Also I can say that in my family including first and second cousins, there are 8 or so of us that are or were on Triptans at some time, and we all work and there are few side effects from using them (far fewer than the migraines themselves). Our migraines are not all the same type either. Some have auras, some do not. Some like me are sensitive to Tyramine, and others are not. I also know and have known about a dozen other people with mirgaines and most take or took Triptans for them (usually Imitrex, some took others).

I don't know if strong side effects triptans are common or not but my doctor pulled me off of them. I tried Imitrex, regular Maxalt and Maxalt MLT, and two newer ones that I forget.

The Imitrex and the newer ones make me feel like there is pressure in my chest and/or a lump in my throat as they are coming on. Not a big deal. That goes away in about 15 minutes.

The problem was - my blood pressure shoots up during a migraine to as high as 180/90. When the triptans were taking effect my BP would spike even higher to around 240/120. This happened twice in the ER and and they brought a cardiologist out the 2nd time who said he felt it was too risky to take triptans. He communicated this back to my primary who monitored me a couple of times while I took triptans and found the same effect. My primary then said she was unwilling to continue prescribing them to me.

I would have fought to take them anyway if they worked better. I only got a couple hours relief from the Imitrex, even less from the Maxalt. My doctor said some have longer action but wouldn't prescribe them so I don't know how that would work.

The other problem is my neurologist felt my migraines were too frequent to treat with an abortant and I should use preventatives only. But I would like a decent abortant as back up.

-Peter

Peter -

Wow, that is exactly my story. I had the exact same side effects. I ended up in the emergency room after my neurologist injected me twice with Imitrex. She sent me there for pain relief and when they took my bp, people started running everywhere because they thought I was having a stroke. Some migraines symptoms can be similar to stroke so they had me pretty scared. But I came through it okay. (just knock me out!!)

Not long after that, it caused actual chest pain and that was my last Imitrex. I now stay away from the triptans. Too bad, I know a lot of people who can use them and they are a big help.

-Cathy

Cathy wrote:Peter -

Wow, that is exactly my story. I had the exact same side effects. I ended up in the emergency room after my neurologist injected me twice with Imitrex. She sent me there for pain relief and when they took my bp, people started running everywhere because they thought I was having a stroke. Some migraines symptoms can be similar to stroke so they had me pretty scared. But I came through it okay. (just knock me out!!)

Not long after that, it caused actual chest pain and that was my last Imitrex. I now stay away from the triptans. Too bad, I know a lot of people who can use them and they are a big help.

-Cathy

ZomigMan, I am not attempting to debate you to be jerk, the 2 posts above are similar to stories I hear VERY frequently relating to Triptan side effects. I had this issue myself with Imitrex and won't touch it with a 10 foot pole because of it. It's nowhere near as bad with other Triptans, though I do get a minor version of the same side effects. I get the chest pain on ALL Triptans, along with pins and needles and sore joints. It's just a matter of how severe it is from med to med. Because of that, it's impossible to take them and work a physical job. I have always been told by my doctor that these side effects are not rare by any means and that a lot of people can't take Triptans because of them. I do not get those symptom from the migraine or any other meds I take for the migraines.

But.... the simple fact is getting rid of the migraine outweighs these side effects in some cases for me. Frova only gives me minor sides so I take it. But I can't function at work on it still. If I take it, it requires a sick day because of the side effects mentioned above. And a lot of other people are in the same vote. A lot of others are not. The only point I was ever making was that it's a realistic possibility that any person could fall into the first category, and they should be prepared for that possibility. I'm not sure why you take such exception to that point just being brought up?

how about a little positive note for a change? (i'm usually the prophet of doom.....)

i have relied on triptans for almost 20 years. the past several years i've had to take one or another almost daily. most all drugs give me side effects, in the form of more migraines and more pain in general, plus fatigue.

