Changing Up the Order of My Abortive Migraine Medications

I recently struggled with a lengthy migraine and was dismissed without support from my migraine specialist. At the time, I thought I had some good options for aborting migraines once they'd begun. However, there were several problems with my plan of attack.

Medication order

First - there were no instructions on medication order. 

When I started working with my previous specialist, he gave me multiple medications to try for my migraines - rizatriptan, Ubrelvy, and ketorolac. In addition, I'd previously used Fioricet and Fioricet with codeine, so I essentially had 5 pharmaceutical options to try when a migraine struck. In the beginning, I thought this was great. If one didn't work, I'd try another. I knew the dosing and timing on each, and I never mixed and matched, but I'd alternate which I'd take or try first.

It turns out this is not a great way to deal with migraines.

Gravitating towards Fiorcet first

In all honesty, I used to grab Fioricet most often because I had the longest history with it, and it'd been successful more often than not in reducing the pain and discomfort I'd received from my migraines. However, I knew that too much use of Fioricet or too frequent use could cause rebound headaches - something I definitely began to struggle with.

Using ketorolac injections last

I also used to save the ketorolac injections for last. For the worst of the worst, the moments when I was crying out in pain and considering visiting the ER for migraine relief. I knew they'd most likely work, but I also only got 4 a month, and sometimes a single migraine day would require 2 injections to disrupt the cycle.

Dosing

Second - the dosing I'd been prescribed was significantly under what it should've been.

When I switched my care to the headache clinic, I learned so many things about the medications I was using and the dosing and frequency and order in which the medications would actually have the highest likelihood of helping my migraines.

Underdosed

For medications like rizatriptan and Ubrelvy, I was prescribed a dose half of what I should have been. So, MAYBE if I took two pills, it could be beneficial, but I was only doing that 4 hours apart. The ketorolac injections from my previous specialist were ¼ the recommended dose, meaning that I could've been getting lasting relief from those injections if they were at the right dose.

Migraine attack plan order

I was also informed that my migraine attack plan should have a very specific order - an order that honestly was reverse of what I had been doing.

My first line of defense today for a mild migraine is Ubrelvy coupled with Zofran (to help with medication absorption). For a moderate migraine, I'm to use the ketorolac injections - up to 2 within 24 hours, and no more than 10 a month. And finally, for the most severe migraines, I am to utilize Fioricet.

I was so surprised at these instructions, but when I thought more about how I had incorrectly been using (and was instructed) previously, the changes really did allow me to benefit from the short- and long-term medications.

Has your treatment plan changed?

Has the order of your medications ever been changed? Has the dose been examined? I'd love to hear about others' experiences after feeling stuck in a treatment plan that wasn't managing your migraines.

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