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Medications & Prescription Treatment

Migranal

  • By Bobbilynn

    I was just prescribed Migranal nasal spray for my migraines. I’m wondering if anyone else has used this med, what your reactions were (good/bad), and how well it worked for you.
    I’m always cautious when I’m given something new (to me) to try even if I’ve heard of it.

    Also, it was suggested I follow a Mediterranean diet to help re-train my brain on its pain sensitivity.

    Anyone care to comment? Thanks for your input!! So glad there is a group to dicuss all this with!

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  • By lhaber4

    robynswiderski:

    Have you started this yet? I just got this to take today to try and break a rebound migraine cycle. Has it worked for you?

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  • By Bobbilynn

    lhaber4:

    I have tried the Migranal twice now. The first time I used it, it did nothing for me and I ended up in the ER to break the pain. I tried a second time and still nothing. I realize it takes time for meds to work, but I was hoping it wouldn’t make me rely on the ER for pain relief.

    So far, no good. I use the nasal spray and my doctor wants me to try the injecgtions. I’m not up for that if the spray doesn’t work, I’m not so sure of going to needles.

    Hope it works for you!

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  • By Ellen Schnakenberg

    lhaber4 – I would encourage you to have a candid conversation with your doctor. It’s likely that he will explain that he really wants you to get relief, and that this different delivery system may work better for you. You simply won’t know until you try. The ER is going to give you injections, but usually those meds are ineffective in actually aborting the attack, which really is our goal. If the attack is aborted, the pain goes away.

    Are you on a preventive yet?

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  • By lhaber4

    Ellen-

    Before I got the Migranal I went to the ER last wednesday and the migraine came back 12hours later.

    I got enough courge to try the Migranal, on my fourth day and it did take away the sharp stabbing pains which is good and now I’m left with my tight/pressure type headache.

    I have been on preventives since august 2011. The current ones I’m on are Nortriptylne, Verapamil, and Zanaflax. They seem to not be doing a great job sadly.

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  • By taralane

    I just started using Migranal about a month ago. My first tx took about 2 hours to get any effect, and it was very expensive for the 8 treatment package. I was trying to break a 6 day, level 8 migraine and had no success with any other treatments.

    The ER I went to only had Dilaudid and Morphine, and I knew both would give me a rebound headache, so I asked for a scrip for the Migranal which I had read about but not tried. I had used DHE 45 injectable 15 yrs. ago, but this was a new delivery system, and I found it worked well. The second time I used it, was even better.

    I am on a lot of preventatives, and have been for years, but finding good rescue meds is the hardest thing for me, since my body becomes more intolerant of them more quickly as I have gotten older.

    DHE 45 is one of those meds for me, that seems to get better with use, unlike most other meds. I will post again if it stops working.

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  • By mljmorris

    I use the Migranal nasal spray when my other meds don’t work. We tried DHE as an inpatient last January 2012 and found that it worked and my neuro switched me to the nasal spray for home use.

    It is expensive for the 8 pack (and you can’t buy it any other way). One bottle is one full dose according to my neuro’s orders and it does take several hours to get the full effect. I’m still left feeling completely run over by a truck and out of it for the next 24 hours, but after that day-after I’m usually okay and good to go. When it’s that bad that I’m reaching for the Migranal one more day isn’t that much more and at least I’m not in pain any more.

    Also we always follow up any Migranal treatment (or other migraine meds) with a muscle relaxer for tension and anti-nausea med because both of those are always an issue for me. The goal is always for me to sleep it off. So far when I’ve reached that point and needed to take the Migranal it has worked. I’m only allowed two bottles a week, but I really only want to take one (and have) because it does raise my blood pressure more than I’m comfortable with.

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  • By taralane

    MLJ Morris – thanks for mentioning the high blood pressure you’ve noticed with the DHE-45 use. I have been going to either the Migranal or the 1ml/vial injection (also expensive and they come in 6 vial boxes for around $250.00 only). I have used 5 of the injections and 2 migranal tx’s in the last couple of weeks and have noticed a change in my heart rate, just sitting down, doing nothing. I am seeing my doc next week, and will ask about that as well.

    To Anonymous – I got very used to injecting myself about 18 yrs. ago when I was having DHE-45 injections 3x/day. It is really not hard to do, just get someone to show you how and you will find that the needle does not hurt at all. Sometimes there is a sting from the medication going in, but that can be fixed by putting saline solution in the needle after you load it with the DHE. It totally takes away any sting from the meds.

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  • By Chris Hicks

    Hello to the group!

    I am in day nine of a bad cycle. Basically a single migraine from days 1 – 7 with a two hour break and then another intense migraine on day 8 (yesterday). As I write this things are better, but I am not free of the migraine. It is low in intensity right now, but it feels like I am walking on the edge of an abyss… any sudden movements and I will fall back in!

    My neurologist has prescribed the three day “migranal burst”, which I have done several times over the years. The burst lasts for three days and involves regular, scheduled sprays into each nostril at specific time intervals. Since my insurance decided to ramp the copay up to $200 per six or eight vial box this has become an option that is cost prohibitve. My neuro’s office is offering samples this time around to allow me to puruse this path.