BUT i have had no side effects, zero, in all these years from imitrex, maxalt, and amerge. the other 4 triptans tried did not help.

certainly, i could not have a 30-hours/week job at age 72 if not for these miracle drugs. i feel great sympathy for those who find the triptans are useless. and i always add, as other people have, here on this forum, 'if one doesn't work try another and another'. unless, of course, they have intolerable side effects. dianne

tdu wrote:ZomigMan, I am not attempting to debate you to be jerk, the 2 posts above are similar to stories I hear VERY frequently relating to Triptan side effects. I had this issue myself with Imitrex and won't touch it with a 10 foot pole because of it. It's nowhere near as bad with other Triptans, though I do get a minor version of the same side effects. I get the chest pain on ALL Triptans, along with pins and needles and sore joints. It's just a matter of how severe it is from med to med. Because of that, it's impossible to take them and work a physical job. I have always been told by my doctor that these side effects are not rare by any means and that a lot of people can't take Triptans because of them. I do not get those symptom from the migraine or any other meds I take for the migraines.

But.... the simple fact is getting rid of the migraine outweighs these side effects in some cases for me. Frova only gives me minor sides so I take it. But I can't function at work on it still. If I take it, it requires a sick day because of the side effects mentioned above. And a lot of other people are in the same vote. A lot of others are not. The only point I was ever making was that it's a realistic possibility that any person could fall into the first category, and they should be prepared for that possibility. I'm not sure why you take such exception to that point just being brought up?

My exception here as it were is that you and several others have claimed that Triptans are not effective for the majority of people, and/or that Triptans have such severe side effects for the majority of users that anyone taking them cannot work or otherwise function when taking them. That is contrary of my own experience using them and the many published results of studies on Triptans that indicate that Triptans are effective in a majority of people with migraines, and that the majority of them do not suffer extreme or severe side effects. In my view you are needlessly scaring people into thinking that Triptans are not effective, or that they will cause them to have such severe side effects as to their being ineffective to use.

I am not saying that Triptans are completely safe, or that everyone should use them, or that everyone will not have side effects. Side effects can and do occur with any drug and any substance. As posted here, obviously some people have severe reactions to Triptans and they simply cannot use them, or they have to run through the entire smorgasboard of them to find one that works. However, I would not hesitate to tell people that get migraines about them, and as the majority of people seem to get good or better results using them without severe side effects, I would recommend them to anyone that suffers from migraines and has not tried them. Triptans are effective in reducing migraine pain by countering the vaso-dialation that causes the pain in migraines. So in the process of reducing migraine pain, they raise your blood pressure. For that reason, if you are at risk for a heart attack or stroke or have high blood pressure, you should beware of using Triptans for migraines.

I have a post-it on my bathroom mirror that says, "Don't get hooked on the cure". I take Triptans only as needed and I take as little as possible to get rid of migraines. I have not found them to be addictive or to have severe side effects. They work for me in about 90% of my migraines. I have low blood pressure and I am in really good physical shape, so I am not at risk for a heart attack or a stroke. I also do not have any adverse effects using Triptans, and they are very effective in reducing or eliminating migraines that would otherwise have me in bed for a day or days at a time, and taking all kinds of pain killers. Triptans are VERY expensive. Zomig can run anywhere from $10-$40 per pill, and insurance may or may not reduce the cost. For that reason I would not expect anyone to eat them like candy, but my doctor tells me that some people take them daily to prevent migraines (against his recommendation). I have found it better to try to prevent migraines from happening by avoiding foods that have tyramine, and in the event I do get a migraine, I take Triptans at the fist sign of onset (usually a sharp headache on one side of my head behind either eye).

Triptans are generally safe, the chest pain many experience is not cardiac but likely due to spasms in the esophagus as the tiptan takes effect, according to recent studies. But they are not that effective.

When I was first diagnosed with migraines, injectable triptans had recently become available and were considered extremely effective. In fact, some doctors felt that if your migraines didn't respond to triptans, they weren't really migraines.

So I was upset when I was told I couldn't use triptans as I REALLY wanted something that worked. But my neurologist said not to feel bad, that the earlier studies had dramatically overestimated how well they worked.

When done with proper randomized, double-blind methodologies, they found much lower response rates . Only about 1/3rd of people get a good response with any one triptan (using the maximum dose). See:http://www.ncbi.nlm.nih.gov/pubmed/11152011

And of those that do get an effective response, 30-40% have the migraine come back when it wears off.

