Debating When to Take Abortive Medications
Last updated: February 2023
Some individuals may wonder why this is even an issue. The sad reality of the matter is most of the time you get 6 to 9 abortive migraine medication doses a month, regardless if it is a pill or a shot, etc. Unfortunately, many of us are impacted with a migraine on a daily or almost daily basis. So this is where the game of debate comes into play, how bad do you let the pain get before you take something for it? If one dose of medication did not kick the migraine, do you use another dose to try to manage completely getting rid of the migraine?
Medications taken at the start of an attack
Migraine abortive medications are prescriptions such as Relpax, Maxalt, and Imitrex. These drugs are intended to be used at the initial onset of a migraine, meaning as soon as you feel it coming on. This approach allows the drug to work more effectively at getting rid of the migraine. The problem behind this method is for those of us who have chronic migraine.
Avoiding medication overuse headache
We are faced with many more than the 6–9 days of migraine a month. Granted they limited the quantity to prevent the individual with migraine from using too many doses and possibly developing a medication overuse headache or serotonin syndrome. These can be almost as debilitating as the migraine they were attempting to overcome in the first place; causing many individuals to oftentimes delay or simply try not to take the medications to avoid the side effects that may follow. The remaining problem is that if you only get six doses of your abortive a month, what happens during those other twenty-four days?
With limited doses, when do you take the medications?
Due to the drastic nature of the shortage of abortive type medication compared to the days of migraines, a great debate begins to take over for each individual with migraine. We know the medication works best when you take it immediately, but most of us are faced with the dilemma of taking the medication, and then the migraine ends up not being one of those really bad ones. Have you just wasted a precious dose of medicine? On the opposite end of the spectrum, if you wait too late to take the medication and the migraine is already too bad, then the medication will not work as well to stop the migraine. Then even though you took the medicine, you are still left in misery and tend to need that second dose.
The sad reality
The very sad reality of this situation is it is something that so many individuals with migraine face on a monthly basis. In most cases, the doctors who treat us are too worried about liability issues to consider prescribing a larger quantity of the medication. In the event that they do decide to prescribe more, the insurance company tends to want to argue with you, the pharmacy, and the doctor over the medical necessity.
The best chance we stand to get the doctors to understand that we may need more medication than the normal amount is to track our migraines in detail for each month. This involves recording which days you had one, how long it lasted, if the medication was used, and how much medication it took to break that migraine or migraine cycle. The more information you provide to your doctors, the better they can understand what you face and hopefully the better they can treat you.
Do you find yourself in this situation yourself? Do you have more migraine days than medication available to fight the migraine? Have you had any conversations on the subject with your doctors?
Have others downplayed your migraine pain?