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Debating When to Take Abortive Medications

Debating When to Take Abortive Medications

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?

The abortive medications

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. 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 often times 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?

Thus the debate is born

Due to the drastic nature of shortage of abortive type medication compared to the days of migraines, the 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 end 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, than 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.

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 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?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Sunny
    3 months ago

    One thing that helps is to find things that help stop the migraine that are NOT prescription – and to do or take them at the very first sign that a migraine MAY start to happen soon. Do not wait for pain or aura – by then it’s too late. Many of us get little warning signs, a tingling or a feeling that something is “off.” That’s when alternatives can help. Try them, give them a half hour and if there’s no improvement (or sooner if thing start to escalate) then take meds. I find that if I do this, even if I need meds, I can use less and the meds work better. And over the course of several months, I get fewer and less severe migraines.
    Some of the best for me (and with actual scientfic studies to back them up) are:
    1 – ginger – a study found ginger, taken at the first warning sign of a migraine, is as good an abortive as sumatriptan. I use a tea with 1.5 grams ginger (costs about $3) – be sure to let it steep 20 minutes, then squeeze the teabag out and drink. If I still feel off, I repeat. Fresh ginger does not work. It has to be dried. The heat increases a substance called shogaol which reduces inflammation and cox2.
    2 – mixed tocophtrienol/tocopherol – A specific form of vitamin E called evnol contains 8 forms of the vitamin, 2 of which have been linked in studies to reduced neuroinflammation and lower pain-causing cox2 – these 2 forms are gamma tocopherol and gamma tocotrienol. Again, regular vitamin E which is all alpha does not have either of these – in fact, alpha tocopherol supplements can decrease the gamma ones and actually make inflammation worse. Evnol is found in several supplements, available from places like vitacost or amazon.
    3 – fish oil – this can help reduce inflammation, and sometimes if taken when I feel “off” can keep a migraine from developing
    4 Hot or cold packs – this can vary from one person to another. See what works for you. I find either hot or cold work best when I move them around, like put an ice bag on my cheek for a few second, then the back of my neck, then my forehead, then temple, then back to my cheek, etc and keep doing it for at least 10 minutes.
    You can also try other things like biofeedback, massage, a cefaly TENS unit, NSAIDs. But again – the key is to take or do anything you think might help as early as possible.
    Again, sometimes these work and sometimes they do not, but make a list of non-prescription things that help you and try them first. Good luck!

  • mrs.s.overall
    3 months ago

    As a chronic migraine suffer, I am now on Aimovig, so the daily intensity and frequency of hemiplegic migraine has decreased. But I am allergic to Triptans, so the crackdown on opiates and focus on rebound has caused this to be a huge issue for me as well.

    One trick I have found for me, is to take 100mg of Benadryl (diphenhydramine) at the onset. I have found it helps me to relax a little. Then if it’s still building after an hour or so, I’ll go ahead and take something else.

  • nzinaz1
    5 months ago

    Maxalt now has dissolving tablets, which is good. BUT they’re so godawful bitter I find myself delaying even more before taking one.
    Surely there must be a bright pharma chemist somewhere who’s capable of taking into account such common migraine-associated considerations as nausea & taste perversion? Bleah!
    Doesn’t anyone ever taste things before releasing them?? Here I sit, waiting for nausea med to kick in so I can face putting that *unnecessarily* vile-tasting pill in my mouth, try not to puke while it dissolves, then find anything to get rid of that taste, then wait to see if it will work this time…
    Migraine is hard, frustrating, & unreasonable. It helps to know I’m not alone, or crazy. Thanks to all here.
    (Now I need to go hide…)

  • Jenny918
    5 months ago

    I’ve been getting 20 100mg imitrex for years. For awhile (I don’t need them anymore) I was also getting 8 maxalt.
    I break the 100mg in 1/2.
    So I have an excess, a stockpile, of imitrex.
    I’m in the US. I’ve has 3 different insurance policies over the years and they’ve all covered 20 a month, no question.

  • Yvonne2015
    5 months ago

    Because I had a stroke I can’t take any Tristan’s. I can only take pain medication, usually opioids. I get it from everywhere about the addiction issue but what else can I do with daily migraines?

  • RoseDM
    5 months ago

    For those interested in my earlier post, the monthly injection I use is Emgality (another choice is Aimovig). For me, it’s darn close to being a miracle-drug.

  • RoseDM
    5 months ago

    I used to be that person who had migraines 6 days per week, often twice a day. After a 3rd cervical spine surgery, it lessened to 4xs per week with headaches the rest of the time. I used the maximum abortive medicine allowed and faced that dilemma of running out regularly. Last October, I began monthly injections of a newly approved class of preventative drug. 9 hours after 1st dose my head cleared so much that I realized I hadn’t felt that way in over a decade. I had literally lived with constant headaches & was so used to it that I thought I was headache-free whenever it wasn’t moderate or severe. I do still get occasional migraines (average 4 per mo.) and occasional headaches but I am clearheaded more often than not.
    Forewarning though, the injection can (for me, does) cause painful, itchy swelling that can last a few days. Also the 4th week it starts wearing off and headaches/migraines come more frequently. But for all that, it has been life-changing. I highly recommend it!!

  • DreamsdoAmanda
    5 months ago

    Its a juggling game ‍♀️‍♀️
    I also face this. my go to is Maxalt and vallium . I can get more in Australia so I am never without. My go to first is Aspirin first 900mg, then a codeine tab if an hr later its not working as I dont know where I am going to end up – headache or migraine .
    Then if the codeine tab isn’t working and its building I take 1 vallium and maxalt. But it all depend on how quickly it is coming . It may be starting with vallium [ 5 mg are amazing for me ] and a lot of the time that works ‍♀️ if not 20 min later then a Maxult. In saying that I am now on daily Beta blocker 40 mg daily and they have decreased to 1 migraine a week and about 4headaches a week . But thats better than 4 migraines a weeks so I am grateful.

