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Medication overuse & how many triptans per month?

Can I get a straight answer on medication overuse - how many triptans per month?

I have chronic daily migraine with some level of migraine pain every day 24/7. I usually get between 8 and 10 full blown attacks a month for which I take triptans. Sometimes the attacks come one day at a time but more often they come 3 to 4 days in a row. I have had migraine for 40 years, becoming more and more chronic in the last 10 years. I have only been using triptans for the past 10 years and sometimes wonder if using up to 10 per month for up to 10 years now is contributing to getting more full blown attacks. When I ask my neurologist, he won't really give me a straight answer, he just says no more than 10 a month and take them early in the attack. However, if I don't take them for the longer attacks, I would miss out on so much, whether it be work, social stuff. They seem to run their course whether I take them for 2, 3 or even 4 days in a row. Any advice?

  1. The triptans rebound. I get by the 9/month at 100mg limit by taking 50mg at the first sign of a migraine. That way, I can get 18 migraines a month and still be within the Rx limits. Waiting on a prayer for the CGRP antagonist release.

    1. Way my pain management doctor explained it was 10 days of pain control (plus I can have 5 other days with using toradol or baclofen). 10 x 24 hours - I always count a "new day" as when I go to sleep so if one starts during the night I can use meds the whole next day without counting it as a second day.

      So it doesn't matter what or how much you use (within limits - talk to your doc), I tend to have those 3-5 day long migraines so I hit them triptans at beginning (maybe even two doses) and then use toradol, baclofen or cambia for the rest of the time. I do tend to go over for a few days because mine are so frequency and severe - still end up in urgent care for IV meds once a month (this is after a toradol shot at the doctors too).

      If your headaches respond to triptans but come back after the med wears off and forces you to take another dose - you probably have over used them for your body and getting rebound headaches from them. I regular do get a migraine (treat and it stops it) but then the next day get symptoms and another starts BUT there are definite starts and stops and TWO completely separate migraines. So just watch and journal if needed. Hope that helps!

      1. I have the same problem you do. Triptans worked great for me at first, but now after ten years of taking them, I get 5 day long migraines, the triptan works initially, but the migraine always recurs. I think I have MOH even though I have always been careful not to overuse triptans/pain meds more than 2-3 days per week. Now I only use a triptan ONCE per week, and NO pain meds (which sucks) and the triptans still don't get rid of the migraine without it recuurring. It comes back worse than the original migraine. So they're kind of useless for me at this point. I tried taking a break for 2 months from everything, but apparently it didnt help.

        The only thing that works at this point is going to the infusion center to get Depakon/Magnesium by IV. But that's a major derailment of the day, expensive and takes a few days to work. Migraine sucks.

        1. You make it sound like your doctor isn't really answering your question, but the fact is he/she might be. However, you might need to be asking a different question! Have you considered switching triptans? I recently was feeling like Maxalt was not quite doing the trick anymore, and my symptoms were changing. At first it had made such a huge difference in my treatment over Imitrex, but, over time, it seemed like I always needed two doses and my attacks were lasting longer and longer. I thought we'd try one of the four other triptans I had never tried before. But there is a new delivery system for the very first triptan, sumatriptan (the generic of Imitrex), you blow it up your nose with a gadget! The brand name is Onzetra, and it is a challenge for me in "migraine brain" mode. But it has been working so well!!!!!! Because it is new, there is a program to try it for free from the manufacturer. My neurologist contacted the pharmaceutical company and they contacted me. Then it was mailed to me.
          Also, I have "bridge" protocols in my arsenal for when I have reached the limit of my regular abortives. (I trust my doctor; she allowed me 12 Maxalt per month.) When the migraines lasted beyond 4-5 days (I only used triptans on two days), it was time to consider more drastic measures... the bridge, then infusions if necessary.
          I wish you well, literally!

          1. There is another nasal for imitrex - one dose spray unit; first and second fingers on the side, thumb on the trigger - spray in one nostril and done. This is what I use and LOVE IT .... it better never get discontinued. I do live in Canada so not sure if that affects anything or not.

            By imitrex: sumatriptan nasal spray 20mg
            DIN 02230420
            Made by company - GlaxoSmithKline inc.

            Maybe something to look into? I've seen the other one .... it is crazy!

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