No Midrin available -- now what ??

For the last few years, I've managed my frequent migraines with tramadol or Midrin. I previously used Imitrex nasal spray, but it became too expensive and lacked effectiveness after several years; that's when I was switched to Midrin, which helped only somewhat, but did alleviate climb-the-wall pain. Recently I learned two things: Midrin has been discontinued by the brand and generic manufacturers; and (2) Imitrex nasal spray has a generic equivalent, which remains quite high in price.

My goal was to use the very pricey (even with liberal co-pay) generic nasal spray for the worst of migraines and try to manage the rest with tramadol. The pharmacist said there was a serotonin reaction and did not know how it would affect me individually. I'm also on 30 mg of Prozac, which already has a SSRI serotonin connection. I was shattered.

I'd stop the tramadol, but then I'd have to use too many generic sumipitran nasal sprays, which I don't want to do for many reasons, financially and for my health. Tramadol or OTC analgesics don't touch the tough migraines.

What can I do? My next consult with my migraine neuro is in a month, but I'm wondering if anyone has any ideas. I get extremely frequent migraines.

For what it's worth, I've seen at a leading headache clinic for years and have tried countless preventives (none worked) as well as the full array of complementary therapies more than once and often 5+ times (Botox, acupuncture, biofeedback, physical therapy, counseling, etc.), all of which had no effect. In fact, the Botox worsened my migraines.

Thank you!

That's a really tough situation to be in. It sounds like you're a migraine Pro by this point, but I 'm going to ask some basic and probably stupid questions. Just humor me for a bit.

What's your official diagnosis? CDH, Chronic migraine, ect.? Since you go to one of the big headache centers I assume they performed a differential diagnosis to rule out things like NDPH, comorbid neuralgias (occipital and sub-orbital) and secondary headaches. Have they ruled out some of the less common triggers like cerebrospinal fluid pressure issues, PFO's, etc?

How often do you take analgesics? I know some people have to take pain meds daily and there is just no way around it, but have you ruled out rebound headache as an exacerbating factor?

I know you've been through plenty of med trials. If your interested you can list them and we can try to brainstorm some others to try.

OK with the basics (sorry) out of the way...

Sounds like the pharmacist is worried about serotonin syndrome. Talk to your headache specialist. You may still be able to take triptans. I wouldn't completely rule it out yet. I've taken triptans (higher doses) and ssri's (moderately high dose) concurrently in the past.

For really bad pain, I believe there is some type of time released morphine capsule. There's marinol as well. A consult with a pain specialist may be warranted.

What about semi-frequent I.V. treatments (e.g. magnesium, depacon, DHE, etc.)? I know a lot of migraine clinics have their own, in house blends.

They are coming out with or have just come out with a DHE nasal spray.
There are also the older ergot based abortive drugs.

If you really want to go for the gusto, they have some relatively new medical devices out. E.g. Vegus Nerve Stimulators, TENS unit, occipital nerve stimulators, transcranial magnetic stimulators (I think there may be a home/portable unit available now).

I assume you've done the elimination diet thing. There are some anecdotal reports to suggest using some of the epilepsy diets could be helpful. I.e. ketogenic diet (need to be monitored), low glycemic index diet, modified atkins diet, GARD diet.

I hope you find something that is helpful!

Post Edited (EvilFluorescents) : 2/19/2011 12:28:46 PM (GMT-7)

I presently use generic Imitrex tabs and have found them to be just as good as the brand name.