    Its a bit like juggling the symptoms for bit to see which way you go. I also find that during the headaches I take hydrolite – full of salts and that helps also ..

    When my head is completely clear it feels so weird and amazing to feel nothing – clearly its not that often

    if someone said to me If you drink 1 glass of horse urine a week you will never experience pain again I would ‍♀️

  • mrs.s.overall
    3 months ago

    Amen to trying just about anything. Over 20 years ago I read that if you tied an open banana peel to your forehead it could relieve migraine. Guess what I did? Felt really stupid and it didn’t work, but like you said…

  • mistycatbaby
    5 months ago

    I play this same game every month as well. My migraines like many of us are a daily handicap. I use extra strength Tylenol and Prochalorazine for an initial stab at preventing a full blown one. I’ve tried all the medications mentioned with little to no success. I’ve been to two pain clinics with no success. Many medical people are suspicious of migraine sufferers thinking they are seeking opiods. From a doctor son in law faking migraines is a favorite of addicts in emergency rooms. In my opinion we need to have a medical registry of migraine sufferers. An ER waiting room is the last place I’d go for help. The bright lights and noise are just too much. If mine has progressed quickly to the woof my cookies stage I take a T3 and Gravol and use a large solid freezer pack on my head.

  • Jenny918
    5 months ago

    I’m unable to take Tylenol or anything with codiene. They give me migraines.

  • Ali A.
    5 months ago

    Boyyyyyy do I feel this. When I have a bad month with migraine and am low on pills, every bit of pain, throbbing, & pressure in my brain becomes an internal debate on whether or not I need to “waste” a pill. The good news is, my insurance company recently let me fill both my Relpax and another migraine med that I don’t love as much, but if it’s a less severe migraine/headache I can take that instead.

  • BensonTherapy
    5 months ago

    True Dat!! ❤️

  • sunpadre
    5 months ago

    I too face this situation quite often. With only 9 sumatriptan pills a month, it is sometimes hard to make them last. I’ve never thought of cutting them in half – will have to try that and see how it works. Usually, when I have a migraine coming on, I’ll start by taking 3 Excedrin and 50% that takes care of it. If not, then I take a sumatriptan next, which almost always takes care of it.

  • bspinks
    5 months ago

    I have chronic migraines and take 30 imitrex a month. My insurance company will only allow 9 so I use GoodRx. I get 30 Imitrex 100mg for $28 through Costco. I have no issues with rebound headaches because I get them daily anyway. I’m sure others are like me so i thought I’d put in my 2 cents to try to help someone. Good luck all.

  • Jenny918
    5 months ago

    I’ve been getting 20 100mg of imitrex for years.
    One day I just asked my doctor to change my rx. I expected my insurance to deny but they didn’t. I’ve even changed insurance policies 3x over the years with no problem.
    I break the 100mg in 1/2 so I have 40.

  • BensonTherapy
    5 months ago

    Good info! Thanks!

  • HilaryC
    5 months ago

    There is one more factor not mentioned in the article. Once I have a migraine building it gets harder and harder to think clearly, which means that you are making medication decisions while becoming less and less decisive. Here in Canada I have no problem getting prescriptions for all the sumatriptan I need, and even get it basically for free through something called “Fair Pharmacare” which is like governmental extended prescription benefits. The limiting factor is that I am not supposed to take it more than three times a week and no more that 2 doses in 24 hours.. The catch is that if you take it that often, as I generally do, it will become less effective.

  • Shalamar
    6 months ago

    Someone was in my head and stole my thoughts…

    That is EXACTLY what I go through!

    I save meds for Dr. Visits, family affairs, etc. It sucks, it means I live in a cold dark box. Or I try to”Push Through & Pay Later”. It is so draining Physically , EMOTIONALLY & Spiritualy.

    I don’t know what it’s like to be pregnant and I don’t suggest I know how it feels either. Sure I comprehend the concept, but I will never know the feeling of being kicked from the inside of my stomach. My point is I have people in my life that think they understand me, however have not been kicked from the inside of thier skull, felt pain shoot through their body like lightning just from opening up the blinds. I Cycle through time on the Migraine’s timeline not a by any normal calendar and clock. – Shalamar

  • deedeevee1
    8 months ago

    I am so familiar with this debate it’s ridiculous. My doctor gets it and prescribes accordingly, it’s just a battle with my insurance that occurs regularly. So unfortunate that we need to do this for medication that only works a small percentage of the time anyways.

  • blueaphalt
    9 months ago

    Been here many many times. It’s a sad reality for most chronic migraineurs -the abortive med debate: Do you take it now? Is it bad enough? But what if you take it now and can’t take anymore this month? You have that event coming up in 3 days. You may need it then. But this migraine, especially if left untreated, could easily still be there in 3 days and at that pt, there is little aid even if you take the meds.

    It’s a vicious internal debate. It leaves you sick when you maybe could stop it. It leaves you sick because you need to save your meds for the days you must function. It leaves you sick because you didn’t treat and now this migraine won’t stop and it’s been 8 days.

    I’m praying that the new gepants will offer less restriction in # of doses one can take a wk/month once they are on the market.

  • Eric1
    9 months ago

    I am currently on naratriptan 2 times a day, getting the quantity approved by the insurance was a fight. Thank God I have a great Dr. It dowsnt break my headache just lowered it some. I have NDPH since 3/18/2016 9 am. I’ve tried so many things. The naratriptan is the only thing so far that has any effect and I do understand rationing when the insurance changes and we had to go through the approval yet again.

  • AZReynolds
    9 months ago

    This is my biggest battle with my migraines. Since insurance companies rule the roost, I can’t get Relpax at all anymore and I’m hanging onto my meds from 2017 only doling out pills to migraines that rate 8 or 9 on my pain scale. (For me, 9 is unable to talk and 10 is unconscious. I have syncope migraines.) Therefore I have to treat all my migraines the same way I did in the 1970s: hot/cold packs, muscle relaxers, nausea meds, elbow trick, etc. Thank God for CBD oil!!! It has saved my life! Heaven help us if the insurance companies ever get control of it!!!!

