Migraines & Off Label Uses of Prescription Medications: Part I

As I’ve discussed in previous articles on this blog, the Food & Drug Administration has a very specific, strict set of policies and procedures for approving a medication for treating or preventing a particular condition.

However, as many of you likely already know through personal experience, doctors often prescribe medications for off label purposes. Read on for more information about this practice.

Particularly when treating conditions like chronic migraine disease, for which there are limited FDA approved medications, doctors must become creative in looking for different options for those patients. Although drug manufacturers are legally forbidden from promoting their products for off label uses, there are no restrictions on doctors prescribing drugs for off label purposes.

In reality appropriate use of off label prescribing may be beneficial, not just for drug companies, but also for patients. It encourages the discovery of new treatments we might otherwise never know about if no one tried them. Consider the miniscule amounts of research funds dedicated to migraine research (though we try all the time to improve this), off label trials of medications approved for other conditions is one of our best bets of finding preventive options that help even the most difficult to treat among our community of chronic migraineurs.

Furthermore, since these medications are approved for other purposes, you can easily access information about side effects and other information that can help you make a decision about whether the medication is something you feel comfortable trying. You’re certainly not flying blind just because it isn’t specifically approved for migraine prevention.

So if a doctor suggests trying a medication approved for treating other conditions like epilepsy, depression or fibromyalgia, don’t be alarmed or surprised. This is normal and no reason to refuse to try a suggested treatment. As a patient, ultimately it is your body that bears the risk of trying a relatively new medication that we don’t know much about, but if you otherwise feel comfortable with the option, don’t be afraid to give it a try even if it isn’t yet specifically approved for migraine disease.

Please stay tuned for part two of this article, which addresses paying for off label uses of medications.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (19)
  • Jessica Andis
    8 years ago

    I take propranolol, Depakote, klonopin, wellbutrin & Seroquel and I still have chronic daily migraines. I did botox and had the worse migraine. I was admitted into the hospital and was given DHE-45 iv with not much relief.

  • Jessica Andis
    8 years ago

    i tried topomax and it made me not hungry and i lost weight and i have a hard time gaining weight so they had to take me off of it.

  • Cheryl Nunn
    8 years ago

    my doc put me on topiramate and they have helped me alot

  • Jessica Andis
    8 years ago

    i have been to several neurologist from Beaumont texas to the surrounding areas i live now with my mother.

  • Jessica Andis
    8 years ago

    i have been to several chiropractor, my mom has them and my grandmother on my mom side has them.

  • Nicole Klingensmith
    8 years ago

    I had 3-4 a year. Long story short i had a chiropractor adjust my neck…it really helped! .Have you tried a Chiro?

  • Lola Aileen Vanslette
    8 years ago

    There has not been a medication invented or discovered, as yet, that has stopped or prevented or eased my migraines. The closest I have come is taking 800mg of Ibuprophen and two extra strength Tylenol. I was prescribed that when I lost a lot of blood after having my twins and was having a major migraine attack. It is the only thing that touches it.

  • Teri Robert
    8 years ago

    When it comes to Migraine prevention, there are only four medications that are FDA approved – propranolol, timolol, divalproex, and topiramate. For Chronic Migraine, there’s only one – Botox. NONE of them were originally developed for Migraine prevention. There are NO medications on the market that were originally developed for Migraine prevention, not even one.

  • Teri Robert
    8 years ago

    Thanks, Amanda and Julie! This article was written by Diana Lee.

  • Teri Robert
    8 years ago

    Rachel Boice if Topamax was working, your doctor might suggest increasing the dosage. Topamax wasn’t a good match for me, but in that same family, Zonegran worked really well with nearly no side effects. I’m so glad I can lift your spirits. You’re very welcome.

  • Teri Robert
    8 years ago

    Julie W. Carnes the data is there to support Botox for Chronic Migraine. The studies didn’t show it to do as much for episodic Migraine – Migraine and headache on fewer than 15 days a month. I know quite a few people who do well with it. If I were personally looking for an effective preventive, I’d consider it worth a try. As for Maxalt, each of the triptans binds to different combinations of serotonin receptors. Thus, we can respond differently to them. That can explain, for example, why Maxalt could work better for someone than injectable sumatriptan (Imitrex).

  • Rachel Boice
    8 years ago

    I use Topamax for my migraines and it does not seem to help anymore. I go back up to my Neuro in a few weeks. Does anyone have any suggestions for me to try. Thank you Teri for all your help. You lift my spirits so much.

  • Catherine Charrett-Dykes
    8 years ago

    Julie, i have botox and it is great!!!! it deals w/all the muscle tension in my face, neck and shoulders

  • Julie Carnes
    8 years ago

    Meee too, Amanda! Teri Robert is amazing!

  • Pen Ort
    8 years ago

    I am getting less and less life and more and more migraines, but have failed all those preventatives and more. Why dont they find something for us, rather than have us rely on side effects of drugs for other conditions? Is it surprising they either dont work, or dont work for long.

  • Amanda Lynea Cartwright
    8 years ago

    LOVE your articles. Thank you!

  • Julie Carnes
    8 years ago

    What are your experiences/thoughts on Botox? I was reading article about that earlier… What about Maxalt? That has worked for me- actually better than the injectable treatments such as (whichever one is the needle free/generic Imatrex).

  • Lori Sanford
    8 years ago

    Jaclynn-What kind of med. were you on for prevention? I take a seizure med for prevention, and my husband just has a fit about it.

  • Jaclynn Gates
    8 years ago

    This is a touchy subject! Although you may find a hidden “cure”, there’s also the huge risk of gaining other complications like myself! Seizure meds for migraines and nerve pain have caused me to actually have seizures now! I say patient beware and become knowledgeable about what you’re prescribed before you take it! Weigh the risks! Off label uses should not be promoted without further investigating it yourself!

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