How many Triptans?

I've said this before and will say it again. You can't always go by what your doctor says. Look at the differences in doses for triptans that we are told by our different doctors. I am fortunate to have a health insurance that offers free of charge a consultation with a pharmacist where you bring in all of the drugs you are taking. Once you have this visit, co-pays are free for the first 6 months of the year except for newer ones where there may be a small co-pay. A pharmacist is a lot more knowledgeable than a doctor when it comes to drugs. Although I am happy with my doctor and neurologist, they don't know me like I know myself. In fact, unless you tell them, they have no idea how many doctors you are seeing and how many drugs you are already taking. It is sometimes up to you to inform them. They don't always ask. As far as the triptans go, I would tell your doctor just what we are talking about here. Why do some people only get 8 a month and others 24? What is safe in their opinion? If only 8 are safe, why are others getting 24?, etc.

As far as the 24 I get, I do not need more than maybe 5 a month. I pick my 24 up every month though to add to my cache. I feel like a bear loading up for the winter. I love having my cache of drugs. It is comforting whether I need them or not. Pretty sad but not as sad as being in pain. I just don't want to run out. That is enough to give me a migraine thinking about it. I don't know how you guys that only get 8 or 9 and have no other abortives, do it if you need more than that. Everyday is "should I or shouldn't I take one". That doesn't seem right.

I haven't had my consultation with my pharmacist yet but will keep you informed as to what his opinion on amount of triptans is.

All Triptans, Ergotamine family drugs are dangerous drugs because they are vasoconstrictors factors.
What does that mean?
That mean they do the diameter of vessels too much smaller.
What does that mean?
That mean less blood go through this vessels.
What does that mean?
That means less blood to the irrigated area.
What does that mean?
That means less blood to the heart muscles.
What does that mean?
That mean the heart can't work in full power.
What does that mean?
That mean he can work at the lowest power because the blood that supply heart muscles to work is in too low value.
But I have to go to the stadium to play a football match!
You can't go to play, because when you do effort your heart muscle need more blood, but your heart can't get it because you took triptans drugs.
What can happen if I play?
The heart response to the less blood when he need more is known, it’s an ischemic syndrome, that chest pain will be the first alarm.
Yes I read in the enclosed instruction in the triptans box that when patients feel chest pain he must stop taken it!
Yes they recognize that heart problems can occur due to these drugs.
Why they do it when they know that it can be dangerous for heart?
Always there are fools!!!!!
Why doctors make me take it?
Also there is much than fools!!!!!!
When they meet tog ethers always disasters happen as Jim Cary movie.
All medicaments that work as Vasoconstrictors are dangerous drugs, for some patients even in small quantity they are dangerous,,,,. Why??Migraine has 2 stages: 1- Aura stage.2- Headaches stage. What happen in Aura? In aura stage, a special alarm system for migraine will be started. This alarm system will work due to strong vasoconstrictors in small arteries into the brain in a certain zone. So if this zone is visual zone as most migraine patients then aura symptoms will be visual. In some migraine cases aura will be absent. What happen in headaches stage? In this stage, a strong vasodilatation of certain extra cranial artery will happen, that cause headache itself, while at the same time intra cranial arteries will have strong vasoconstrictions. Extra cranial vasodilatation will cause headaches, while intracranial vasoconstrictions will cause all accompanied symptoms related to the affected intracranial area. This intra cranial affected area explain the different form of migraine headaches.Intra cranial strong vasoconstriction in some migraine patients, can explain the small brain ischemic modification that we see in MRI of brain in some migraine patients. That explain why triptans and ergotamine can be as a poison for migraine patients. They can help to reduce headache itself by forced this vasodilatation to be smaller, but at the same time it forced the constricted vessels to be much smaller. You can imagine the real danger here, especially in BAM.

I only get 6 triptans a month, and neurologist has called the insurance company and tried to get more. I didn't know that insurance companies should not be limiting/determining how many triptans we get a month. I will call my insurance company tomorrow as this really annoys me. How can they say how many I need, and how they can turn down a Dr. who is advocating for me? Thanks for the info!

crt wrote:Some doctors seem to believe that too many triptans can lead to a stroke, others don't. Did your doctor explain the mechanism whereby triptans could cause a stroke?

Chris

I actually had a stroke, and it was caused from the migraine--not any drug. I wasn't using any medication at the time. They did extensive tests and ruled out everything that possibly could cause a stroke. I'm in tip top condition and very healthy. Their conclusion was that the migraine caused the stroke. That is why I'm so scared of migraines, not any medication I have to take to avoid them. As far as triptans and stroke goes, my neuro is the one that prescribed 24/month, and the reason I go to this particular neuro is because he was recommended after my stroke (his specialty). He obviously isn't concerned about triptans and stroke. No wonder we are all confused.