  • Countingthetoll
    10 months ago

    My ptoblem is I cannot take Imitrex, Zomig, etc. I am stuck with gabapentin & fioricet. It kind of helps but not really.

  • JanetH
    5 months ago

    Right there with ya. Although I tolerate gabapentin well, it didn’t really help. Am now on a low dose of lamotrigine (200 mg/day). It’s a drug used for bi-polar. Dr. tried to increase it, and within 3 days, I was hyper, couldn’t sleep. It was starting to give me manic symptoms. Went back down to previous dose and could sleep. If I forget to take it, I get a headache for sure, even at 200 mg, so it must be doing something. Problem is, not enough of something.

  • Yvonne2015
    5 months ago

    because of stroke I can’t take any of the triptans, I can only take pain medication, usually opioids. I get the problem with opioid addiction but what else can I do?

  • carine1988
    11 months ago

    Medecine don’t help me when i have migraine. I just relax. You can buy “relaxing gel eye mask”(www.migraine-relaxation.com).It can be helpul.

  • epa3030
    11 months ago

    Such an issue! Every time I feel like I’m getting a migraine- the dilemma of whether I need my abortive meds kicks in. I have a huge debate in my head. Is it bad yet? Is the ibprofin working? Can I wait it out but not too long because then the meds won’t work. I have a system now that I rotate my abortive meds. I have imitrex and maxalt and frova. I usually have plenty through the month. But I remember long ago the stress of only having nine and freaking out when I was close to running out! However I have to be careful now to not use any too much because then I run the risk of meds overuse and rebound. I have also had issues where I’ve taken imitrex solely for months and it stops working. I then have to rotate to something else and come back to it later. I just started a preventative Med in August. I’m hopeful.

  • JPaula
    11 months ago

    I’ve just started taking Naratriptan a few months ago and quickly realized the same thing that you write about.
    I usually don’t start with it but if my other medicine doesn’t work with within an hour I take 1/2 of the Naratriptan. Often that is enough and if not I take the other half.

  • Ellie
    1 year ago

    I experience this debate every time I get a migraine, and I have to add resistance building to the factors I have to consider. For me, that actually outweighs rx limits or overuse headaches because I build resistance to meds so quickly that taking anything every few days means it will lose its effectiveness in a couple months at best. And I’ve never found a preventative that works to any degree.

  • KatherineO
    1 year ago

    I have exactly this problem. Ten-14 migraines a month and nine sumatriptans. And even though my doctors have told me not to worry about serotonin syndrome, I do worry. But sumatriptan is the only thing that works for me. Hoping to try aimovig.

  • NanceInNj
    1 year ago

    I live with this dilemma month in and month out, even with Botox treatment. My neuro has tried to get additional authorized with the insurance, but it never works. And there is the problem with overuse headaches. I now have her prescribe me both 100 mg and 50 mg imitrex so I can break pills to make them last longer and use higher dose when I have a crusher headache. I rarely take them as early as I should, and I still end up down to having no or few pills by the end of my 90 day Rx. I usually ride out one to three mild migraines a week sans meds, to avoid over use.

  • shell-bell
    1 year ago

    I’ve been in this situation before. What my neurologist did was to prescribe 100 mg sumatriptan and have me split the pills in half, so I’m taking 50mg per dose. This gives me 18 doses per month, rather than nine, which wasn’t usually enough. If I need more after a couple of hours I can still take the second half. Additionally, I take the first sumatriptan with one 550 mg dose of prescribed naproxen sodium, which really helps to kill the pain. Thankfully, I rarely need to take more than the first dose.
    Although I have a few less migraine days per month compared to a few years ago, I still refill my Rx monthly so I’ll have some excess and won’t run out. It gives me tremendous peace of mind.

  • Sherrell
    1 year ago

    Had the conversation with my Dr. He suggested that I take 1/2 the Immitrex rather than the whole tablet. It has worked well. I am more confident in taking the meds at the onset of the headache with out the “running out” fear. I also don’t worry about the rebound as I am taking a half dose. The biggest challenge is waking up with the migraine. Then there is little relief.

  • revmyo
    1 year ago

    I am perhaps fortunate to have discovered an “abortive” medication, injected sumatriptan, which basically always works, no matter when I use it in the migraine cycle. As it happens, though, I’m better off waiting as long as I can before using it, because if the attack hasn’t reached, say, the halfway point (which isn’t necessarily easy to determine), I can wind up having to take another injection after two to three hours. Given the effect sumatriptan has on my blood pressure, that’s not ideal.

    That said, I’m so grateful to have found something that works. I used to need to visit the emergency room several times a year with out-of-control migraine, complete with crippling pain, excruciating photo- and noise-sensitivity, violent vomiting etc. (Y’all are familiar with that stuff, I know.) I was amazed that once the ER folks got around to medicating me, about an hour later I would feel fine. I eventually (duh!) thought to examine the list of meds they had given me, and lo! there was: IV sumatriptan. When I found out that I could self-administer it, it was like water in the desert. There’s only been one ER visit since, when my BP was too high to tolerate the sumatriptan. That time, they gave me toradol instead, which was also pretty effective.

