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Medications & Prescription Treatment

Triptans

  • By Ellen Schnakenberg

    Skel, Only your physician is qualified to prescribe your medication. That said, there are a handful of different triptans. Each has something special about it that makes it somewhat unique. For instance, while Imitrex injections act very quickly, Frova tablets last the longest. While some patients need the fast acting qualities of sumatriptan (Imitrex) others do much better when the triptan stays in their system an extra long time, such as Frova provides. Those with Menstrual Migraines usually do better on Frova.

    So yes, there are multiple types of triptans, and while one may not be working for you, another might. Seeing a headache specialist who is well versed in the different types of triptans and how to use them is best, but if that’s not possible for you right now, consider asking your doctor to try a different triptan in case you might have some better luck with it.

    Sumatriptan itself doesn’t usually need “time” to work. Either it works for your attack, or it doesn’t. This doesn’t usually change a lot with time or repetitive use, although every attack can be different from the last one you had…

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  • By bonkersbgood

    I started on Imitrex(nasal) and it worked beautifully the first time or two. Within seconds I had relief and I could live amongst the living again. But as time went on–the Imitrex worked less and less until I had a reaction to it. My throat closed shut and I could not suck one ounce of air. Talk about panic! EVERY time I had this reaction I would get the throat swelling 72 hours after I took the Imitrex. And what is weird is that my migraines usually last right around 72 hrs too. Anyone else have reactions to Imitrex. It worked beautifully the first two times!!!

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  • By Teri Robert

    BONKERSBGOOD,

    Yikes! Sorry that happened to you. What did your doctor say about this? I don’t understand how the Imitrex could have caused that reaction 72 hours later because it should have been totally out of your system long before that. The half-life of Imitrex Nasal Spray is only two hours, so it’s out of the system within 12 hours. I’m not questioning what you say, just trying to figure out how this could have happened. Have you tried any of the other triptans? Zomig also makes a nasal spray.

    Teri

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  • By Gregory Gauthier

    Wren, how often have you been using the Axert ? Have you tried the sumatriptan injectable (SumavelDosepro) ? That works incredibly fast (at least for me, although side effects happen faster also). Greg

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  • By Anonymous

    Within the past two years I have had a steady increase in the number of migraines that I am getting. With what I am reading, I think I may be lucky because the triptans usually work for me. I am just concerned at the amount of them I am taking. I take about 6 a week, but at least I am still functioning at work. I worry about the impact this will have on my body.

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  • By Teri Robert

    Sallie,

    You said you’re taking six triptans a week. How many days are you using them. The number of days seems to be more important than the number of doses. Are you working with your doctor on preventives?

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  • By Anonymous

    Hello Teri,
    Thanks for responding. Typically, I am able to take one and I am good to go. Of course, good to go is relative. However, I have the tricky ones that may take two doses or the Meds may not work at all. I would have to say that I am averaging 5-6 days a week (I hate to admit that). I definitely feel that I have gotten stuck.
    I am on preventatives, believe it or not. My current cocktail is zonisimide, topamax, buproprion and flexaril. I have just not been able to get them under control as they have been increasing. I did have a wonderful 2weeks free of migraines when I was put on prednisone to break the cycle. Unfortunately they returned once I came off of it. I had my first round of Botox in November with the hopes of some change. I am scheduled again in February, but I am unsure if I want to continue because I feel that I may be worse.
    My Neuro said that I am ok as long as I don’t take more that 6 triptans in a week. I did have a visit with the PA in the office and she didn’t seem to have the same approval of the 6 triptans number, but would not disagree with the Neuro.
    I know my husband is worried every time I take something and I don’t feel that I can honestly ease his mind. I have been taking the triptans since I was about 17 and I am now 32, but I have never taken them in the quantity that I am now.

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  • By BeringC

    A migraine sufferer for 3 years (living in the tropics)I discovered Zomig and Imigran Nasal spray 4 months ago, and felt like my life had been saved.
    However a month ago while in the shower I noticed that the veins running over my hips were suddenly visible. I had never seen them before.
    Two weeks after that I noticed visible veins in my arms and shoulders.
    I went to my GP who was confident it was a side-effect of the triptans, due to the vascular nature of their work. She asked me to not use them anymore and to seek out natural alternatives for preventing and treating migraines. That same day I had a migraine attack, as the pain increased (with no relief from massage, cold showers, deep breathing, and visualisation) I could not handle it anymore and took a spray (20mg dose) which killed it. The next day I noticed a new web of veins across my chest, so I think my GP is right. She says she feels they will eventually go back to normal.
    I can’t see any documentation of this side-effect in my research.
    Has anyone else ever come across this and do I have anything to worry about?