    In the past migranal bursts have been helpful in breaking bad cycles like this. I am hopeful that this will once again be a salvation from the horrible pain. There are, like with any medication, side effects. For me, thankfully, they are minor and include such things as nasal irritation, excessive tiredness. These pale in comparison to the pain of the migraine.

    Here’s hoping this works!!

    Take Care,
    Chris

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  • By Nancy Harris Bonk Moderator

    Hi Chris,

    I’ll be anxious to see how this works. Have you every tried a three day steroid pack to break a nasty migraine cycle? Many people find this very helpful.

    Nancy

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  • By Chris Hicks

    A bit of follow up. I did not have much luck with the Migranal. Working on another strategy. First option from neuro, Thorzine ’til I slip into a mild coma (or close to it) is not super appealing.

    Might suggest steroid pack to neuro to see if that is an option she can support.

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  • By merrie

    I tried the migranal for the first time last night. It did seem to work…but only for a very short time 🙁 I took it at 11:20 pm, started to feel some relief by midnight, and by 1:40 am, migraine was back. Also noticed my heart was racing all through the night and this morning, and I got really sick this morning, which may have just been because the migraine was back on full blast. Not sure how much good it does me to have something so short lived, but on the other hand this is the first medication I have had any good results from at all so guess that’s something.
    Merrie

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  • By merrie

    Does anyone have experience with the injectable form of this med? SHE-45? I gave it a go with the migranal but it wasn’t that effective. Now I am going to try the injectable. I was shown how in the Dr.s office, seems pretty easy, but any tips as to what to expect as far as side effects or anything else would be appreciated. I am a little nervous about trying it. Also the Dr gave me a script for toorodol sprix nasal spray, anyone tried that before?

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  • By Ellen Schnakenberg

    merrie – you might have better luck inquiring in the threads for those specific meds. Just be sure and tell them you’re also on DHE 45 too, and are looking for interaction experiences 🙂

    ~Ellen

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  • By merrie

    Just tried the DHE-45 for the first time. Nervous as hack, and not a fan of the glass vial, or injecting myself for that matter. Hopefully it works after I have gone to such trouble. On the plus side my insurance covered it. Twenty dollars for 8 vial
    If anyone has any words of reassurance, I would appreciate it.
    Mer

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  • By Ellen Schnakenberg

    merrie, Many patients find this is helpful for them. I’m glad you’re giving it a chance. Now will keep fingers and toes crossed this helps. Remember too, that this is a trial for you. It may require some tweaking to get it just right.

    ~Ellen

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  • By merrie

    Hi Ellen,
    It did work 🙂 and with minimal side effects, just shakey and nausea but not too bad. Worse part was injecting myself. I do feel like I got run over by a truck, but this migraine was really bad, so that is normal for me. Hopefully it won’t come back later or tomorrow when I wake up. I made dinner and even ate some of it! Yay! Thanks for the encouragement.
    Mer

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  • By Barbara

    I was prescribed Migranal a week and a half ago as well as Indomethacin to break my 16 month, non-stop migraine. I have not experienced any relief thus far and have only been able to use the Migranal twice. Mostly because I reached the 8 allowable uses within the first day and am only allowed that per week. Having to wait 24 hours before and after my use of Imitrex has made the use of the Migranal virtually impossible. I am attempting to wait the 24 hours so that I can try the Migranal and hopefully get a positive outcome

    I see my neuro on Monday and hope to have gained some relief by then.

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  • By Nancy Harris Bonk Moderator

    Hi bbopp,

    I’m sorry you are not getting any relief yet. Have you tried a steroid taper pack to try and break this extended cycle?

    May I ask how often you are taking Imitrex? As much as we want our pain to go away, if we take migraine abortive medications like Imitrex and/or certain pain relievers, whether they are over-the-counter or prescription, we run the risk of getting medication overuse headache or moh. If we have moh, our migraines will be more difficult to treat and we may end up in a daily cycle of pain that is very hard to break. Let me share information on moh with you; https://migraine.com/blog/help-how-can-i-not-overuse-migraine-medications/.

    Nancy

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  • By Barbara

    I take Imitrex about 4 times a month with the exception of the last week and a half. My go to is Gabapentin. It does not really work very well unless I take 600-900mg. My neuro has ok’d use of it this way. I was able to use the Migranal today and feel worse than before. I am now in a position where I cannot use Imitrex, but thankfully, Gabapentin takes the edge off.

    I was told initially that I had a rebound headache (I did not agree) and am very aware of what I take and how often. I have done 2 tapers of Prednisone and one 3 day dosing of Methylprednisone. The result being that I felt as if I had been run over by a freight train and had no relief each time.

    Monday I go back to my neuro and after two weeks of Indomethicin and Migranal, he is considering the Raskin protocol.

