Triptans for migraine abortion: does it work for you?

October 6, 2009 10:24 AM

With regard to triptans, what defines victory over a migraine?

I am a longtime sufferer of migraine with aura and am currently cycling through various triptan drugs in the hopes of finding one that will abort my migraines. I have tried Maxalt and it did nothing for me, and am now trying Relpax. Last night I took it during the aura and this morning I have no headache, though victory so far is hard to define as I had the aura right before going to sleep for the night.

For people who have had success with the triptans, I have the following questions:

1.) do you personally define the triptan as working by complete abortion of the headache, or simply by some reduction in severity/duration? Have you ever been able to completely stop a headache in its tracks?

2.) how many triptans did you try in order to get an effect?

3.) do you have experience where one triptan didn't work quite as well as you'd hoped but not badly, and then you tried another one and found it to work marvelously?

I guess my main point here is in me trying to decide how far I should go with a given drug, when an "ideal" triptan for my physiology might be right around the corner and I'm just missing up by accepting whatever I'm on. Probably a deeper medical-philosophy question than applies to just triptans, but I'm looking for personal experiences.

posted by sickinthehead to health & fitness (15 answers total)

For me, total success with Imitrex is when I may have the halo, but I don't have the pain. I still feel woobly and not quite *on* after the triptan, but it's so much better than 12 hours of hallucinations and agony.
posted by headspace at 10:44 AM on October 6, 2009

IANAD.

The manufacturers regard treatment with triptans as "successful" if they relieve the pain 50% of the time or more, and if the pain relief brings the migraine patient from "non-functional" (i.e. can't get out from under the covers without debilitating pain) to "functional" (still in pain, but able to do stuff).

The fact is, migraines are incredibly hard to treat, we still don't know what actually causes them, and no one quite knows *why* the triptans work when they work. I have yet to see anyone, in my experience, who finds any triptan to work all the time. It's not a magic bullet.

My advice, such that it is, is to talk to your doctor about using a different triptan each month from among the common ones that he/she considers to be safe for you. Whichever one has the best "batting average" is the one that you should keep using.

Good luck. Migraines suck.
posted by Citrus at 10:59 AM on October 6, 2009

My experience with Imitrex was very similar to headspace's. I switched to Axert because my doctor's daughter liked it better than Imitrex, so he recommended it for me -- and it did work better. Still not 100% guaranteed to blast it away, but the earlier I caught the migraine (but after the migraine itself started, not during the aura) the more complete the relief.
posted by katemonster at 11:22 AM on October 6, 2009

I don't have aura, but I have found success in beating migraines (for what I hope is) for good. I had good luck with Imitrex for a while but then found I built up a tolerance to it. I've been taking Relpax for several years, sometimes in conjunction with a 550mg Anaprox (equivalent to 4 Aleve, I think). If I take a Relpax by itself and I don't have noticeable relief in 30-45 minutes, I take a second. I've never had to take a third and would probably call the doc if two didn't work.

For me, relief = pain free, perhaps a little woozy.
posted by Sweetie Darling at 11:23 AM on October 6, 2009

I don't take triptans because they are contraindicated for my kind of migraine, but I would like to reiterate what Citrus said - migraines and their treatments are pretty poorly understood, so success is more like baseball batting averages than high school math test scores. I feel lucky when the abortive I can take results in a dull headache.
posted by Pax at 11:24 AM on October 6, 2009

Imitrex totally eliminates the headache for me (I mainly use the injection). Of course, you may still have some of the side effects: feeling a little cloudy/out of it that day, slight dizziness, maybe some slight aura- whatever is typical for you. But when I take the shot, I can count on the headache subsiding within 20 minutes and should be GONE-gone within an hour. So I definitely count that as success.

Everyone is different, of course.
posted by Eicats at 11:24 AM on October 6, 2009

IANAD. IANYD.

Maxalt stopped working for me after a while; that was the last in a long line of triptans I tried over the years. I was getting rebound migraines all the time, and was just exhausted.

