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?

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Comments

View Comments (26)
  • Anne
    3 years ago

    I’m glad it works for you 🙂 The only thing that works for me is Relpax. I’ve tried Zomig – in tablet and nasal spray. The tablets seemed to work better – the nasal spray mutes the migraine but doesn’t really take it away. Tried Migranal – nothing. Imitrex – nothing. Of course my insurance thinks I only need 9 tablets a month and i get way more than 9 migraines a month so I have to beg borrow and steal different ways to make it through my extra migraines.

    I’ve also tried a bunch of preventatives – botox, blood pressure meds, topomax – nothing works yet but I keep trying…

  • The Migraine Girl moderator author
    3 years ago

    Thanks for the note! (Sorry it took me many months to respond.) I find it endlessly fascinating that a treatment that’s a breakthrough for one patient doesn’t do much for the next. Have you tried any lifestyle changes or dietary changes to help with the migraines? Those helped me so much more than daily prescription meds did. Fingers crossed you’re having a great 2016!

    -Janet G.

  • RachelRoo
    3 years ago

    I have been using Zomig nasal spray for years and love it. It works so -quickly- when it does, it truly is fantastic on that end. Once you get used to it administering the spray is much simpler than the ritual you described, now I’m practiced enough to do it in seconds. I’ve turned away from a classroom full of kids, popped off the top, tilted my head and squirted the little delivery ‘airplane’ (what IS it called though?) and said “Just a second guys” and returned to instructing the class. I too, use it for headaches that are coming on quickly and need to be eliminated quickly: So waking up with something intense at night, or having something suddenly blindside me at work. I don’t experience any side effects that make it so that I can’t carry on with a normal day. Teaching a class, taking care of my child…assuming it kicks out the headache which it does most of the time.

    The downside I’ve found is it doesn’t always kick out headaches for good…sometimes a headache eliminated through Zomig spray will return for me in 12-24 hours. I’ll then need to use the spray or a tablet again, or that and a rescue to kick the headache all the way out. But I’d say that’s only about 50% of the time, and it almost always kicks the headache away long enough to get through my day. As a working mom, that is highly appreciated, and I call myself a fan.

  • The Migraine Girl moderator author
    3 years ago

    Sounds like you and I have very similar experiences. I’m hoping it keeps working for me and that I can convince insurance to cover the nasal spray in full. (I call it the little airplane thingy!) -Janet G.

  • BeeG
    3 years ago

    I took Zomig tablets, twice, had a horrible reaction each time, never took them again. Also never found out why I had such a strong reaction, the neuro was not very helpful. But on the subject of nasel sprays, I’m curious if anyone else has been “crazy” like me to try this, there’s an OTC spray called Sinus Buster, it’s active ingredient is capsaicin, the chemical that makes hot peppers hot, I have used that for migraines. It hurts for 30-60 seconds but then the migraine pain is diminished for awhile. Not a cure, but you know how you only get so many abortive meds per month? Sometimes this helps when I’m trying to save my meds for a worse migraine.

  • The Migraine Girl moderator author
    3 years ago

    I tried a capsaicin nasal spray before! Like you, it was helpful (even if it just distracted me from the pain) for a bit before the migraine pain set back in again. I stopped taking it after awhile, but it was definitely not a failed experiment.

    Do you take other triptans (not Zomig)? I wonder what it was about Zomig that you had such a bad reaction to; I’m sorry your doctor wasn’t very helpful. What sort of reaction did you have, if you don’t mind my asking?

    -Janet G.

  • deborahvan-der-harst
    3 years ago

    I am currently using the nasal spray Migranal. It stops my migraine pain in 15 to 30 minutes which is about a quarter of the amount of time it takes my Maxalt tablets to ease the pain. It is effective and fast acting. I take it only for my most severe migraines because of the potential cardio-vascular side effects. I take an SSRI, Zoloft and ADHD medication, Adderall ER which is a stimulant. Adderall and Migranal should never be taken together. My blood pressure was high for a day. With Chronic Kidney Disease Stage 3, I can’t afford to have high blood pressure. I also worry about serotonin syndrome because those same meds also increase the effects of the anti-depressant. So, although Migranal is my preferred migraine abortive, I use it sparingly. I also get Botox injections every 3 months.