As for me, obviously, over medicating is preferable to a migraine. Fortunately, it is rare I have to take more of anything than is prescribed but on the few times I did, I felt it was safer than getting a migraine.

thank you linda. I am sitting here having tried so hard not to take a Triptan....is never had as many (10) this time of Month. Scared, confused and waking every morning in bad pain. I try hard not to succumb, but the pain is driving me demented. At least this one has helped.
I don't need more horror stories' especially from the Experts. Stressed enough. Appreciate your post of sanity at this time. TY

Pen, I can't imagine just settling for pain when you have medication available but scared to take it. That is almost worse than not having any medication to take at all. As with any medication, talk to your doctor about it.

Since that stroke I haven't had a migraine that has lasted more than a day (and that is even rare to have) except after my car accident in October where I immediately went to the ER on day 2 and and my neuro prescribed steroids for a few days to make sure it didn't come back. That is how paranoid I am about migraines--not the medication. And I am a person that before my migraine days wouldn't even touch aspirin.

By the way, all of my migraines are a 10. That might make a difference with me also. I either have none or it immediately progresses to unbearable if I don't take something. I have often wondered on this site how so many people live (or can even sit here and write) with daily or almost daily migraine but I realize they aren't always at a 10. I can sense that you are often in pretty bad pain when you write. I sure hope you get some relief. You seem to be doing every right. It isn't fair. I hope your Christmas isn't interrupted by these horrible things. We are expecting a major snow storm for Christmas. On top of all the other stress of the holidays, I will probably take a triptan before celebrating. That has always worked for me so far. I only do this for big stressful occasions so they aren't ruined. Best wishes!!!

Linda again, thank you.
I am scared because since October I have taken 1 ,2 and now 3 more Triptans than ever before, and al lI hear is rebound...
I dont know if I have rebound, all I know is I cant get out of the spiral....
I have no idea if Triptans are so dangerous or not, but I know how much pain I am in 10 and even 12....
I may be weak but i have to get through this for now, get over the Christmas holiday.
then I pray someone can help me. I have no idea what has changed...gone wrong....NONE
The one I took today at noon worked too well too fast and gave me 2 hours of relief before coming back...
Now i am back to about a 7 and nothing else to take.
Whe nI go to bed tonight it will come back full strength, I dont know what happens at night, but I now dread going to sleep.
I was never like this, I am stronger than this, or I was....
P

Pen - mine are always at night too. I've never had one just pop out of the blue in the day time. Someone said on this site that when you have them at night (like a lot of us do) that they are actually caused by something that happened the day before and doesn't turn into a migraine until night time. ??? Who knows. I know that I'm better sleeping kind of sitting up opposed to laying flat. I've given up with prevention and just take care of them when they come. Maybe after the new year I will try something else. I do wonder how safe preventatives are also when some of them have such horrible side effects. Makes you wonder. I get my migraines about 3 times a week no matter what the weather is, what I eat, don't eat, sleep, don't sleep. I'll be thinking about you.

Any updates on your pain, pen? I would like to know how you're doing. I have had constant headaches since Dec. 14th - every single day. Luckily I have barely used triptans for the past few months, so I have plenty of meds, although I have been cutting my Imitrex in half. But I get nervous taking so many triptans, like you do.. but at this point, I do not care- as long as it takes the pain away.

My dr. prescribed 30 Zomig a month for me, and I lived a normal life.

Then Medicaid decided that they would limit me to 12, and my life now is anything but normal...

Those who want government-controlled health care should talk to me...

Holly

Welll thanks for asking. Forgot where I was, but I am now up to 12 again and 3 days of the month to go.
I am not happy about this, but have been very strong where I can be and only taken them when I felt I couldnt cope.
LOT of migraines this month and last, really dont know why. I just hope I can finish the month without taking one on the next 3 days.
Same old same old. Go to bed reasonable and BANG there it is when I wake. I REALLY need to find out what does this at night.
Would totally change my life.....Wonder if Dr Robbins has any ideas??

Wow 30 Zomig a month......did you take 30? Did they give you the rebound horror stories?
I just wish they would sort that out and decide which is worse, a lot of Triptans, or letting migraines get out of control.
So sorry to hear you got cut right back. 12 from 30 is savage. The only interesting thing is, if ouy were in rebound and got put back to 12, you would know....
Any difference there?
We have been restricted too long becuase of cost....if the right people had these monsters maybe we might get a little more empathy...