    And so it goes…

  • dpasek
    1 year ago

    I have been with the same primary care physician for years and he understands my situation, so he has always written the maximum quantity on the prescription that my insurance will accept without a prior authorization. It used to be 56 tablets for a 3 month supply, but it has been gradually reduced and now it is 36. That is 12 per month, regardless of the strength. There’s a loophole! (BTW, the shelf pack of tablets is 36 doses, the blister pack is still 9.) 25mg of Imitrex is usually sufficient for me but sometimes I need to double dose. Episodes last typically 2 to 4 days and I get 3 to 4 episodes per month. So I need from a minimum of 6 (yeah, right) to a maximum of about 18 (closer to typical) doses per month . I fit the description of “high-frequency episodic pretty well and none of the preventive meds work for me. So I get the 100mg strength tablets and cut them approximately into thirds for 36 doses per month of at least 25mg each and usually somewhat more. I’m covered. I have been hoarding for years the doses that I haven’t used. I have found that Imitrex tablets and even the nasal spray have a *very* long shelf life, in excess of 10 years stored at room temperature. I have some samples that are older than that and they still work fine.

  • Marysu
    1 year ago

    Yes, I use the 100mg tablet in quarters and it really helps me with controlling the chronic daily migraine I’ve had for many many years. My goal has always been to stay functional and between these small doses of Imitrex and small doses of rescue meds I can! I feel for everyone on here because I know the fight we all have with this disease.

  • surlychick
    1 year ago

    The reason I sometimes wait to take an abortive is because of the side effects. In particular, I HATE Zomig nasal spray, even though it works. I’ve managed to go quite a few months without taking it now, instead suffering a bit more and trying lots of other things. Whether I take the Zomig or not, I’m still unable to work for a period of time, and it just tastes like poison when it drips down the back of my throat. Ugh.

  • dpasek
    1 year ago

    I get the bitter taste from Imitrex nasal spray and I just put up with it. I am quite sensitive to bitterness and I detest it, but it’s not nearly as bad as a bad migraine. The bitterness does not last nearly as long as an untreated severe migraine. I only use the spray to treat the most severe migraines that don’t respond to a first dose of a tablet within 2 hours, so I rarely need them.

  • lerickson82
    2 years ago

    I’m actually feeling relatively functional now that I’ve had a radiofrequency ablation on both sides of my neck, but I do fall into this problem at times. My Headache Dr from Diamond Headache Clinic asked me if I take my abortives right at the first sign, and I explained this very problem. I am now on 3 different types of abortives – a triptan (Treximet, which has Aleve in it), an NSAID, and Migranal (DHE). I rotate these when things are bad. The only thing is that you’re not supposed to take Migranal within 24 hrs of a triptan. So that can still become a game, but I don’t worry too much about running out of my meds.

  • zahkree
    2 years ago

    I have migraines everyday, and I face the challenge of do I take my Maxalt or not. I faced the same limit of 6 pills a month. Maxalt is now generic and my insurance now pays for 18, and I asked my doctor to write for that max amount, they also make both pill and dissolvable form, and I get all I can.

  • Amanda Workman moderator author
    2 years ago

    Would your doctor go along with increasing the amount of medication she wrote for you since your insurance was okay with it? I definitely hope so. I know that still leaves you days that are not covered unfortunately 18/30 is better than 6/30 at the very least. Stay strong honey. Sending you lots of love
    Amanda Workman

  • Paul
    2 years ago

    My doctor prescribed me the generic Imitrex pills, sumitriptan, as well as the Imitrex injections.
    I usually have a pretty good sense when my migraines are starting whether or not they are going to be severe. If so I go for the injection. If not I go for the pill.
    Plus I take topiramate daily.
    I don’t see why this couldn’t be an option for anyone else who takes Imitrex.
    My insurance company has changed three times in the last year or so: BCBS, Medicaid, Medicare, and they have all covered this situation.

  • Steven Workman moderator
    1 year ago

    Some insurance medication coverage can vary even from policy to policy within the same insurance provider. Its good that your different insurance plans have covered the medications. For many people though, that is not the case. My wife recently had a BCBS plan that was based in Louisiana, even though we live and work in Texas. That plan covered her Botox treatments. Now she is on my BCBS plan based out of Texas and we have been fighting with the insurance company for almost 6 months, yet they are still denying coverage.
    Steven Workman (moderator)

  • Amanda Workman moderator author
    2 years ago

    My insurance has also given me the injections and then the new generic Relpax pill to alternate. I do like you, use the injections for the worst migraines and the pills for the ones that don’t seem like they will be as bad. Granted, when chronic it’s still not equal to an abortive a day/attack kind of thing. But I think some doctors refuse to give patients the option to have two abortives. I’m glad to hear that Medicaid and Medicare also covered both abortives for you. I always worry that they would try to short change individuals. Thank you for responding to my article
    Amanda Workman

  • Amanda Workman moderator author
    2 years ago

    Honestly I think doctors allowing patients two types of abortives is newer thing, for most doctors. I know it was something I had to fight with my doctor about and others may be afraid to do so.

    I’m very amazed that you can tell how bad the migraine will be just at the beginning. I have never heard of somebody making that comment. For most people, they can feel when it’s coming on but how bad it may or may not get is a mystery. That’s definitely something a lot of people could learn from, especially if they don’t have enough medications.
    Amanda

  • dpasek
    1 year ago

    Amanda, I have a way to predict severity that is unique to me. Most of my migraines are on the right side, and those fall mostly within a reasonably consistent range. If I get a migraine on the left, it will almost always be a severe one, and usually I will have to take two doses of imitrex for it successively, sometimes requiring a dose of the nasal spray.

