Treatment series: Zomig
Thanks to the encouragement given to me via article comments by you migraine.com community members, I spoke with my neurologist at my most recent appointment about getting an acute migraine medication that would be effective for me even when I am totally nauseated. We went over a few options, and I told her I’d rather try a medication that’s absorbed through my nasal/mucous membranes than do injections again. (Briefly I was on an injectable medication to treat my psoriatic arthritis and I really would prefer not to go down that route if there are other options.) One of my readers had mentioned that suppositories are very helpful, but this didn’t even come up with the doctor even though I’d written it down on my list of things to talk about at my appointment. Maybe I subconsciously ignored that option, not ready to go down that road. Ha!
Dr. M., whom I really like and respect, prescribed Zomig. She instructed me to use my Imitrex or naratriptan (Amerge) as I usually do and to reserve the Zomig for migraines I wake up with and rapid-onset migraines. Every time I get a new migraine drug, I have a flash of misguided eagerness to try it. I get so hopeful about new treatment and so completely curious about whether or not it will work that I actually, for just a moment, find myself looking hopefully toward the next migraine. Within seconds, the logical side of my brain catches up with my more spontaneous side, and the temporary curiosity is staved off. (Does that ever happen to you? Do you get perversely excited to be able to try new meds the next time you get a migraine?)
Lo and behold, I didn’t have to wait too long. A few days after filling the prescription, I woke up at 3:00 am with a migraine that was already pretty rough. I’d gone to bed feeling a little off but didn’t want to take any medication in case sleep would rid me of the possible migraine attack, and that turned out to be a mistake. So there I was, stumbling at three o’clock in the morning, opening the Zomig pack. Thankfully, I’d had the wherewithal to read the instructions fully and make sure I knew how the delivery device worked before I had a migraine attack. Trying to read instructions when your brain is foggy and you’re in bad pain is not a good method—you heard it here first.
Standing in my bathroom, I followed the instructions step by step even though I was so tempted to just snort the dang medication and have it work. I lightly blew my nose (both nostrils). I then washed my hands and removed one of the six delivery devices (they look like little airplanes or rocket ships) from the plastic tray in the prescription box. I then removed the cap (sort of like removing the nose of the airplane). Using the finger of one hand to close off one nostril, I placed the tip of the device into the bottom of the open nostril. I then squeezed while lightly breathing in through my nose, feeling a sharp but brief burning sensation in the nasal cavity of the open nostril where the medication had gone.
The stuff tastes pretty gross, so I’d recommend sitting down on a comfortable chair, bed, or couch when you self-administer. If you’re like me, someone with a sensitive gag reflex and migraines with nausea, tasting that gross taste in your nose and throat combined with standing can make you a little dizzy, and I was briefly nervous about needing to throw up from the sudden but short-lived nausea. The liquid dripped down the back of my throat a little once I got back in bed, and it tasted sharp and almost metallic. I didn’t enjoy it, but it wasn’t intolerable in the least.
WIthin thirty minutes, my migraine pain was gone. Out the window. GONE. It was kind of amazing and reminded me of that first and most miraculous time I ever tried Imitrex. The post-migraine tiredness and blasé took over for a couple of hours, but I am fine with that as long as I know the end is in sight.
Since that episode, I’ve had to take Zomig just one other time. It worked a little less fast than the first time, but the difference in time was negligible. The taste was just as bad, but I expected it this time, so that made it easier to take.
Have you ever tried Zomig or any other snort-able/sniffable medication for migraine? What was your experience like? How do you decide when to do a nasal injection and when to take oral meds?
Have you tried an abortive nasal spray for migraine?
Can you tell when a migraine attack is coming?