Hope everyone had a reasonable Christmas. I was mig. free for Christmas Day after having one Christmas Eve. Boxing Day (Dec 26) got another, then yesterday was free.
Today a blaster hit about 5am, so I capitulated and took #12. Hope some of you did better than me.
Oh and the snow is clearing but more promised....Good old Global Warming!!!

I agree with you about deciding which is worse -- struggling with a migraine or taking a lot of triptans. I have to take a triptan when I get a certain level of pain or I will not be able to function. Plus I get nausea and throw up until I am dry heaving. My brain feels like it is swelling as well.. There is no way that type of pain can not harm the mind, imo. but I digress..

I hope you can get through these next days migraine-free.

I've been taking daily triptans for years. Yes, I do strongly feel there is a rebound effect complicating things, BUT nothing else worked, even before the rebounds, and if I could just up and stop taking them, gee, don't you think I would have?

I can't speak for anyone else, but my heart is healthy, my B.P. is low normal, and I suffer very little side effects, except for the cost! and I manage to get triptans from out of the country for about $3 a pill, because my insurance won't cover more than 6-12 a month, depending on their latest decree. There's a lot to be said about the evils of rebound, all I can say is avoid it by taking the least you can without going crazy. BUT if you get huge relief from triptans...well, is that any worse than taking morphine related drugs every day, that can really hurt your liver, just for example? The doctors have a real knee jerk panic reaction about triptans that are undeserved, just use the same precautions you use for any drug, minimize it as best you can, but reduce your pain above all else, because living in pain is not a solution simply because doctors are baffled, or fearful of the FDA.

Renee

In regard to what holliygolightly said, "There is no way that kind of pain cannot harm the mind"--I agree. I think enduring migraines is worse than the harm medication "might" do. I would choose to be pain free and worry about the consequences later. A migraine is no life anyway. Maybe have your liver checked periodically to make sure there is no harm done there.

I don't think you are taking enough to have rebound Pen. The whole rebound thing is confusing to me. What difference does it make if you are suffering from a migraine or rebound--you are still in horrible pain either way.

I have found the postings on this subject so interesting .Just registered today after a gruelly few weeks taking tiptans 14 nights out of 20.Was worried this was too many but waking at 4am with severe pain I tried to resist but gave in every time.Took double dose last night and knocked my self out for 12 hours -bliss but dread going to bed tonight,
Most of you seem to be from the US and I feel for you with your insurance system of health care. God bless our UK national health service.I used to be given Imigram as I needed it but now take a non branded sumatriptan which works well but was worried I was taking too many.Hoping to enjoy New year and fisk a drink which I know is a cause .
Happy New year too all fellow suffers

Rosalind - I can't speak for others on this site, but I am from the US and have excellent insurance, health care, etc. I can get anything I need at little or no cost and can see a doctor the same day I need one--no waiting.I can see any specialists also. I wouldn't change it for anything! That is why so many of us are against Universal health care in our country.

Casey wrote:I've been taking daily triptans for years. Yes, I do strongly feel there is a rebound effect complicating things, BUT nothing else worked, even before the rebounds, and if I could just up and stop taking them, gee, don't you think I would have?
I can't speak for anyone else, but my heart is healthy, my B.P. is low normal, and I suffer very little side effects, except for the cost! and I manage to get triptans from out of the country for about $3 a pill, because my insurance won't cover more than 6-12 a month, depending on their latest decree. There's a lot to be said about the evils of rebound, all I can say is avoid it by taking the least you can without going crazy. BUT if you get huge relief from triptans...well, is that any worse than taking morphine related drugs every day, that can really hurt your liver, just for example? The doctors have a real knee jerk panic reaction about triptans that are undeserved, just use the same precautions you use for any drug, minimize it as best you can, but reduce your pain above all else, because living in pain is not a solution simply because doctors are baffled, or fearful of the FDA.
Renee

You really made me feel better with this posting, thank you. I had just take migard 13 the most ever, and it was really upsetting me. 2 days to go before the month is out....
I took it for a dreadful head pain from my neck, all over my head and into my eyes. Wasnt sure it was migraine but couldnt stand it, I have to confess I took the migard in tears....
within an hour the pain had al but gone....so perhaps it was migraine and just hadn't settled in one side yet.....
It is now 8 hours later and I have pain again in my left back of head, sore too. Also on outer eyebrow.
So relief, but was it worth yet another migard....I am so confused and down on myself..

I ended up taking 13 Migards. The most ever, but not as many as i feared.
Today is the 1st day of 2010 and I managed not to start it with a migraine.
I think its coming overnight though, but you never know.