  • Katyb
    2 years ago

    Wow! Amazing, amazing posts and so much information! Much more than 45 yrs. of visits to neurologists, PC doctors, etc. I have migraines that are not debilitating, BUT if left go, I will be in bed! Therefore, my PC doctor, who is very understanding – empathetic is the word – has given me a script for 30 sumatriptans per month! Now, this is years and years in the making, believe me! I’ve been to headache clinics (sort of like rehab, but strictly to wean you off everything you take and start from scratch) and one of the best neuros in my area for migraines. NONE of these people are advocating the use of Fioricet (which I use for pain) nor anything more than 6 Imitrex (sumatriptan) a month. REALLY??? 6 per month is a joke if they understood how it affects your entire life! I did some research with a famous doctor in NYC who wrote many articles in the JAMA and they all centered around the daily use of triptans. He said that if the patient doesn’t respond to preventatives (me), botox and diet restrictions have been adhered to (me), then research shows that one sumatriptan – maybe before bedtime or whenever “your” time to get migraine happens, he will go with that. His name is Dr. Alexander Mauskop and he’s the Director of the NY Headache Center. Board Certified Neurologist. You can Google him and all the comments from people who have been helped. So, I printed out pages and pages for my PC doctor to read (my neuro threw them in the trash in front of me) and now I do that and am living a full, pain-free life (no fioricet anymore) and if I have a breakthrough horrible migraine, it is most always due to a virus I’ve contracted or bug.
    He said there is no proof that Imitrex damages your heart if taken in that fashion. Now, I will tell you that my friend who lives in Europe says it’s common to get scripts for that much a month. I agree with all these posts below in that it’s all about the money! What a travesty! I get the generic and it’s only a $1.00 per pill for the 30. I don’t run it through insurance and the pharmacy runs it through in a different way. I’ve had a echocardiogram to see if my heart was being affected (I’ve only been on this regimen a year now) and I get bloodwork done every 6 months. Nothing is out of the ordinary.
    What IS difficult is finding a doctor that will agree to this unless you go to Dr. Mauskop. I don’t know anyone in my area (Philly suburbs) that would agree to this. I was just so sick of taking fioricet, etc. etc. and icepacks, heatpacks, massages, etc. to no avail and I found his information on the internet.
    I had THE worst reaction to the migraine botox treatment – I literally thought I was going to die. And, I had to wait until it wore off – 3 months! The anti-epileptics are terrible! They make you feel like a zombie. I hope each and every one of you can find a doctor that will take the time to read Dr. Mauskop’s articles on this and maybe give you a bit more than you’re getting now.

  • Cathy
    2 years ago

    I now do this too. One Naramig (Naratriptan) a day. I still get migraines but nowhere near as many. It’s brought the problem under control.
    Before this I tried just about everything. I have had to give up work. I still feel fragile, but life is alot better since I started one triptan a day.

  • ix3jvy
    2 years ago

    its About the money. Bottom line period.

  • Amanda Workman moderator author
    2 years ago

    Unfortunately it definitely comes to that with insurance companies and a lot of migraine treatment options. There is so much we could possibly benefit from and they find ways to deny the coverage. Sounds like you have had fights with the insurance for your care. Sending you lots of love, strength and positivity
    Amanda Workman

  • ix3jvy
    2 years ago

    I think the issue isn’t rebound I think the real issue has to do with the cost of the abortive medication. It’s funny I can only get 6 relpax (and we know that is really exspensive ) but I can get a ton of imitrex. I don’t buy the whole dependence thing bottom line is the money. Insurance doesn’t want to pay.

  • Amanda Workman moderator author
    2 years ago

    I think a lot of the limits is the insurance not wanting to pay too much money. The same ways as botox injections are crazy expensive, even with botox saving cards.. Relpax has come out with a generic now. It’s Eletriptan. You might be able to see how many of the generic you can get now that it has one. Hopefully that helps you out some. Sending you lots of positivity and strength.
    Amanda

  • Snoopy10
    2 years ago

    One more comment on this, my migraines come with a ton of aura and each day I’m kind of a little “migraine-y” so it’s another factor in debating if I take it. Meaning I pretty much always take mine when it’s too late. If I always took mine at the first sign, I’d be taking it every day!

  • Snoopy10
    2 years ago

    Such a great topic and I always wait too long to take mine and have to take a second dose. I do also worry about rebound headaches. I’m also constantly debating whether I can get away with taking Excedrin Migraine or really need the Imitrex, and sometimes end up taking both. And I’m not really sure if I should be doing that!

  • Jeanne
    2 years ago

    I haven’t experienced rebound headaches on imitrex, or on maxalt. (I have prescriptions for both because my insurance will pay for separate prescriptions but not double of one kind. Nuts, I know.) The last information I read was that triptans aren’t proven to cause rebound headaches like some OTC meds can. Your mileage may vary, of course.

  • Amanda Workman moderator author
    2 years ago

    Yes, I also have to get the imitrex injections but then the (now generic) Relpax pills. Sometimes your doctor can ask your insurance to pay for more of one of your prescriptions, my insurance actually approved more shots than my doctor will write a script for me.
    My nuero wanted me to stop taking my prescription anti inflammatory for my fibromyalgia because she was worried about the rebound headaches. But she wasn’t worried about my abortives.
    Amanda

  • Amanda Workman moderator author
    2 years ago

    For most people the benefit to taking excedrin migraine is the caffeine (250 mg of Aspirin. 250 mg of acetaminophen. & 65 mg of caffeine). But you should probably check with your doctor about combining the two medications. I’ve had a nuero add caffeine to my migraine protocol but not the other two…

  • dpasek
    1 year ago

    I avoid caffeine like plague. I am highly sensitive to it and withdrawal from it will cause migraine. I titrated myself for sensitivity, and I get a whole spectrum of side effects starting after only 3 days of 25mg per day doses. At 10 mg per day, I get no side effects. Caffeine side effects for me include muscle tics, heart palpitations, GERD, IBS, and after about 5 days, I start waking up in the middle of the night with severe stomach pain that seem to be caused by spasm of the lower eseophagal sphincter. (I feel bloated, but am unable to burp.) All of these symptoms resolve within about 3 days of discontinuing the caffeine. So, I have a threshold that I know approximately as a result of experimentation. I try to stay below that. If I exceed it during one day to the point where I can detect the stimulant effect, I minimize my incidental consumption for the next couple of days. I know from genetic testing that I am a slow metabolizer of caffeine because of low activity (I’m heterozygous for that SNP) of the Cytochrome P-450 1A2 enzyme that detoxifies caffeine by demethylation. People with high activity P1A2 will not notice side effects such as these.