  • The Migraine Girl moderator author
    3 years ago

    deborahvan-der-harst,

    Thanks for your feedback! Sounds like you are very cognizant of when and how to use your nasal spray Migranal. I have to put on my migraine advocate hat here and make sure your doctor is aware of all your health conditions and medications you take. (Based on the way you explain the situation, my guess is he/she is aware and on board with your treatment plan.)

    Does Botox seem to be working for you at all?

    Thanks for your thoughtful feedback.

    Sincerely,
    Janet G.

  • BCN
    3 years ago

    I used to take Zomig but I confess that fire a while of taking it, it became a debate every time. Yes, it took my migraine away, but in its place it would give me a series of strong side effects that would make me wage if it was worth it. Tension all over, especially in the neck, jitters, spaciness, etc. It really felt like something in it was very wrong. Until one day, it sent my blood pressure up to over 180 and that was the end of it. I cannot take it anymore.
    A lot of those symptoms I had other times could also be related to high blood pressure without me knowing.
    I then made huge research on it and I can promise the price to pay to get rid of your pain in the long run might not be worth the series of side effects it can cause.
    I know every body is different and, of course, every pain is as well. I only recommend you always look carefully at the small print and see beyond the immediate relief. These drugs haven’t been around long enough and more and more issues are showing up.
    I hate my migraines but I have lived with them since I was fifteen. I am not looking forward to adding another more dangerous illness to my list just yet.

    Good luck!

  • The Migraine Girl moderator author
    3 years ago

    Dear BCN,

    Thanks for the thoughtful feedback. I definitely know what you mean about there being a dearth of research on the long-term effects of certain migraine meds. I wrote about that a couple of years ago, actually: https://migraine.com/blog/the-unknown-long-term-effects-of-medications/

    I haven’t noticed any severe side effects of the Zomig nasal spray but will re-read the pamphlet and be sure to be on the lookout for potentially dangerous side effects.

    Take care; thanks again for your wise words.

    -Janet G.

  • Butterfly7
    3 years ago

    I’ve never taken Zomig. I have Imitrex but it doesn’t work that great for me.

  • marti
    3 years ago

    I take (generic) Imitrex tablets, but the tablets don’t work if I wake up with a migraine. NOTHING works for those – and then my neurologist prescribed Imitrex nasal spray. I still take the tablets for “regular” migraines and only use the spray when I wake up with one. It won’t stop it, but it reduces the severity and duration. I’m lucky that my insurance covers both. I get 9 tablets for $4.00 and 6 sprays for $4.00. That’s usually enough to cover the month.

  • The Migraine Girl moderator author
    3 years ago

    If Zomig stops being effective for me, I may need to look into using Imitrex nasal spray. I am glad that the nasal spray at least works a little bit for you, and I’m grateful your insurance actually covers the medications!

    Take care,
    Janet G.

  • Janet
    3 years ago

    When did Zomig become a nasal spray??? I still have tablets…what’s wrong with my doc and why am I being treated like I’m in the dark ages so to speak. This is disconcerting. 🙁
    Janet

  • The Migraine Girl moderator author
    3 years ago

    Janet,

    I am not sure when Zomig became a nasal spray. I doubt your doctor is willfully ignorant of it or is trying to keep you in the dark about it, he/she may just not think you need it if the tablets are working okay for you. As migraine patients, we often have to be polite yet assertive about our care. If you are waking with migraine and/or if oral medication isn’t working effectively for you, it may be time to bring up alternative approaches with your doctor, including nasal sprays, transdermal patches (when/where available), and suppositories. Best of luck to you!

    -Janet G.

  • SJD
    3 years ago

    I don’t know if the generic for Zomig works as well but the Canadian pharmacy I use sells the generic called Zolmitriptan 5MG nasal spray 7 doses for $28.99, 14 doses $49.99 all the way up to 35 doses for $78.99. I don’t know if I’m allowed to us the name of my Canadian pharmacy (I’m an American) but it’s Pharmstore. It’s an online pharmacy. Even with insurance I can’t afford some of my medication unless I get it outside the country. I get my Naratriptan and used to get my Relpax through them.

    I’m going to remember Zomig or the generic version. I was unaware of how effective it is.

    Oddly since moving out of Colorado I don’t have nearly as many migraines and when I do they are much milder. I think the altitude brought them on.

    This is a great blog. Very helpful.