Rosalind: as you said you can't speak for anyone else on this site, please don't! "So many of us" in the U.S. do not resist health care reform, as you claimed, we are literally dying for it! I won't go on about it much because some may think it is off topic, but the truth is it is very much TO the topic of this discussion, if you read the posts on just how many people struggle, with inadequate insurance, with no insurance, with insurance companies with no ethics. In the U.S. countless people are suffering horribly, are going bankrupt, and dying due to lack of adequate health care. To suggest otherwise is just simply wholly inaccurate. And by the way, if you like your insurance , absolutely no one will make you change it! If you are going to worry about it, why not get the facts so you can have peace of mind instead? Sorry to be so adamant, but unethical, greedy insurance companies have made aspects of my life health, when it didn't have to be that way, thanks to the 'pre-exisitng condition" clause, plus. I am one of the experts on what I WRONG with health care in our country, and people like migraine sufferers should be outraged at the naysayers to reform. Ok, I'm off the podium.

Renee

I am new to taking drugs for migraines. My first prescribed drug was Imitrex and I was given 9 pills. The bottle and directions from the pharmacy were not in compliance with what the Dr. told me. I was told to take no more than 2 pills a day and if those two pills did not work then not to take anymore, the pills must not be working. If they work, then you should only need the two pills per day. However, the bottle said take no more than 4 in 24 hours and take 1 every 2-4 hours. So, I took 1 pill every 2-4 hours (trying to read the bottle and determine how many to take once I had the migraine was not a good idea) and the headache did not stop and I had quite a few of the side effects of the drug......crappy first experience with a new drug.

Since then I have been to the Dr. and she gave me Frovatriptan (free samples) and I will see if that one works better. Again, only 2 pills per day.

dothemountain wrote:I am new to taking drugs for migraines. My first prescribed drug was Imitrex and I was given 9 pills. The bottle and directions from the pharmacy were not in compliance with what the Dr. told me. I was told to take no more than 2 pills a day and if those two pills did not work then not to take anymore, the pills must not be working. If they work, then you should only need the two pills per day. However, the bottle said take no more than 4 in 24 hours and take 1 every 2-4 hours. So, I took 1 pill every 2-4 hours (trying to read the bottle and determine how many to take once I had the migraine was not a good idea) and the headache did not stop and I had quite a few of the side effects of the drug......crappy first experience with a new drug.
Since then I have been to the Dr. and she gave me Frovatriptan (free samples) and I will see if that one works better. Again, only 2 pills per day.

Triptans are usually 1 in a day with a second IF the first works but the pain returns If it doesnt work take no more for that attack.
So what the dr told you was correct. Frova has a long half life (22 hrs I think) so less need for a second dose. I take Frova and have never taken more than one in a day. Also they dont like you to have them on more than 3 days a week.
I hope the Frova work for you.

Pen

So, the Frova works for you Pen...and you take one a day and do you need the second one? Next month will be my first chance to see if this works and I hope it does!

dothemountain, frova was the one and only triptan I had on and off success with!
I liked it! I wish you tons of luck with it I stopped using it when it stopped working completely
and my neuro decided triptans were not the way to go with me.

I have a good feeling about it for you.
Pain free days

dothemountain wrote:So, the Frova works for you Pen...and you take one a day and do you need the second one? Next month will be my first chance to see if this works and I hope it does!

The Frova works and I have never taken a second one. It takes from 2 to 5 hours and side effects and efficacy vary each time.
They are no wonder drug but I couldnt survive without them. My only problem is taking too many the last few months as I have been having a hard time.

Good luck.

The standard recommendation by doctors, as per their instructions from the FDA, is not to take more than 2 a day, and not to take more than 2 in a week. And yes, there IS a rebound effect with potentially almost any medication, as 'overuse' can cause your body to adapt to the drug's presence over time. And - depending on the drug and the degree of pain - stopping use of a rebound can be harder than any doctor can imagine, it is a horrible challenge. Rebound is NOT about addiction, which has a very real psychological component. This is about treating pain, a physical reality, but it can become psychologically a real challenge, as you try to treat your pain, while trying not to take take enough of the drug to helps relieve your pain - talk about a paradox! The first time I was given triptans I was told by the expert neuro that no, it doesn't cause rebound. He was wrong. He wasn't the first to tell me that.

You are doing the right thing by asking questions, always the best place to start. No one has all the answers, not me, nor the doctors, definitely not the FDA (nor the CDC). but I have found getting educated as best I can - from as many sources as possible - to be the most powerful tool I have to fight this awful condition.

Renee