Fostair 200/6 Is it normal to develop headaches and it trigger migraines? Any advice on alternatives?

[LRLR]

Hi. I started fostair 200/6 about 6 weeks ago after becoming unsettled on fostair 100/6. I had no problems with 100/6-no side effects and found it settled my asthma quite well for a while.

However, during 6 weeks I have had the 200/6 I have had 5 focal migraines with no obvious trigger (This amount is unusual for me and I always know my trigger- illness, blood sugar) During the last week I’ve had the worst migraine I’ve had in 15 years, and every morning I’ve had pressure on top of my head, with mild headache and terrible light sensitivity, sound sensitivity, irritability, brain fog and exhaustion. It wears off by the afternoon but feel terrible from it. I suspected it is the fostair as it starts as soon as I take it, and when I missed a dose yesterday morning it didn’t happen- no headaches or head pressure all morning like usual. When I took my dose at 1pm I got the symptoms again! Light sensitivity to cloudy daylight, feeling exhausted and irritable with pressure in my head.

Does anyone know what this is? Has this happened to anyone else?

It has made me so unwell I cannot face taking anymore inhaler I’d rather be breathless than go through this. I have instead gone back to my 100/6 inhaler and feel so much better already. I know this is probably the wrong way to step down but I feel I have no choice.

This is ashame because my asthma has been managed the best it’s ever been in the last two weeks on this 200/6 dose, but clearly I cannot tolerate it.

Please could anyone recommend another inhaler that would manage me as well but without the headache inducing ingredient fostair has please? So I could discuss with gp.

Thanks so much

[twinkly29]

Why are you taking it at 1pm? The 200/6? That one should be taken twice a day (the 100/6 can be used throughout the day). Just asking as I wonder if they've got you on a stupidly high dose which is causing it.

My other thought is ask to go back to the 100/6 and have a different add-on instead of having the 200/6 Fostair. It's difficult to suggest an inhaler that would work as you'd need to try something for 8 weeks to know - but as you were ok on 100/6 Fostair then I don't think it's the ingredients per se as they are the same. So it's a mystery! What exactly were you on dose wise of 100/6 (puffs etc) and what are you on now?

[LRLR in reply to twinkly29]

Hi thanks both for your replies.

I am on 200/6 twice a day 2 puffs. I usually take it religiously at 8am and 5pm, however on Saturday I accidentally missed my morning dose and couldn’t take it until 1pm. This was completely one off but this accident made me realise the fostair was causing the head pressure and light sensitivity. As I don’t have symptoms all morning until I took it at 1pm then it started. All other days symptoms started at 8 am after taking it.

For the 100/6 fostair I was on two puffs a day morning and evening. Looking back I did have a few migraines on the 100/6 but I didn’t consider fostair was the trigger until now maybe? However I didn’t have the head pressure and these daily build up of problems so could it be I can’t tolerate it in a strong dose?

The symptoms didn’t become severe until over the 5th week so wondered if it is the build up of ingredients in my lungs I can’t tolerate? I’m just guessing!

[twinkly29 in reply to LRLR]

Ah ok! That sounds perfectly ok dose wise - was just worried they'd told you to take twice and day and then a load in-between as well! At least what happened means you have a possible cause though.

So....sorry more questions....what have you tried before in terms of inhalers? Just trying to fathom whether it might be the steroid or the LABA (long-acting bronchodilator). Am thinking the steroid as the amount of LABA is the same for both inhalers/doses. But if you've had that steroid before then hmmmm.

[colleenlight in reply to LRLR]

hi 😊 I know this was a while ago! i’m on my 6th week of fostair and started having constant migraines, i am a migraine sufferer anyway but this is ridiculous 😭 did the doc offer an alternative?

[jadiieee151]

i am currently on 200/6 dose but I do not feel the things you mentioned but I do have symptoms like tonsils after I started using it. i don't know if they are related.

[Poobah]

Fostair is quite a potent inhaler. It can affect potassium levels in some patients and this can lead to various issues, including raised blood pressure which in turn could lead to migraines. I'm not saying this is what's happened to you but the patient leaflet does highlight potassium levels as something doctors may wish to monitor. Unfortunately, testing potassium levels isn't straightforward so a blood test alone may not accurately reflect what's going on. Clearly your experiences on Fostair 200/6 are horrible and I would talk to your asthma nurse or GP about a full meds review. There are other inhaler options that may suit you better. Also check your blood pressure, just in case it has been affected.

Another possibility could be a VitD deficiency. If it's too low then it can affect your vulnerability to migraines, which can then be exacerbated by medications such as Fostair. We don't store VitD and after a couple of winters plus various lockdowns & shielding it may be that our levels are inadequate due to a lack of regular exposure to the sun. Your GP may run a VitD blood test if you request one but it's unusual to get more than one test a year, so if you start taking VitD3 a further test to check your levels may have to be done privately. They're around £30. I used to suffer regular migraines but have only had one in about 8 years since I started taking VitD3 (after having my levels checked).

Definitely the first thing to do is to review your asthma meds with your asthma nurse or doctor and tell them exactly about your side effects.

[LRLR in reply to Poobah]

Hi Poonah

Thank you for this insight and information that’s very useful to know. I will try to get an appointment with GP ASAP however they have no appointments when I just phoned. Will try again tomorrow.

Do you think I will be ok stepping down like this for a few days? I’m worried about getting an attack.

I do have montelukast to try from my consultant but I didn’t end up taking it as I became managed for 2.5 weeks so didn’t want to over medicate myself.

I suppose I could start this if I get breathless? Or should I start it straight away?

Sorry for questions sorry if you are not able to comment on this sort of thing.

Appreciate your help!!

[twinkly29 in reply to LRLR]

You need to start it and take it consistently. It takes time to kick in, it can't be used as a quick treatment. It's not overmedicating, it's establishing control - which is control for several months before things get stepped down, not "ok for 2 weeks"!

Don't step down your Fostair or anything else at the moment. If you do have slightlow potassium, it's easy to sort by eating potassium rich foods, so maybe just do that anyway; you won't overdose on potassium through diet.

As Poobah said though, it would be useful to have your BP checked, but please don't step down your inhaler.

[Poobah in reply to LRLR]

Definitely start Montelukast and review after a few weeks - you'll know if it's helped by then. As for stepping down your Fostair, as Twinkly said, best talk to your GP or asthma nurse first. A bit of a hint in getting an appointment. If your asthma has declined then stress to the receptionist that you're struggling. They should give you a same day appointment. If they don't then phone the 111 service to discuss that you're struggling with asthma but also severe side effects of your asthma inhaler. I suspect they will say you have to see your GP ASAP and will note the NHS system accordingly. This will be seen by the receptionist when you phone them, but explain anyway that 111 have directed you to make an urgent GP appointment. The 111 service may give you a good step down in meds in order to avoid the severe side effects if they think it's safe to do so, especially if you're seeing your GP the next day.

Good luck!