  • The Migraine Girl moderator author
    3 years ago

    A big change in pressure–including going from low to high altitude or incoming storms–is a major migraine trigger for me. I am grateful to hear you’ve found some relief after your move.

    I used to get drugs from a Canadian pharmacy (with my doctor’s encouragement) but luckily can now get everything I need at mostly-affordable prices from the neighborhood pharmacy down the street.

    Thanks for the kind words about the blog, and thanks for reading. I appreciate your feedback!

    -Janet G.

  • Butterfly7
    3 years ago

    My husband wisely determined that my migraines are triggered by longitude & barometric pressure. I have few if any headaches when in the SE region of the US.

  • Charlotte Best
    3 years ago

    I took Zomig tablets for years. It was an exceptionally helpful drug for my migraines. Then through my drug coverage Zomig’s status changed to a Tier 3 drug and I could no longer afford it. My doctor switched me to Sumatriptan tablets and that drug has been helpful; however, my drug coverage only allows nine tablets per month yet I have at least 12 to 15 migraines per month. In the past I have appealed that decision and was granted 15 tablets per month. My drug coverage has changed, and it appears that I will have to go through the appeals process once again. I am thankful that I have drug coverage because, as we all know, migraines are utterly debilitating. Often I think of my poor mother who suffered from migraines and had no help for them. I don’t know how she did it.

  • roewade19
    3 years ago

    Hi Charlotte,

    Just wanted to let you know a couple things about Zomig. First off, I take Zomig ZMT 5mg. It’s a dissolvable tablet and it normally kills my migraine within 15-20 min. You’re so right about Zomig being expensive. So, I wanted to let you know about a pharmacy that is an advocate for patients who can’t afford it, have no insurance, or have insurance but even with the insurance it’s still to expensive. This is actually for anyone who suffers from migraines. Go online and visit http://www.impax.com
    There you can print out the forms needed in order to qualify for the program. If you have insurance and the Zomig is still expensive, then you’ll need to indicate you have insurance but even with the insurance it’s still to expensive. They have a number you can fax the forms, once you’ve got everything filled out. You’ll need to have your Dr fill out his info and the RX(prescription info) info in the Drs section. They will need household income, but it’s worth it, and they deliver it to you, plus you call them when you need a refill. I’ve always used the Zomig ZMT, the dissolvable just worked better & faster for me. My Drs instructions stated take one Zomig daily for migraine, and the way he wrote RX would give me 18 pills per month. It normally worked out pretty well, just had some problems when the barometric pressure changes occurred, usually went thru them quicker at those times. Impact saved my life when I didn’t have insurance and when I did. I was on the program for a little over 4 yrs. You are enrolled for a year and when refills have all been dispensed, you’ll need to have your Dr fill out his portion on the Impax form and fax to Impax to update for another year in their system. Impax sends you new RD forms with each medication delivery, so you just save one for when you’re coming to the end mod your refills. I normally would call in my last refill and then fill out my portion of the form & take to my Dr to fill out his, then his MA would fax it to Impax, that way I wouldn’t have an interruption in receiving my Zomig. Thank God I now have great insurance thru my hubby, he works for the City, so there benefits are awesome. I now just have a $10 copay, where as before with my other insurance, it would have been $100 per month for 6 tablets. So, check out Impax, it’s a real lifesaver, I highly recommend them to anyone. Zomig has been the only medication that’s helped my migraines.

  • Jen
    3 years ago

    I use to take Zomig but I put it under my tongue and it would dissolve, when I would wake up with a Migraine. I agree and wish I could get more than 6 a month since I suffer from 3-4 migraines a week. Towards the end of me taking them I would cut them in half to get more. I am sure I wasn’t’ suppose to but I was desperate to try anything. I really didn’t get any serious bad side effect but what I did get was a warmth feeling, my heart would race for about 15 minutes and I would get really tired. But I would take those symptoms over a migraine any day. Good luck to you all.

  • DEBGOLD
    3 years ago

    I have a side effect with the pill form of Zomig is that it desiccates my body. I dry out really quickly. I have tried other drugs in this category and they not been as effective as this particular drug. It does take about two hours to work. I am glad that I have it. I wish that I could get more than 6 per month to deal with the 12 to 16 migraines that I usually get per month.