  • lindaann
    2 years ago

    This dilemma honestly causes me no end of anxiety. I have chronic daily migraine/tension headache and then every day there is the looming debate, is this one bad enough to treat. I usually make the decision based on 1) how nauseous I am, 2) how much I have to accomplish that day and 3) how high my pain tolerance is that day. There is also a clear line that I seem to cross that indicates to me that this one is one that will go the full way to epic migraine proportions that leaves me nonfunctional, in bed and listening to pod casts (one of my coping strategies). If I have taken abortive twice in a week, I might try to ride out a full on migraine as I live in fear of the much dreaded REBOUND. I have been in rebound before and do find the more abortive I take, the more full blown migraines I get. It sucks! I have taken a leave from work and find things easier to manage now but do want to go back to work, which means more abortive because in order to work , well you all know how that goes. I used to get more days post riding out a migraine, migraine free, but not anymore. My migraines have become worse with age, large sigh!

  • Amanda Workman moderator author
    2 years ago

    With the nausea, you should ask about phenerghan or zofran. They come in several different forms (pills, dissolving and suppository). That could help you a lot.
    I do understand wanting to work and that when you do work there being more migraine attacks. I have personal experience here, I was let go for my medical issues but my migraines are not as omg bad as they were when I was working every day. I do believe the stress plays a part in it lady. Maybe discuss it with your doctor prior to starting work up again.
    Sending you lots of strength and positivity
    Amanda.

  • lightweaver
    2 years ago

    I thought I was the only one who had this issue.

  • Amanda Workman moderator author
    2 years ago

    You are definitely not the only one with this issue. So many of us who have chronic daily migraines, simply do not have enough abortives for us to treat all of our migraines. Sadly it’s very common. I hope you’re having a great weekend.
    Amanda

  • Casper6
    2 years ago

    That is the million dollar question, what to do when you only have certain amount of abortive doses per month? At this point in time I have 12 to 15 migraines a month. I am working with a new doctor to see if I can reduce. But I do have 3 different types of abortive med’s. I take Imitrex, Amerge, and Relpax. My insurance only pays for one of the once a month. So I get the Relpax filled with insurance. Amerge, I don’t fill that often. Because that one only works if I take it at the very first twinges. Thank goodness I can get Imitrex through another discount prescription card. (Not insurance) I guess I can understand putting limits on these drugs, but they are not the one living with the pain of migraines, and how it can hinder your life. There has to be a happy medium some where.

  • Amanda Workman moderator author
    2 years ago

    You are definitely correct. There has to be a way to meet in the middle with drug restrictions and how many migraines we deal with every month. This definitely seems to be an overwhelming issue for so many people of all ages. I’m glad you found a way to get one of your medications filled without fighting your insurance.
    Amanda

  • mrst53
    2 years ago

    I am lucky in that after 50 years of migraines, I have had a great doctors that have understood my migraines. The docs kept great records, so every doc, knew what the previous doc had done or prescribed. The docs have understood about my migraines.. Firional every other day for headaches with Frova on the other days. I have no warning when my migraines hit, so I take whatever med I need as soon as it hits.
    Both my PC and my wonderful Neuro doc, allow me more meds (frova) than the usual 9 pills a month. The Firional, I usually get 60 or 90 pills. Keep searching for docs that will bend the rules and fight for more meds a month.

  • Amanda Workman moderator author
    2 years ago

    You definitely have been lucky to have such good doctors. I think some areas just do not have many options when it comes to good nueros. Some travel 100 miles round trip or more to see different doctors. A lot of people unfortunately either keep trying or eventually settle for a “decent” doctor. We definitely need better options of doctors overall
    Amanda

  • Karen
    2 years ago

    I too am interested in ideas people use to deal with that “Sophie’s Choice” dilemma we have to face every day.
    *Which migraine do I TREAT with the limited abortive (Imitrex) that works perfectly IF taken EARLY-at first symptom-
    *And which migraine do I WILLINGLY ALLOW to become EXCRUCIATING PAIN? Knowing I’ll be curled up in the fetal position day and night until the migraine itself “decides to end”, crying (which makes the pain worse!), completely useless as a human being and unable to even move a limb-never mind “function” and do what I needed to do during my incapacitation-for the time that particular migraine can take to pass WITHOUT TREATING IT.
    The TORTURE is that as I suffer worse than Drs allow animals to suffer, I’m LOOKING RIGHT AT THE MED THAT WILL EASE THIS UNBEARABLE PAIN BUT I CAN’T TAKE IT!!
    Even if I gave in and tried taking that limited precious Imitrex dose in my horrible pain-it would be too late. It won’t work when the migraine has progressed that far. So the med is wasted if I take it in my agony! So I HAVE to continue suffering however long the migraine lasts.
    Something needs to be done for those of us who suffer DAILY MIGRAINES ANYWAY-MOH or not! What’s the medical rationale of NOT TREATING a migraine with the med that WORKS “to avoid MOH” when you are getting DAILY HEADACHES ANYWAY? What’s the difference what you CALL that DAILY headache we ALREADY have? That horse has ALREADY left the barn!
    Isn’t it more humane to treat the patient for what IS HAPPENING ALREADY rather than denying their med more than half or more of the time in “hopes” of “preventing daily headaches/MOH” that are already happening?
    Don’t they realize what despair people like us face more than half of EVERY MONTH dealing with this kind of untreated pain? Some WOULD consider suicide as an option! Is that what it will take for insurers and cowardly Drs with no compassion for individual needs to consider this horrific state of affairs for our lives?

  • Cathy
    2 years ago

    I totally agree. It’s a terrible & cruel decision to have to make, & it really is a kind of Sophie’s Choice.

  • annie7
    2 years ago

    thanks for your post. i couldn’t agree with you more.

