Expert Answer: Muscle Relaxants & Migraine
Last updated: October 2022
Question: Any advice on the best time of day to take Flexeril for migraine? I am on 10 mg to avoid grinding/clenching, especially at night, and I have such a bad hangover effect in the morning it's a herculean effort to actually get up. Any advice on the best time to take Flexeril so it's still effective but I can still function normally before, say, noon??
Great question! Flexeril (cyclobenzaprine) has a fairly long half-life of 18 hours.
That means that half of it is gone from your system in 18 hours. With the way half-lives work, that means it takes 90 hours a single dose to be totally clear of your system, though the greatest impact will be during those first 18 hours. Thus, it’s not exactly a “hangover effect” in the morning, it’s still the effects of the Flexeril because you’re still within that first half-life.
One reason Flexeril isn’t used more for Migraine is that it does tend to make many people drowsy. Taking it earlier would be one option, but that might result in your being groggy more of the day — a trade-off of drowsiness between the time you take it and the time you go to bed instead of the next morning. You might talk with your doctor and see if a 5 mg dose would help you as much as the 10 mg you’re currently taking.
Another option would be a similar medication with a shorter half-life. I know quite a few patients (myself included) who use Zanaflex (tizanidine) at night for various issues from sleep disorders, to insomnia, to night-time bruxism (grinding) and jaw clenching. It has a much shorter half-life of just 2.5 hours, and most people wake with no grogginess or drowsiness. It comes in 2 mg and 4 mg tablets, which are scored and can be split, and 2 mg, 4 mg, and 6 mg capsules. This makes customizing the dosage to patient needs fairly easy.
I’ve been using Zanaflex for a sleep disorder, periodic limb movement disorder, for several years now, and it’s been a great help. On those rare occasions when I wake before morning and have trouble sleeping again, as long as I can sleep three more hours, my doctor has told me that I can take another dose. When I’ve done this, I’ve slept well again through the rest of the night.
Of course, Zanaflex is just one other option, but it’s one I wanted to share with you. I hope this helps!
Do you have a migraine toolbox for when an attack hits?
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