  • Kim
    3 years ago

    I have been using Zomig nasal spray for years for the acute attacks, like you I usually wake up with it. I generally take a nap after inhaling the spray. I have found that the effect lasts about 6 hours.

  • sgtcjl
    3 years ago

    I had same experience. The nasal spray worked better than anything else I have ever tried! Too bad my insurance doesn’t care what works. They refuse to cover the nasal spray form. And to the poster with depression: you are not precluded from taking these drugs. You should always tell your doctor what other meds you are taking. Seretonin syndrome is a huge concern for many, myself included, and you have to be carefully monitored for it, but the two drug classes CAN coexist. To others considering the spray, don’t be dissuaded simply because you are on antidepressants, just be sure to tell your doctors!

  • 1h5m63i
    3 years ago

    Finding the Zomig nasal spray was a Godsend for me. No other triptans worked (I’d been searching for over a decade and nothing worked…Imitrex might as well have been a sugar pill for me). I had migraines once per week, 3 days at a time consistently. Even though I don’t get aura I finally went to a neurologist. This neurologist did a wonderful job of having me go through everything I’d ever tried (which was a long list) and explaining how Zomig works. She explained (as you might already know) that when a migraine attack occurs, it’s basically a lightning bolt shooting up through your nervous system through the back of your neck dilating all of the blood vessels in your brain. Zomig, like all triptans — constricts the dilated blood vessels back to normal. Sometimes if you don’t catch it soon enough (i.e when you wake up in the morning with a migraine or when you can’t take the triptan right away) those blood vessels have been rubbing up against the tissue on your brain causing inflammation. (No kidding, right…that’s what we’re feeling when the pain lasts forever.) That’s when you need an anti-inflammatory (ibuprofen or maybe a stronger prescription like Indometacin) to cause the swelling to go down and give it that final kick goodbye. That double dose should do the trick. If you need an anti-nausea pill to offset the migraine or the heavy anti-inflammatories, I recommend the dissolvable Zofran pill. Honestly though, I just try to catch the migraines fast and take the nasal spray…that way I can avoid a pill cocktail every time I get an attack.

    I also, can testify that I’ve been on an anti-depressant the entire time (2+ years) I’ve taken Zomig nasal spray with no ill effects, but everyone’s body is different. Just be aware of your symptoms. I also take the 5mg pill from time to time, but the 10mg spray is the most effective. As long as I catch the migraine in its infancy, I can typically get it to dissipate within 30 minutes…one hour at most. And that means gone. I woke up this morning with a killer migraine. Took the spray, two Ibuprofen and was able to go on a 4-hour hike with my husband for his birthday this afternoon. It’s a lifesaver — definitely a quality of lifesaver. My mother and my sister also take this medication, yes, migraines are very genetic in our family…apparently. My mother is smaller than I am and had some heart issues with the Zomig pill, so now she cuts them in half and is fine. Again, just pay attention to your symptoms.

    Lastly Zomig is, yes, quite expensive. I can get a box of 6 10mg Zomig nasal spray doses for $75 through a Tier 3 drug insurance plan. My doctor also gave me a “discount card” from Impax where I can get another box for $75 per month…ask about this. After that, I go to CanadaDrugs.com (though I’m going to look into that generic available through Pharmstore.com). I ration and am envious of those who can afford to pay $330 for 6 doses (that’s full price w/out insurance). I currently am paying for medications in lieu of being able to own a car so that’s not really an option for me. But I am just thankful there is something that gives me relief, allows me to work, live life and hope for better tomorrow.

    ** Even if this medication doesn’t work for you (i.e. Zomig is your sugar pill)…keep looking! Never give up. I saw 10+ doctors in four different states across a decade before finding the right medication. For some people it’s medication, some people have thyroid issues, others it’s tension/stress…try not to lose hope. The answer is out there somewhere and some smart doctor is going to figure it out someday. See a neurologist even if you think it’s overkill. They know what they’re doing when it comes to your noggin 🙂

  • AndreaAndiH
    3 years ago

    I wish I could have continued taking Zomig – it really is a wonderful medication – but I never should have been prescribed it. 🙁
    I went to the Houston Headache Clinic, and the quack ignored the fact I took antidepressants (YOU HAD ONE JOB) and gave me Zomig. It worked like magic, but it also put me in the hospital with Serotonin Syndrome. 🙁

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