    Barbara

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  • By Nancy Harris Bonk Moderator

    Hi Barbara,

    Are you taking gabepentin on a daily basis? This medication when used for migraine is to be taken on a daily basis, unlike migraine abortive medications and pain relievers – where taking these meds more than two to three times a week can create medication overuse headache or rebound.

    Let us know what the neurologist says? In the meantime is it time to think about a new doctor – a migraine specialist? Here is information on why these doctors are so special; https://migraine.com/blog/how-are-migraine-specialists-different/ and if you want to look for one; https://migraine.com/blog/looking-for-a-migraine-specialist/.

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  • By Barbara

    If I do not take Gabapentin at least twice daily, I can practically guarantee a level 7 or higher day ahead. The other rescue medications, I take as a last resort, and hopefully early enough. I get only minor relief from them at all, 2-3 hours at best.

    I do have questions:
    I have been taking a PPI inhibitor (Prilosec, Zantac, etc) prescribed by my doctors for 9 years now. My partner and I discussed that could be one of the factors at play in finding relief.

    1) Is it possible that my liver can not filter out toxins or process medications after such a lengthy period on Prilosec?

    2) What would a detox period look like?

    I will let you know how it goes tomorrow. Thanks.

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  • By Nancy Harris Bonk Moderator

    Hi Barbara,

    I’m not sure I made myself clear – gabapentin when taken daily for migraine, is a preventive medication. It is used in hopes of reducing frequency and severity. Abortive medications such as Imitrex, Relpax, Zomig and others like them are used to stop a migraine attack. Rescue medications such as muscle relaxers, and certain pain relievers are used when abortives fail or cannot be used. Let me share information on these with you in this link; https://migraine.com/blog/migraine-preventive-abortive-rescue-medications/.

    The FDA reported in 2011 that PPI medications can deplete magnesium levels in some people. This may be problematic because many people with migraine have low levels of magnesium. PPI medications may also not allow vitamin B12 and vitamin D to be absorbed properly. And again, people with migraine may be deficient in these two vitamins. So yes, these medications may be contributing to your frequent migraines. Here is an FDA link for you; http://www.fda.gov/drugs/drugsafety/ucm245011.htm.

    I really am not sure about a detox period on PPI medications, this should be discussed with your doctor.

    I hope this helps,
    Nancy

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  • By Barbara

    Hi Nancy,

    I have not been able to use Gabapentin as a preventative because I have had no break in the cycle thus far. I do though, understand what you are saying.
    I did have an appointment with my neurologist today. I am stopping the Indomethicin and am going to begin a DHE treatment for 10 days. I will be giving myself subcutaneous injections at home along with low doses of Reglan. I will be avoiding Imitrex during that time. We came to this decision mutually based on the fact that the Migranal had some impact on my migraine. If we can break the cycle, then maybe the Gabapentin can work as the preventative we hope it is.

    Thank You for you counsel and support,
    Barbara

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  • By Nancy Harris Bonk Moderator

    Any time, Barbara. I wish I had a magic wand that could make it all go away!!

    Just had another thought, have you discussed a steroid pack to try and break this cycle?

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  • By Ellen Schnakenberg

    Barbara,

    Preventives are often begun despite being in a bad “cycle”. In fact, this method is sometimes the only way a patient is able to find any relief for their attacks. Have you discussed this possibility with your doctor?

    I would also really agree with Nancy and encourage you to find a Migraine and Headache specialist. They are so much better educated in diagnosing and treating these attacks, and have many more tools in their toolbox that might result in relief for you. The longer you are in this situation, the harder it is to revert back to a episodic pattern: https://migraine.com/blog/will-my-chronic-migraine-ever-become-episodic-again/

    Steroids are often a very useful option to break an intractable Migraine attack. Dose packs are often the least effective use of this class of drugs however. Especially intractably tough attacks may require intravenous steroids or higher dose prednisone given over a longer period of time. https://migraine.com/blog/migraine-treatment-experience-iv-steroids/

    Hang in there. You didn’t get this way overnight, and it is going to take some time to get you out of it. Working with a good doctor is super key. That would be something really important to work on…

    ~Ellen

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  • By Barbara

    I started Gabapentin shortly after this Migraine began, not as a preventative, but more as a pain reliever. I take 2-6 times daily and as of today, have obtained only minimal relief. Recently, I was also put on Verapamil as a preventative. Again, with no break in the constant pain, relief was only minimal. I have done Prednisone 2 times, and Methylprednisone high dosage once, with no relief. I have not had episodic migraines, but only one that came on suddenly and refuses to let go.

    However, working closely with my PCP and Neuro (who is the chief of Neurology in my area), we found I could obtain 2-3 hours of significant relief with the use of Migranal. Based upon this, we now started a 10 day modified Raskin protocol I can do at home. I am giving myself twice daily subcutaneous injections of DHE and taking Reglan orally 20 minutes prior to the injection.

    Relief after 2 injections is significant and I am finding that my personality is returning and I am actually smiling and participating once again. I have 18 more injections to go and a follow up appointment right after. Hope for relief is within reach and the preventatives may actually be able to do what they are intended.

    Will keep you updated.

    Barbara

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