My doctor then prescribed atenolol for me to take twice daily. It's basically beta blockers, used for people with high blood pressure (I don't have that), but it has a very useful side effect of zapping migraines. I think it's something to do with opening up the blood vessels.

Atenolol (generic for Tenormin) has been an absolute miracle for me. I've gone from having a migraine once every 10-14 days to maybe two a YEAR. When I do get migraines, they are quickly treated with Maxalt.

I haven't noticed any side effects with the atenolol -- they made me sleepy and sluggish for the first couple of weeks I took them, but I was fine after that. (Note: Do check with your doctor, since low blood pressure can be just as much a health issue as high blood pressure.) And they cost me just $10 a month.

If you want to move away from treating your migraines to possibly preventing them, I highly recommend talking to your doc about this. Good luck -- I know what you are going through.
posted by vickyverky at 11:39 AM on October 6, 2009

I had to try several different triptans before finding one that worked. First, I tried Maxalt, which did absolutely nothing. Then, I tried Relpax that partly relieved my headache. I decided to give Imitrex a try and found that it helps completely.

I was actually shocked the first time I took Imitrex and it felt like the migraine just turned off after about 30 minutes to 1 hour. Now, I literally feel no pain after the Imitrex kicks in.

When I first feel a migraine coming on, I try taking Advil. If the pain continues to get worse, I take Imitrex.

My mom also takes triptans and she found that Relpax works best for her. I think different people react differently to different triptans. I think it's worth it to keep trying different triptans until you find one that works for you.
posted by parakeetdog at 12:24 PM on October 6, 2009

IANAD
I'm providing my migraine history for you to compare and contrast with your own. Feel free to ignore it. Of course YMMV.

I'm a 31 y/o male with migraine since I was 12. I get completely debilitating migraine with aura. Zig-zags of light and numbness on half of my body. Sometimes I become dysphasic (problems speeking and undertsanding). The more sensory parts of the aura usually last from a half hour to an hour. The dysphasia can last throughout the headache and continue the next day. The headache itself can last from 4hrs to a day.
I also get terribly painful, but not quite as debilitating migraine without aura.
For a long time I used only hydrocodone to treat my migraines- usually 15-45mg (2-6 pills). I tried Imitrex and Maxalt and had no success with either. I finally got tired of hydrocodone making me feel shitty, so I asked my doctor for something new. He gave me frovatriptan, which has actually worked pretty well. It was initially developed for menstrual migraines, but it works well for me and I don't menstruate (not sure what's up with that, doctor says it's an anatomical issue :)

If I take the frova at the beginning of the aura, I have been able to completely stop the migraine. I have also had the aura run it's course and not gotten the headache. I have to take it near the beginning of the headache for any relief. Otherwise it's hydrocodone and ice pack time. My understanding is that this is pretty typical of all triptans.

In answer to your first question- I count success as anything that can get me to a functional state within a reasonable amount of time (an hour or so for me).

In answer to your second question- I only take one 2.5mg pill for initial effect and then a maintenance dose 2hrs later. Usually don't need a third. Max dose/day is 3 pills. Unless something has changed, this is pretty typical for all triptans, and you shouldn't be taking more than one pill at a time. They promote vessel constriction and too much can lead to an loss of blood flow (ischemia) and serotinin syndrome.

Couple other things to consider- have you experimented with route? Imitrex comes in injectable and inhalable forms. I know the idea of stabbing a needle into your thigh might not be terribly appealing, but what price a migraine-free life? Also, I'm somewhat embarrassed to admit that it was not until recently that I discovered the wonderful powers of ice. I've had it work on it's own and also had it potentiate the effect of the triptan. If you're anything like me and you thought "what's a little bag of ice gonna do for my huge migraine," I would recommend trying it.
posted by brevator at 12:41 PM on October 6, 2009 [1 favorite]

Sorry you're going through this. Migraines really bite.

For me, victory over a migraine is when the pain in my head is dulled, but the pain I get in my stomach from the triptan doesn't rival the migraine.