  • Amanda Workman moderator author
    2 years ago

    You’re most definitely welcome. I hate we have these kind of issues on top of our pain conditions. Hopefully one day we will no longer have this kind of problem
    Amanda

  • pwrnapper
    2 years ago

    My empathy to all of us migraine and headache sufferers. Ours is a life full of constant pain and like a crap shoot we don’t know when “the beast” will show up. Personally I have Cluster Headaches, which are much different from migraines and viewed as “the worst pain known” and I believe it. Being a sufferer for more than 15 years CH has almost destroyed my life and career. While I am episodic now thankfully I was chronic for many years with 5-6 CH attacks per DAY. Totally disabling CH attacks and not something we can just live with. The kind that you curl up in a fetal position, hold your head and cry type, do you know what I mean?

    I’ve tried just about everything as preventative and abortive know to medical science. After many years of running around to different doctor and trying different meds I finally found the combination that works for ME to manage the Cluster Beast. I finally found a Headache Specialist who works with me and is flexible in trying new things.

    To the subject, the only abortive med that has worked for me consistently is DHE ( dihydroergotamine mesylate) injections. I started out with Migranal, which is a nasal form of DHE and while it worked initially my body became tolerant. I also faced the 6-9 nasal meds per month so facing 5-6 attacks per day that just doesn’t cut it. We switched to the injectable form with 1 ml ampules, which is the recommended does. I too ordered the maximum DHE each month whether I needed it or not, saved up for those months when I ran out.

    During a DHE shortage I started cutting back on the dose I injected myself with. First to 1/2 ml then to 1/3 ml. I found that if I caught the CH early enough the 1/3 ml dose work, knocked the beast away. During my cycle periods I will 3 syringes with 1/3 ml each and use as needed without exceeding the FDA recommended daily maximum.

    We added O2 with a non-breather mask to the treatment plan and I have a neck pillow in the freezer at all times at work and home. The combination of O2, cold and DHE injections really seems to get rid of those horrible CH attacks whereas nothing else comes close for ME.

    So bottom line is Don’t GIve Up, find a Headache Specialist that is willing to work with you and is flexible on your meds. Keep trying alternative meds and treatments until you find something that works. I take Botox and SPG nasal injections as Preventatives and DHE, O2 and cold for abortives. Not perfect, doesn’t prevent the attacks but does make the situation manageable.

    During a DHE shortag

  • Amanda Workman moderator author
    2 years ago

    You have definitely been through your own very long experience. I’m glad you found a process that started to work for you. I think the hardest part for most people is finding that good doctor!

  • Adam
    2 years ago

    I feel for you all. I have been struggling with migraines for decades, have tried a slew of preventives and Botox, with no relief. Recently tried occipital nerve block injections, since I have terrible occipital pain and cant even put my head on a pillow due to the pressure. First injection gave me a week with virtually no migraine (half pill imitrex on one day), which I considered a great success, as my migraines have been largely daily for the last year. It was a very strange feeling to wake up for a couple of days and not have a migraine… This leads to the topic at hand.

    I had been taking imitrex tablets for many years and stressing over rationing my meds. Several years ago, my Neuro managed to get the insurance company to cover the imitrex on an 18 renewal cycle instead of 30. Still problematic considering 9 pills does not equal 18 days.

    Well a couple of years ago, a co-worker agreed to share her imitrex with me, as I was out and in the middle of a migraine. However, she said she would give me half a pill, since she too was low. I never tried breaking in half before. She said she does that frequently. Well ,the half a pill aborted the migraine and from that time forward, I often start with a half and find that it does the trick. Now the 9 pills split in half can get me to 18 day refill.

    However, as of late, there are often days where half a pill doesn’t do it and I take another half or a whole. In addition, I learned in the last World Migraine Summit, that for people like me who wake up with full blown migraine, the imitrex tablet may not be effective, since migraine brings on gastric cessation, which can inhibit the absorption of the med. (Also, as noted in this article, the abortives are more effective when taken early.) They suggested injectable which bypasses the digestive system and of course works much quicker. It also doesn’t irritate an already nauseous stomach.

    Spoke to my neuro and he agreed. Even better, I discovered my insurance will pay for BOTH the tablet and injectable. Another “trick” is I always refill my migraine meds as soon as they are eligible, even on a rare month I have several doses remaining, so I can try and “stockpile” for the really really bad month. (All bad lately.) I hope this is helpful and best wishes for good health to you all.

  • maria.deleon moderator
    2 years ago

    this is a great topic and unfortunately when that happens way too often unfortunately due to cost of medications..however, as a person living with migraines and a neurologists who has treated many patients the best option is always taking abortive therapy as soon as symptoms begin ..i don’t mean just head ache but also the sensory symptoms. by doing so you are guaranteed a higher rate of success in aborting migraine without need to escalate pain or need to take multiple doses plus you will be avoiding the priming that occurs in your brain of desensitization which occurs with chronic pain – i.e. the brain pain center will not get used to pain thus making it harder to treat. maria de leon/ moderator/patient advocate- happy Easter everyone

  • debbieleq
    2 years ago

    Maria, how about my situation? I have daily migraines, as in I go to bed with a migraine and wake up with a migraine. My pain tolerance is extreme (my doctor has told me my 10 is another person’s 15) and everyday I wake up with a 6 to 7. My neurologist tells me to take the Imitrex when I feel the onset, but the reality is I never have an onset symptom because the migraine is constant. About 18-22 days a month I wake up with a severe (10) migraine and it will last all day. During these days I have two choices, go to the ER or sleep. I cannot afford the ER and the reality is every time I end up there it takes 3 courses of morphine for them to bring my blood pressure back to normal. I can’t sleep because I am a mother and have a family to care for. I am just miserable. Abortives are useless and so far preventives are not working either. Some days I find myself taking sleeping medicines to fall asleep so I won’t hurt myself. I know you are not able to give your professional opinion, but as an informed migraine sufferer how would you cope?