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  • By Carol Witzell

    I am a lifelong migraner…first headache at age 4…have Chronic Migraines related to MANY triggers. I am a patient at the Carolina Institute for Headaches in Chapel Hill, NC…a 5 hr drive from my home in Columbia, SC. But it’s worth it. I keep on hand at ALL time; Imitrex 100mg tablets; Naratritan (Amerge…a stronger formulation of Imitrex) 2.5 mg; and Alsuma injections; also a stronger formulation of triptans. Triptans and Phenergen suppositories have given me my life back. I have had excellent results with them. I am now 56 years old; so believe me when I tell you that I have tried every drug on the market…those for prevention; such as anti-depressants or Tompamax (none of which worked); and beta-blockers…I use Verapramil 1 at night; and it seems to help. I also take 300 mg of Lyrica at bedtime. This helps with sleep and with restless legs; which I found is a common shared disorder among migraneurs. After 40-odd years of trying various drugs; I am TOTALLY sold on the triptans! I highly recommend them if you are like me and suffer almost daily migraines.

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  • By Carol Witzell

    I am a lifelong migraner…first headache at age 4…have Chronic Migraines related to MANY triggers. I am a patient at the Carolina Institute for Headaches in Chapel Hill, NC…a 5 hr drive from my home in Columbia, SC. But it’s worth it. I keep on hand at ALL time; Imitrex 100mg tablets; Naratritan (Amerge…a stronger formulation of Imitrex) 2.5 mg; and Alsuma injections; also a stronger formulation of triptans. Triptans and Phenergen suppositories have given me my life back. I have had excellent results with them. I am now 56 years old; so believe me when I tell you that I have tried every drug on the market…those for prevention; such as anti-depressants or Tompamax (none of which worked); and beta-blockers…I use Verapramil 1 at night; and it seems to help. I also take 300 mg of Lyrica at bedtime. This helps with sleep and with restless legs; which I found is a common shared disorder among migraneurs. After 40-odd years of trying various drugs; I am TOTALLY sold on the triptans! I highly recommend them if you are like me and suffer almost daily migraines.

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  • By Ellen Schnakenberg

    Carol Witzell – How frequently are you taking your triptans? Unfortunately, they can be the cause of something called Medication Overuse Headache (MOH) if taken more than 3 about doses per week. Alsuma is a generic version of Imitrex. All triptans work slightly differently, each with a slightly different focus.

    I’m so glad you’ve found something that is helpful and pray you keep having results from them. Good luck 🙂

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  • By Anonymous

    Hi, just a quick question, if anyone knows the answer. During a conversation with my migraine specialist she mentioned that you should never take a triptan during the aura phase of migraine, but only after the headache has started. She continued saying something else and I forgot to ask her about this. I am 42 yrs old and have always taken triptans right at the first sign of an attack (ie visual aura). I was told to do this decades ago in order for the drug to be absorbed quickly enough to work as vomiting usually started within 30 minutes of the aura. Just wondered if anybody knew WHY you’re not supposed to take tripans during aura? Is it dangerous?
    Thanks in advance.

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  • By Ellen Schnakenberg

    vikki – There is a growing body of research that says that you are correct 🙂 We actually talk about this fairly frequently in conference. Here is what just one paper says:

    “Patients should be told to take their triptan at the start of or early in a migraine attack because that will lead to better efficacy, as the migraine process is still located in the peripheral trigeminal system. Once the brainstem becomes involved and central sensiti-zation is present, patients develop allodynia and triptans and other medicines will not work as well.”

    If your doctor would like to look this information up, it can be found in the journal Headache (Headache 2012;52;S2:60-64) October 2012. Author is Alan M. Rapoport, MD

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  • By Andrew Mestern

    I have successfully used 100mg Sumitriptan tablets for the last 5 years, I average 6 or so migraines a month, usually in short clusters of 2-3 days. The last 3 days things have changed, first the Sumitriptan took forever to kick in and didn’t fully kill the migraine. Following that today the first dose did not work at all and the second dose was 50% effective.Afraid to go for a third dose. Wondering about a switch to injectable or nasal.

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  • By sreenivas

    As per my neuro’s prescription, I am using RizaTriptan 5mg SOS and getting relief in an hour in addition to preventive medication.I used to take an average of 5 to 6 tabs of Rizatriptan 5 mg in a month.Yet I am scared of the side effects of this medicine in the long run but there is no other way to avoid this in order to abort the attack at home and at work.
    Is it advisable to continue the present management ?

