Gettin' down and dirty with the 'graines

February 26, 2007 4:02 AM

Migraineurs and chronic pain patients, help! After suffering through a hurricane-force migraine on Saturday, I need a potent analgesic that'll knock a bad migraine into 2006.

You know 'em if you've had 'em. The head-in-a-vice sensation, the dizziness, the nausea. Usually, my migraines don't reach this apex, and are controllable by a few tokes of weed and two fioricets (a barbituate/caffeine combo). But after eight fioricets on Saturday, the pain refused to abate. What's more, the caffeine in the fioricet left me awake and jitttery. Time for a radical solution.

I've experimented with Immitrix, of course, but to no positive effect. So I'm not a good candidate for tryptans. And I'm not ready for the plunge into SSRIs, which some people say are migraine preventitives. At this point, my best bet seems to be Tylenol with codiene, but I'm worried about constipation from the codiene and organ damage from the Tylenol (which I believe affects the liver). Valium sounds like a possibility too. Nix on oxycotin or anything stronger (too scary).

Of course, I'd only use this analgesic WMD for the category five migraines (once every three months), falling back on fioricet for my weekly "visitors." So addiction isn't a concern.

A somewhat related question: I've found that a small, low carb salad at dinner, instead of a larger meal, prevents a migraine the next morning, in many cases. Am I imagining things?

posted by Gordion Knott to health & fitness (20 comments total)

Hm...If Imitrex is no dice, there is a nasal spray form of Imitrex that's supposed to be absolutely killer. Not sure if that would make a difference.

On the non-Rx side of things, Excedrin Migraine is pretty damn great. You have to take it at the absolute first sign that you're getting a migraine (for me, it's the visual aura) and it won't prevent you from getting one, but it will make a bad one a whole lot less awful.

As for diet, there is a ton of different info out there, from no caffeine to some caffeine to no alcohol to alcohol is ok. I think you basically need to experiment and then tailor your diet to your own circumstances to see what triggers you.

Btw, are you a lady? If so, hormones have everything to with when you get them. So, look into changing your diet when you are premenstrual.

And finally, most people agree that stress and anxiety can trigger these puppies. So make sure your lifestyle includes exercise, relaxtion, breathing and therapy(!) if necessary.
posted by sneakin at 4:25 AM on February 26, 2007

I generally tend to shy away from stronger meds so I'm afraid I'm not much help there, but I usually find drinking lots of water (especially if you've taken something with caffeine) and eating something with lots of potassium (a banana is usually good if it doesn't nauseate you too much) helps with any migraine -- even the rare, nasty knock-you-down types. It probably won't get rid of it, but it may very well take the edge off to the point where some medication you've already got will work.

You may also want to try something like Ibuprofen or Naproxen Sodium -- I'm not sure why, but taking something that has anti-inflammatory effects seems to help me (YMMV).

I hope this helps! Migraines are awful.
posted by AV at 4:52 AM on February 26, 2007

Just because Imitrex didn't work doesn't mean other tryptans won't, although I know that experimenting with such things when you have a migraine totally sucks. Imitrex only worked about 30% of the time for me so my doc switched me to Relpax, and that works much better. There's also Maxalt.

Have you tried the ergotamines at all? My insurance company wouldn't cover Imitrex until I had tried basically everything else. They are older but work for some people. I tried Migranal, but there's also Cafergot which has caffeine too.

Lastly, some people take beta-blockers for migraines, as a preventative.

Sorry for the prescription-only advice but nothing OTC really works for mine. Neither does weed, sadly.
posted by cabingirl at 5:33 AM on February 26, 2007

Ergotamines have been taken off the market here in Europe as they can have some very nasty side effects. They were still legal when I was a teen and my brother became a pink elephnt for a whole day.
Migraines can be so personal and certainly can be affected by what you eat.
I sympathise as someone who had the most brutal migraines during my teens. I once knocked myself out against a wall just to get some relief from the pain
Before going the WMD route, I would seriously consider the advice above or acupuncture if you can afford it.
My SO insisted when I was 20 that the amount of drugs I was taking ( an elderly and very sympathetic GP gave me Opiate based drugs like they were smarties) was not normal and I should try something different.
I was a total cynic and got a course of 6 treatments. Within 2 there was an improvement and after the course I ws migraine free.
I have no idea if this was placebo, or just my time to stop having migraines (they can be cyclical) but 8 years of pretty much 2 a month, within 6 weeks resolved to zero, zilch, nada. I have had one in the 20 years since.
Considering this is non-invasive,, non-addictive, please just keep an open mind about it.
posted by Wilder at 5:44 AM on February 26, 2007

Seconding the Excedrin - this has been the only painkiller to help my migraines. Imitrex made them 10x worse. Take as soon as you feel you're starting to get one; if you wait the medicine won't be as effective.

As a side note, Excedrin Migraine and Excedrin have the same exact amount of caffeine, aspirin and acetometaphin. I'm not sure why they're labeled different, but just a thought in case you can't find the Migraine one.
posted by sutel at 6:38 AM on February 26, 2007

Relpax is my savior.

I also take 60 mg of Antenolol (blood pressure med) as a preventative.

See a neurologist. I was getting 10+ a month and going home at least one day a week before I did, and now I haven't missed a day of work in nearly two years.
posted by Sweetie Darling at 6:56 AM on February 26, 2007

I'll throw in my vote for Excedrine Migraine too. Right at the onset of a headache take two with pleanty of water.

After taking Imitrex, injections, etc, this one, if taken at the onset, did better than all the big guns.
posted by brinkzilla at 6:57 AM on February 26, 2007

Excedrine Migraine is pretty much exactly the same as Fioricet, except without the Butalbital (the barbiturate). So it's likely that if you didn't have any luck with Fioricet, the Excedrine isn't going to help either.