Imitrex was not great for me for headache pain. At least half the time I would want to take a second dose. But it gave me terrible stomach aches. I hated a migraine because there was just no getting past it, I was going to be spending the day in bed. If the side effects from the pill is as bad as the headache, that's no cure.

I finally spoke to my doctor, who switched me to Axert. It works better on the headache and doesn't cause the upset tummy. Last time I had a migraine I only lost a couple of hours to it. I wouldn't drive after taking a triptan and a pain pill, but went about life pretty normally otherwise.

Hope you find some relief.
posted by toastedbeagle at 12:45 PM on October 6, 2009

I consider treatment of my migraines with with triptans (I use Maxalt right now, and have used Zomig and Amerge in the past) to be successful if the pain, nausea, visual disturbances, etc., are reduced approximately to the level of a serious but not extreme hangover. Lately it's been bad enough that even my relatively more "successful" doses still leave me unable to work, think clearly, or even do basic low-impact household chores while I recover.

I can count on the fingers of one hand the number of times that a triptan has completely aborted a migraine and returned me to a completely pain- and symptom-free state for more than a few hours. Like breavtor, if I don't catch it before or just after the aura starts the odds of success beyond marginal pain relief are low. Unfortunately, they often start in the early morning when it is hard to distinguish the prodrome symptoms from the normal (for me) urge to stay in bed and sleep at all costs.
posted by onshi at 1:22 PM on October 6, 2009

Thank you all for your informative responses!

Citrus: I am not looking for manufacturer or doctor described victory conditions, only personal experiences.

Vicky: I have debated with myself over taking a beta-blocker for a long time, but ultimately you are not supposed to smoke marijuana on them and I'm not sure if I will trade that for migraines, to be honest. And if that doesn't make me sound like a drug addict (I'm not - I swear!) I don't know what does.

Brevator: I've never tried ice, either. If I am at home when the migraine hits (this virtually never happens), I lower myself into a scalding hot epsom salts bath. My little pet theory on this is that in the ER they commonly give a bolus dose of magnesium for migraine patients, and magnesium is also absorbed through the skin (though obviously in much lesser quantity than i.v. injection). Regardless of whether I'm right, I do find the bath very soothing. But back to ice, do you just hold some ice in the spot where the pain is?
posted by sickinthehead at 2:15 PM on October 6, 2009

I don't get migraines anymore (stopped taking birth control pills, and found that they had been caused by estrogen withdrawal). When I did get them, I did not have an aura.

My first triptan was Imitrex tablets. I found it either worked completely within an hour and eliminated the pain, or it didn't work at all. It was about 50/50 for me. Sometimes this was improved by eating something with it, if I wasn't too nauseous.

I tried a higher dosage to see if I could increase my working percentage, and got some nasty side effects (so that's what "difficulty swallowing" means!) so I switched to Relpax. Relpax worked for me almost every time.
posted by cabingirl at 2:21 PM on October 6, 2009

Yup, just hold the ice over the painful area. It may increase the pain for a bit, kinda like an ice cream headache, but give it some time.
Not sure what to think about the hot bath and Magnesium. Hmmm, I suppose the overwhelming vessel dilation throughout the body from the heat and from the smooth muscle relaxing effect of the mag. would decrease blood flow to the brain. Come to think of it, this is what causes people to faint in the shower (minus the mag), so it definitely would cause decreased blood flow to the head. I wonder if you would get good results from icing your head while in a hot bath? I might just try that.
Once again- good luck.
posted by brevator at 10:38 PM on October 6, 2009

My point was simply that expectations of what Triptans can do are pretty low.

Imitrex didn't work very well for Mrs. Citrus, and Relpax almost worked 50% of the time. She stopped using them a few years ago, due to various and sundry "don't take this with" precautions. I suspect that they would have worked better for her if she took them earlier, rather than resisting and trying to "wait to see of it goes away on its own". For the record, none of the more recent remedies has had a better success rate for her than Excedrin Migraine (the typical acetaminophen/ibuprofen/caffeine combo).
posted by Citrus at 8:14 AM on October 7, 2009