I've seen a number of studies finding the same result. In fact this one lists the meta results of up to 10 studies and finds slightly lower response rates:
"Meta-analysis of Oral Triptan Therapy for Migraine: Number Needed to Treat", J Managed Care Pharm. 2003(9)
See table 2.http://www.amcp.org/data/jmcp/research-45-52.pdf

For example, Imitrex at 100 mg:
The combined study had 1,837 treated with Imitrex, Of these 559 (30.4%) had relief. 895 received placebo and 70 (7.8%) had relief. The number needed to treat is thus 4.7 patients. (95% confidence interval:4.0 – 5.9). The most effective triptan was Rizatriptan 10 mg, where nearly 41% of patients got relief compared to 8.5% on placebo.


These are numbers for being pain free after 2 hours. It is likely more people get a reduction of their migraine from the triptans but still have symptoms. Of course, these people rebound more as the triptan wears off.

It's also likely that if you keep trying different triptans until you find one that work, you'd get a higher response rate. But from what I've read, more than 50% of migraine sufferers don't get any significant relief from triptans. That's why researchers are hard at work looking for better abortants.

One last paper, a easier to read 2010 Consumer Report:
"Treating Migraine Headaches: The Triptans - Comparing Effectiveness, Safety, and Price including best buys"
http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf

Good paper to check out.

The moist effective triptan here is (Table 2):
Axert 25 mg. 34% to 35% have relief at 1 hour, 57% to 75% have some relief at two hours, 18% to 52% have complete relief at 2 hours.

So even looking at "some relief", a lot of people are left out in the cold.

ZomigMan wrote:

tdu wrote:ZomigMan, I am not attempting to debate you to be jerk, the 2 posts above are similar to stories I hear VERY frequently relating to Triptan side effects. I had this issue myself with Imitrex and won't touch it with a 10 foot pole because of it. It's nowhere near as bad with other Triptans, though I do get a minor version of the same side effects. I get the chest pain on ALL Triptans, along with pins and needles and sore joints. It's just a matter of how severe it is from med to med. Because of that, it's impossible to take them and work a physical job. I have always been told by my doctor that these side effects are not rare by any means and that a lot of people can't take Triptans because of them. I do not get those symptom from the migraine or any other meds I take for the migraines.

But.... the simple fact is getting rid of the migraine outweighs these side effects in some cases for me. Frova only gives me minor sides so I take it. But I can't function at work on it still. If I take it, it requires a sick day because of the side effects mentioned above. And a lot of other people are in the same vote. A lot of others are not. The only point I was ever making was that it's a realistic possibility that any person could fall into the first category, and they should be prepared for that possibility. I'm not sure why you take such exception to that point just being brought up?

My exception here as it were is that you and several others have claimed that Triptans are not effective for the majority of people, and/or that Triptans have such severe side effects for the majority of users that anyone taking them cannot work or otherwise function when taking them. That is contrary of my own experience using them and the many published results of studies on Triptans that indicate that Triptans are effective in a majority of people with migraines, and that the majority of them do not suffer extreme or severe side effects. In my view you are needlessly scaring people into thinking that Triptans are not effective, or that they will cause them to have such severe side effects as to their being ineffective to use.

I am not saying that Triptans are completely safe, or that everyone should use them, or that everyone will not have side effects. Side effects can and do occur with any drug and any substance. As posted here, obviously some people have severe reactions to Triptans and they simply cannot use them, or they have to run through the entire smorgasboard of them to find one that works. However, I would not hesitate to tell people that get migraines about them, and as the majority of people seem to get good or better results using them without severe side effects, I would recommend them to anyone that suffers from migraines and has not tried them. Triptans are effective in reducing migraine pain by countering the vaso-dialation that causes the pain in migraines. So in the process of reducing migraine pain, they raise your blood pressure. For that reason, if you are at risk for a heart attack or stroke or have high blood pressure, you should beware of using Triptans for migraines.

