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what do you do when your medications don't work...??

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Migraine Headache
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Posted 11/24/2007 7:51 AM (GMT 0)
So what do you guys do when your meds don't work and you have a migraine? I take topamax for a preventative, then I have imitrex for migraines when I get one but it doesn't seem to make the pain go away. Some times I end up resorting to taking darvocet I was prescribed for something else because I just want the throbbing to stop. My doc just basically says "the imitrex should work fine". One time I ended up going to the ER because my head hurt so bad. I've tried other meds, like maxalt, frova...but I always end up with break through pain. Something obviously isn't working right and my doc just doesn't seem to "get it".
Posted 11/24/2007 3:19 PM (GMT 0)
Maxalt, Imitrex and Frova are all triptans. While they're often effective n treating the onset of a migraine, they're not particularly powerful drugs and don't work for everyone. That being said, there are a lot of in betweens before you go to something as powerful as an opioid analgesic like davrocet (meaning, your options shouldn't be all or nothing).

So, in between abortive medications: anti-inflammatory medications such as injectable Toradol, oral Lodine, Ketorolac, Relafen and Diclofenac. Anti-psychotics (or neuroleptics) like Zyprexa, Haldol, or injectable Droperidol. Ergotamines are widely used alternatives for triptans such as dihydroergotamine (DHE or migranal). Also, you can take short term tapers of steroids for particularly bad, longer lasting, migraines. Two such steroids are Prednisone and dexamethasone. If all of these fail then consider opioid pain relievers; you ought to try the in-betweens first.
Posted 11/24/2007 3:43 PM (GMT 0)
Also, usually if you're having a lot of breakthrough headaches that send you to the ER and traditional abortives won't stop, there's a good chance that it's time to change preventatives.

You say your doctor "doesn't get it." Since you say "doctor" and not "neurologist", I assume that you're seeing a general practitioner, not a neurologist who specializes in headache treatment. If this is the case, I highly recommend that you see the latter type of doctor.
Posted 11/24/2007 6:18 PM (GMT 0)
Hi doghouse,

It sounds to me as though you need your preventative either changed or the dosage adjusted to stop this breakthrough pain. Have you ever seen a Neurologist who is a Headache Specialist??? If not, I would strongly recommend that you do so.

take care

Ann
Posted 11/25/2007 6:09 AM (GMT 0)
I see a neurologist who specializes in migraines. I started preventative therapy with topamax in august and didn't have any migraines for a few weeks. After I started getting them again we upped the topamax dosage..I know that takes time to work. I don't want to up to the dosage too much though because it makes me too tired and foggy.

It just seems to me that when I mention to my neuro that my imitex, or whatever medication I have for the time being, isn't stopping or helping my migraines he just switches me back to another one I've already tried. If I tell him I've already tried it, he gives me the "let's try it again maybe it will work better this time"... It makes me want to smack him! He's never mentioned any of the medication Korbnep talked about - I'm going to look into to those.

I guess it comes down to my neuro doc won't work with me I'll have to find another who will. I just hate having to find a new doctor for stuff...but then again, I hate not being treated for something too.
Posted 11/26/2007 6:55 AM (GMT 0)
Hello doghouse,

Sometimes combining two or more preventative medications can help.  If topomax helps you but you don't want to up the dosage too much you could always ask your doctor to try adding another preventative to it.

I've noticed that it's best to be completely upfront with your doctors so they can better understand your situation.  My doctor only gave me abortive medications like maxalt, immitrex, and periactin.  I kept telling him that none of them helped and he'd switch it to something else that I had told him didn't work.  Finally I said "Nothing you give me helps, I've had to resort to taking the meds I was given for my surgery last year.  I've also been taking high doses of tylonal trying to lower my headache.  My headaches are starting to control my life, this medication is just not helping, I need something else."  Of course I got the "don't take more than what's recommended" speech, but my doctor finally started listening to me when I told him something didn't work.

I've had to go to 5 different neurologists before I found the right one for me.  While it was a pain in the butt to keep switching it was more than worth it.

Best wishes,

Liz 

Post Edited (Liz-hopeless) : 11/29/2007 8:07:29 PM (GMT-7)

Posted 11/26/2007 2:50 PM (GMT 0)
Hi Liz,

I am slightly concerned by your post as your referred to Imitrex and Maxalt as 'preventative' meds which they are not they are 'abortive' meds. I think the Periactin has been given to you as a preventative, but it is an antihistamine, albeit one that is sometimes given when allergies are involved with migraine!

I don't want to teach you to suck eggs when you may already know about these meds now, but do you know that Maxalt and Imitrex are triptans and that they should not be taken together or even in the same 24 hour period? When you have a migraine the blood vessels in your head swell up which causes the pain, and the triptans give the blood vessels a squeeze, thus taking away the pain and restore them to their normal size! The triptans are not painkillers as such, but the effect they have takes away the pain because they treat the cause!

I do agree that you have to persevere to find the right Neuro, and I hope now you are getting some relief Liz.

take care

Ann
Posted 11/27/2007 3:55 AM (GMT 0)
Ann,
I might be wrong but I think what you're correcting Liz for was a typo, though it is important that others do know the difference.

To be picky, triptans are painkillers as their primary function is to cause analgesia.

And Periactin is used as an abortive for migraines (like Maxalt and Imitrex that Liz listed) as it has not only antihistaminic effects but also antiserotonergic ones. Similar to triptans, it acts on 5-HT (Serotonin) receptors, though as an antagonist rather than an agonist.
Posted 11/27/2007 4:54 PM (GMT 0)
Ann,

Korbnep was correct, that was a typo, I apologize for the confusion.  I've been given Periactin as both a preventative and an abortive medication, so I accidentally lumped Maxalt and Imitrex into the same category.  Thanks for pointing that out to me.

Have a nice day,

Liz

Posted 12/11/2007 2:58 AM (GMT 0)
go to my headache ann reply......order mygrex at www.amazon.com amazing drug and cheap...
Posted 12/11/2007 5:33 AM (GMT 0)
Isn't that the same as Acetaminophen, Phenylephrine Hydrochloride and Caffeine which is like sinus medication with caffeine?
Posted 2/6/2008 3:02 PM (GMT 0)

dear liz    where do you go for your headaches. i live in new jersey

                                                             ashley   givenup

Posted 2/7/2008 12:13 AM (GMT 0)
Hello Ashley,

I go to a few different doctors in Michigan, as that's where I live.  I have previously been to Chicago, Cleveland and Minnesota to be treated, but it wasn't helpful, so I'm sticking to Michigan. 

~Liz

Posted 2/7/2008 4:47 PM (GMT 0)
Hi Ashley - I'm in NJ too - going to see Dr. Friedlander at Princeton Headache Clinic next week - haven't see him before but I will keep you posted if you like when I know what I think!

- Megan
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