My experience with Imitrex is that you have to take it immediately at the first sign a migraine is coming on for it to be effective. Once the actual migraine hits, it's too late for it to make much of a difference. If you have classic migraines with an aura, take the Imitrex as soon as there's any hint of an aura. (If you have easily identifiable prodrome symptoms, this works too.) You might try that before you give up on the Imitrex completely.
posted by dseaton at 7:15 AM on February 26, 2007

Maxalt. I love love love it. And I have ben able to take it 15m-1 hour into a migrane and have it still work.

Excedrin is also great, too, but sneakin is right-- in my experience it cuts the pain, but not the nausea, aura, etc.
posted by oflinkey at 8:07 AM on February 26, 2007

Hey! We're studying migraines this week! Here's what I was told in pharmacy school:

To say a migraine drug works, you need to give it an adequate trial - "working" is defined as working 2 out of 3 times. So Imitrex is not off the table yet. Also, all triptans are not created equal - Amerge or another one might do it for you. Also, make sure you are taking an adequate dose. For Imitrex, the dose is a 25 mg tablet every 2 hrs, with a max of 200 mg per day (8 tablets). You can also get a subcutaneous injection of Imitrex, or the nasal spray.

Here are the names of other triptans:
• Almotriptan (Axert®)
• Eletriptan (Relpax®)
• Frovatriptan (Frova®)
• Naratriptan (Amerge®)
• Rizatriptan (Maxalt®)
• Zolmitriptan (Zomig®) – disintegrating tablets

The triptans are first line therapy so I really encourage you to give them an adequate try. I've never had a migraine but I must say that they sound HORRIBLE. I really hope you find something that works soon, because I can't imagine being in that kind of pain.

Here are the drugs that get tried after triptans. But, like I said, go for a full, adequate trial of the Imitrex before giving up on it.

• Dihydroergoatmine (DHE®, Migranol®)
• Prochlorperazine (Compazine®) – IV only
• Butorphanol (Stadol®) – if others fail
posted by selfmedicating at 8:19 AM on February 26, 2007

Oh, and note that the fioricets you have been taking contain tylenol (acetaminophen) too. Yes, you can get liver damage from it - be sure not to take more than 4000 mg of acetaminophen per day. You want to take LESS than that if you are consuming more than one or two alcoholic beverages per day.

If you're healthy and aren't drinking alcohol and aren't taking more than the label says to, your liver should be fine.
posted by selfmedicating at 8:26 AM on February 26, 2007

My doc recommended magnesium supplements for migraine prevention, which I take along with my daily multivitamin, flax pill, and calcium supplement. It seems to have reduced frequency, intensity, and susceptibility (fewer reactions to trigger foods). My previous doctor recommended a B-complex for the same purpose, although that didn't work for me.
posted by amber_dale at 8:47 AM on February 26, 2007

selfmedicating - Maxalt also comes in quick-dissolving wafers (that's how I take it).

Common daily preventatives that your Dr. might try with you include beta-blocker blood pressure drugs like propranolol and low doses of Tricyclic antidepressants like Elavil (amitriptylene) for nerve pain (this is an off-label but not uncommon use for TCAs).
posted by onshi at 9:34 AM on February 26, 2007

My SO has had no luck with any treatment other than Maxalt -- which works wonderfully for her. Another vote for following up on other triptans and/or trying again with Imitrex (obviously, in careful consult with your physician).
posted by BT at 10:38 AM on February 26, 2007

A somewhat related question: I've found that a small, low carb salad at dinner, instead of a larger meal, prevents a migraine the next morning, in many cases. Am I imagining things?

Raising blood sugar (or other blood solutes) causes water to diffuse from tissues into the blood stream. Without adequate hydration to help maintain water balance, this may exacerbate a migraine.
posted by zennie at 12:06 PM on February 26, 2007

I take an excedrin migraine and advil together as soon as I feel it coming on. If it doesn't knock the pain down in an hour, I take one more of each. It doesn't help the woozy nausea feeling, but it does block most of the pain. I never take more than 2 of each on the same day, but often it does take 2 of each (sometimes the second dose 3-4 hours later when the pain starts coming back.) I carry these with me *always*.
posted by putril at 12:09 PM on February 26, 2007

How adventurous are you?
posted by turing_test at 8:51 PM on February 26, 2007

Something I've never seen mentioned in a migraine answer is the stuff that has worked for me for a year and a half: butterbur extract. I take 75 mg twice daily (sometimes the capsule also contains feverfew, which is another herbal remedy for migraine). The NOW and Nature's Way brands are good but there are lots out there. Just don't pay a bunch of money when you can get it for $20 or less. It's available in the better herbal stores or many places online.

German scientists have studied this seven ways from Sunday. It does wonders for me, although a sudden change in the barometric pressure still leaves me suffering. I'm going to experiment with additional butterbur extract.

"That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing."
-- Joan Didion
posted by bryon at 9:02 PM on February 26, 2007

As an addendum, I might note that a migraineur needs to know what triggers the misery. The best way is to keep a migraine journal so you know what you ate, what the weather was like, how much sleep you got, etc., that might have caused the migraine. Me, I'm light sensitive, so I keep the brightness on the computer monitor way down; wear sunglasses outside; and don't look out the window on a halfway bright day, especially in the morning. Morning sun is toxic to me. As previously mentioned, barometric pressure changes have nasty effects; I don't yet know how to keep the weather from occurring.
posted by bryon at 10:59 PM on February 26, 2007

When I get a migraine, I go to the ER and get a shot of demerol. (A shot because I usually can't keep anything down.) It makes me sleep for about 12 hours, but by the time I wake up I don't have the migraine anymore.
posted by IndigoRain at 8:39 AM on February 27, 2007