    Sreenivas Amancharla

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  • By Ellen Schnakenberg

    Sreenivas – I wish I had an answer for you. It is always best to do as your doctor has prescribed. If you have questions I hope you will contact them soon to have those questions answered. There are no across-the-board answers that works for all patients.

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  • By Ellen Schnakenberg

    andrewmestern – I am so very sorry that you have hit this difficult point in your Migraines. It can be really scary when the treatment we have relied on for so long suddenly doesn’t seem to want to do its job.

    There can be a number of reasons for this. One of those is that triptans can sometimes become less effective, or ineffective when central sensitization has occurred. Here is a link about central sensitization that might be helpful for you to discern if this might be happening to you. Please discuss this with your doctor, so if additional therapies etc need to be implemented you can do so before central sensitization becomes a problem. Hang in there…

    https://migraine.com/blog/migraine-allodynia-and-central-sensitization/

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  • By Andrew Mestern

    Fascinating article about sensitization, thankyou, i see one mistake i have been making with my meds. I always wait and wait to take the Sumitriptan. I tell myself it might go away,or maybe its just a headache, and of course it never does. I dont get an aura, my only indication is usually extreme cravings for caffiene and food, any food.

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  • By Blaine

    I realize this thread hasn’t been updated in almost two years, but I’m finding the efficacy of generic Sumatriptan varies considerably between brands. I’m hoping for feedback.

    I tried Dr Reddy’s Sumatriptan about five years ago. It didn’t work at all, so I stayed with Treximet. Due to co-pays on Treximet increasing over 10x last year, I’ve been trying other brands. Mylan sort of worked, though it took at least two hours to kick in and another migraine would occur for a 2-3 consecutive days. Watson worked extremely well, to the point I dropped to half a (100mg) pill; it kicked in within an hour but often I still had another migraine the following day (unfortunately Watson isn’t making Sumatriptan now, hopefully that’s only temporary). I call these “rebounds” but I’m not sure if that’s the proper term for migraines on consecutive days.

    Some questions:

    1. On every forum I’ve seen, complains about Dr Reddy’s Sumatriptan were frequent until 2012 but just stopped at that point. Do people find this works now? It seems to be the most common generic.

    2. Any comments on other brands?

    Note: I hope posting about brands is OK, I looked through the rules and didn’t see anything about it. I’ve experienced such a huge variation in efficacy I’m surprised no one talks about it.

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  • By Erin

    Triptans stopped working for me and when I stopped using them, my migraine frequency decreased. Just a thought for anyone who is chronic. Try going off them for a bit.

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  • By Anonymous

    This is in reply to bdbr —

    I hear what you’re saying about Dr. Reddy’s Sumatriptan. When my pharmacy first made the switch on me without my knowledge, I was on 50mg Imitrex and they went generic with Dr. Reddy’s. I didn’t notice the change and simply took one when my migraine started. It sort of worked in that it stopped the migraine…but it came back almost immediately a couple hours later, whereas the name brand Imitrex always took care of things permanently, if you know what I mean. However, with our insurance being the way it is these days, we HAVE TO use generics or go broke, so I have found if I use 100mg Dr. Reddy’s along with two Excedrin, and sometimes one Aleve, it takes care of my migraine. And I agree with you about all generics not being created equally. I also take Topiramate and have found that only the one made by Cambor works; all others are akin to taking sugar pills.

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  • By Blaine

    Thanks for that info AbsinthePlease. I’ve just started using Topiramate so I’ll look into that brand.

    An update – I got a script of Dr Reddy’s a month ago and have used 50mg (actually a half pill of 100mg, usually with Aleve) a few times and it works moderately well – about the same as Mylan, but at 1/3 the price.

    I checked with the Costco pharmacy and their Sumatriptan is made by North Star, a US pharmaceutical company, and sells for a non-insurance price of $21.87 for 9 pills (less than half the price of Dr Reddy). That sounds promising as well.

    In any case, given the varying prices and efficacies of generics I strongly recommend migraneurs put some effort into finding the best brand. Supporting good brands also helps all the other migraneurs out there too!

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  • By Anonymous

    To bdbr – I need to correct a spelling error: it’s Camber, not Cambor. And I don’t know where you live, but in my area, and it’s a large metropolitan one with many big name pharmacies/general merchandise stores, e.g., Walmart, Walgreen’s, Target, etc., the only one to carry Camber Topiramate is CVS; they told me it’s their preferred brand.

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