I have a post-it on my bathroom mirror that says, "Don't get hooked on the cure". I take Triptans only as needed and I take as little as possible to get rid of migraines. I have not found them to be addictive or to have severe side effects. They work for me in about 90% of my migraines. I have low blood pressure and I am in really good physical shape, so I am not at risk for a heart attack or a stroke. I also do not have any adverse effects using Triptans, and they are very effective in reducing or eliminating migraines that would otherwise have me in bed for a day or days at a time, and taking all kinds of pain killers. Triptans are VERY expensive. Zomig can run anywhere from $10-$40 per pill, and insurance may or may not reduce the cost. For that reason I would not expect anyone to eat them like candy, but my doctor tells me that some people take them daily to prevent migraines (against his recommendation). I have found it better to try to prevent migraines from happening by avoiding foods that have tyramine, and in the event I do get a migraine, I take Triptans at the fist sign of onset (usually a sharp headache on one side of my head behind either eye).

Again, everything you are saying is fair based on your own experiences. I don't claim to be an expert, but I just think you are underestimating the instances of side effects though. And while I don't want to post any info on effectiveness because I don't know any (and again, they work for me), I think over estimating the effectiveness on a wide group. I will leave it up to other forum members with more knowledge on that matter though (like the poster above) to discuss that issue. I will only speak to side effects. I have had migraines since I was 7 and I am 36 now. I have seen numerous specialists in that time, and have been told by all of them that the side effects I experience are quite common. I have been told the same by my GP's and emergency room doctors. So you are posting advice for the OP based on your experiences, but the rest of us are simply posting a word of caution based on our own experiences. I don't think anyone said not to at least try them out. Just to prepare for either scenario or something in between.

Well, at least someone is posting studies to debate the studies that I posted. So one would conclude after reading them that Triptans are effective in a smaller population than the original published results. However, it is hard to say what the actual effectiveness is by this contrast in results published. Somewhere between 30% and 80% effective, depending on where you look (the average of which is still 50%). Or Triptans are becoming less effective over time, or as they are used in a wider population. As for migraine diagnosis that is another huge issue in this process, as some people seem to have other types of headaches. My migraines were mis-diagnosed until I was in my mid 40s. I guess as Triptans are effective for getting rid of my headaches, my headaches are properly diagnosed as migraines? TOC here... I read that cluster headaches may also be treated with Triptans (though I think that migraines are being mis-diadnosed as cluster headaches). After being admitted to emergency room situations on several occasions, I have a rather low regard for emergency room doctors. I am also on the local ski patrol, and I see a lot of cases in the first aid room myself. My father was also a mal-practice lawyer, so I read a lot of medical cases from the age of 12. But putting all that aside...

I am still inclined to think that when people are happy with a med for migraines, they are less apt to post online in forums like these. It seems that forums like this one wind up with more people who are not responsive to available meds. That is my narrow view anyway. Also from my many discussions on migraines and Rx drugs used to treat them with my rather prominant neurologost/psychiatrist (double specialist) at Stanford Medical Center, Triptans are effective in his cases the majority of the time. If anything, he believes that his patients tend to over-medicate using them and rely on them more than trying to avoid migraine triggers. Some even take them as preventatives, before eating or being exposed to whatever triggers their migraines. He says that a lot of his patients cannot always get Zomig scripts filled when pharmacies run out, as has been my experience. So a heck of a lot of people are taking Triptans out there. My feedback and that from my neuro doctor anyway. Also it seems to me that most people on this forum use Triptans of some type or other, even the ones that say they are not effective, or if they have extreme reactions to taking them.

So to put things into my personal perspective, Triptans are VERY effective for my migraines (as well as for others in my family). I had a migraine this morning and I took a Zomig an hour ago and it is fading away now... all but gone. No real side effects that I can tell. I get few rebound headaches after taking Zomig. As I have posted before, my migraines are generally triggered by amines like tyramine. Supposedly about 30% of migraines are triggered in this way. More are being triggered this way as the result of people being put on MAOIs, so the percentage of this type of migraine is actually growing. I have yet to find a study that separates out the triggers for migraines and the effectiveness of Triptans. I am also a male, and most people that get migraine are females. Maybe there is some significant aspect to that as well, I do not know. In doing research on my migraines, I have come to believe that my migraines are but one symptom of a rather complex process of digestion of food intake and the resulting amines in the bloodstream. Typically MAO-A in the gut would process amines like tyramine before they get to the blood vessels to cause vaso-constriction, and the resulting vaso-dialation and migraines. Tyramine causes a spike in blood pressure by constricinting blood vessels. People on MAOIs have to be carefull about eating tyramine or they may get a huge blood pressure spike that can cause a stroke or heat failure. They are also likely to get migraines from eating tyramine rich foods.