  • SkiingIsBelieving
    1 year ago

    I was recently prescribed Zanaflex, a muscle relaxant to take before bed–it has a side-effect of sleepiness, and can help with those of us who wake up with migraine, because once we wake the episode is too far to respond to the triptan. The generic is tizanidine. I haven’t tried it yet but the neurologist said it works wonders for some. Maybe worth asking about?

  • Netty
    2 years ago

    Recently I’ve been trying something more natural. I’d read about studies using powdered ginger to treat migraine as an abortive. It came up equal in effectiveness to Imitrex. I put 1/4 tsp in warm or cold water and stir. Yesterday I also added a 1/4 tsp of tumeric because my neck and shoulder were hurting too. Migraine and neck and shoulder pain were completely gone. I found this info at nutritionfacts.org put either ginger or migraine in their search engine.

  • mike1875
    2 years ago

    I am both frustrated and amazed that 72% of we migraine patients are under medicated. I also have cardiovascular disease. At no time has my cardiologist told me that taking my Statin drugs should be limited to only so many a month. The bad side effects are out weighed by the job they perform to help me survive. In what way are Triptans different? I get a Migraine virtually everyday. I use Frova and 8mgs of Dilaudid as soon as the symptoms hit. If I wait they don’t work. I am then incapacitated which leaves my employees without a boss along with all the physiological problems that occur with each episode. Why are we second class patients? Perhaps the reason is that the drugs cause rebound headaches and yet I can have a month of Migraines and then a week without. There is no rhyme or reason. I believe that we are the subject of our Doctors lack of knowledge and fear based practice. I am sure that I am not the only one to have thought that death would be a better alternative than the continued pain when I was in the middle of a Migraine attack. I do not have a death wish!! However living in constant pain without the ability to treat it especially knowing that treatment is available is cruel and unuusal punishment. We don’t treat our pets this badly.

  • Katyb
    2 years ago

    I’m surprised you’re allowed Dilaudid, as well. The only person I know that gets that is my friend in Canada. I never tried it, but usually anything narcotic doesn’t help me at all. It takes the edge off, but the next day, I feel worse. Glad it works for you!

  • Amanda Workman moderator author
    2 years ago

    I’m honestly impressed you are allowed the dilaudid. Most nueros refuse the idea of pain medications in addition to abortives. Many doctors do not want “to be watched” for prescribing pain medications or too many medications. And you are correct, if we had a pet in this much pain, we would likely be referred to end their suffering. But that is not an option for us. We have to keep pushing through it all.
    Amanda

  • drmaryb
    2 years ago

    I have a different sort of dilemma with when to take abortives – but I really feel for you folks. My issue is that head pain is often not the first sign I have of migraine nor is it the worst. I may be very nauseated for a day or two first. So I think: is this a migraine or something else? So I don’t take it. By the time the headache hits, I tell myself: it’s too late now so why bother?

    I also must say that the abortives often don’t help me that much. If I do have bad head pain, sometimes they relieve it – but the rest of the migraine goes on (nausea, fatigue, mental fog).

    I’m not complaining. Obviously, many of you have it much worse than I do. But it’s not fun either way.

  • Tamara
    2 years ago

    I’m in that position multiple times a month. I also have never ending pain so it’s hard to know whether it’s a migraine flare or not. If I don’t take a triptan and it is a migraine it ends up in a multiple day horrible time that commonly ends up in urgent care for stronger IV meds.

    However my headache specialist and I decided to change how I use for meds for three months to see if their is any difference. I use to take a triptan (tablet or nasal spray dpending on how quick it comes on) then second dose in a few hours if needed, then add toradol if still nothing, This way I spend an average of 5/10 every day as my lowest, it sucks. I have tried over 12 preventatives with no success, including Botox and cannabis.

    My specialist and I are giving 3 months to see if the following gives any better. I am hitting every migraine hard with imitrex injection, or zomig nasal spray PLUS toradol, zofran and baclofen all at once at the first sign. No waiting and no worrying about medication overuse for now. We will reassess in 3months and ensure it’s not making it worse. But I definitely end up with multiple day migraines because I wait too long and then they don’t work. I do also worry a lot when I have used 10-12 days of meds when it’s only the beginning of month. Of course that anixety and stress makes for a rough cycle. Crosses fingers.

    This is definitely the worst part of chronic migraine

  • Barbs
    2 years ago

    Excellent questions raised in this post. I was a little bummed, however, you didn’t share any of your strategies for stretching your allowed abortives. But I assume you are soliciting ideas from our group on how they cope. So, here goes with mine. Absolutely imperative is keeping a tracking calendar, as is a good sleep schedule and eating/drinking before reaching the “need” point. Beyond that, I support my current preventative (which I’m not sure is helping much) with supplements like magnesium, feverfew, butterbur, riboflavin and a couple other lesser things. I still have 10 to 12 migraines a month and struggle with that tipping point for taking one of my six injections. Typically, I take it when the pain hits about L6, followed up an hour later with a dose of a product containing five different homeopathic substances which I repeat three hours later. Along the way I may include use of peppermint oil to the head, ice packs, etc. And I’ve killed the migraine. But wait, what about the other 4 to 6 migraines a month? Well, there’s OTC formulations but I absolutely don’t allow myself more than 10 to 11 total doses each month of RX and OTC. So yes, I suffer through a few migraines without their help and do everything I can to mitigate the pain with supplements and homeopathic remedies. I’m very lucky to have a supportive husband, I no longer work, and I can focus on pain management. It’s a structured life which can be constricting for some, but I’m reconciled to it for now and fully enjoy the moments of non-pain days. My heart goes out to those sufferers who still have to fight their way through days of pain while working or having young families — but strict adherence to a balanced wellness plan is my strongest recommendation.

  • debbieleq
    2 years ago

    This is some great information, and I commend your discipline.

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