So perhaps we need to sort ourselves out here. There seems to be wide variation in types of migraine triggers, types of migraines experienced, and types of Rx drugs that are effective for them. Finding your type and triggers are critical. Avoiding the triggers after finding them is also critical (though not always possible). Having them diagnosed properly, and then figuring out what drugs may be effective for treating them is also critical. All of these would be effective methods for answering the OP here... I am not trying to beat a dead horse, the horse is alive and well, and people need some type of reasonable answer in their quest for treatment of this horrible 'disease'.

I think you are right, there is a bit of a filter here, we are seeing the more extreme end of migraines.

I think most of the people here are here because their migraines are or were causing a significant impact on their lives.

But many still post after they find a good solution to their migraines. Sort of like veterans who get together to talk about the war, because nobody else could understand what it was like to be there.

I'm the latter. For about 10 years my migraines were destroying my life. Believe me, I avoided every possible trigger. I went on an elimination diet that took a good 6 months to really work through. In my case, elimination of triggers was some help but did not really resolve the problem.

Since I've been on good preventatives, my migraines are normally just a nuisance, only flaring up every now and then. I don't worry about triggers anymore, either.

But I still enjoy touching base here now and then, especially when I'm having a flare up.

charmed quark wrote:I think you are right, there is a bit of a filter here, we are seeing the more extreme end of migraines.

I think most of the people here are here because their migraines are or were causing a significant impact on their lives.

But many still post after they find a good solution to their migraines. Sort of like veterans who get together to talk about the war, because nobody else could understand what it was like to be there.

I'm the latter. For about 10 years my migraines were destroying my life. Believe me, I avoided every possible trigger. I went on an elimination diet that took a good 6 months to really work through. In my case, elimination of triggers was some help but did not really resolve the problem.

Since I've been on good preventatives, my migraines are normally just a nuisance, only flaring up every now and then. I don't worry about triggers anymore, either.

But I still enjoy touching base here now and then, especially when I'm having a flare up.

My story echos yours. In 30 years of dealing with migraines, and seeing specialists, doctor's naturopaths, and everything else under the sun I have addressed every trigger from every angle possible. I have done every elimination diet possible as well. I agree with Zomigman 100% about triggers, the hard part is a lot of us have multiple triggers, and it does not matter how much we adapt our lifestyle to counter them, we will still get migraines. And for a lot of us unfortunately working most types of jobs can be a trigger or there are triggers at the work place. Preventatives have been the only feasible option for me. Taking Triptans and narcotics multiple times a week while at work just does not mesh with a lot of people or a lot of jobs if they experience even mild side effects from the drugs. If you are one of the unlucky ones with severe side effects, it's completely out of the question.

I tried several preventative options in the past that just did not work for me and was turned off trying them. I had a serious rash of migraines though where my work was really affected so I decided to give it another shot. I ended up finding one that seems to work with few side effects (or has for the last while anyway). Not missing a day of work for 2 months, and not being dopey from meds at work has been such a load off my shoulders.

But, our own experiences and opinons aside, the original poster obviously has to try everything and see what works. The Triptans exist for a reason, so I wasn't suggesting he doesn't try them first. I was only suggesting he may also went to consider seeing a specialist as well as a backup plan in case he can't manage his work situation with the Triptans, or can't manage the side effects. If he's really worried about the work situation, he should have multiple options ready to pursue.

A question to the last two that posted on this thread: what preventatives are you taking?

ZomigMan wrote:A question to the last two that posted on this thread: what preventatives are you taking?

I am on Topamax. Currently on 50 mg, and having no limiting side effects. I get a bit of anxiety at times, and my memory can be a bit cloudy. Taking it at night, I am generally ok during the day. I don't know if I will stay on this dose, or if it will be increased. I guess it depends on if I keep having these results.

I'd have to take multiple doses of Triptans for really severe migraines over 2-3 day periods, and on top of the side effects listed I would get a horrible 'hangover' effect from them. So the mild side effects I am getting from the Topamax don't even compare to that. But, other people have nasty side effects from it. So it's the same deal, you only know by trying.