Changing triptans

[Pattipan]

I've been taking triptans for frequent migraines more or less since they became available in the UK. It was Imigran at first, but when Zomig came along I changed to that and a single 2.5 mg wafer is usually pretty effective at clearing a headache/migraine within two to three hours. However, I do take on average 18 to 20 a month, which I know is too many but like so many of you my quality of life would be nil without this prop. I hate the idea of being addicted to a prescription drug, but without the resources of Michael Jackson and a rehab clinic I can't see how I'll reduce the dose (and it didn't do Jackson much good, did it?).

Prompted by a post on this forum I recently researched Eletriptan (Relpax) and asked my GP if she thought it might help as it apparently causes fewer rebounds or instances of having to repeat medicate within 24 hours. Unfortunately she was just off on hol so I've not had a chance to discuss it, but she left me a prescription for six 40mg tablets with strict instructions to see her when she got back.

Reading the side effects, I'm scared. As a post-menopausal woman it implies I probably shouldn't take it (on the American website drugs.com) and it does seem a big dosage compared with what has cleared my pain in most cases before (though I had a biggie yesterday which kept me in bed all morning.) However, as I used to get 3 day migraines pre-menopause that is fairly tolerable.

Should I stick with what I know and accept that to maintain a reasonable quality of life I'm a Zomig addict, or is it worth trying eletriptan if it might reduce the overall number per month? Has anyone got any ideas? I'm now 24 hours since last Zomig so could try the eletriptan when (not if, sadly) the next one strikes.

Thanks, Patti

[Juliapester3]

Hi pattipan, I sympathise with you as I have recently discovered triptans after 20 years of toughing it out and realise that they are effective and how tempting it is to keep taking them. Sadly it appears that Drs used to hand them out with no stipulations allowing the sufferers to get hooked and in a vicious cycle. I have been taking sumatriptan but asked my Dr for frovatriptan which is a slow release tablet which you take once every 24 hours. I asked for this as its supposed to be good for menstrual migraine however he was very reluctant to prescribe as the side effects can be severe. Needless to say I backed down because I,m scared of meds anyway!. With this in mind I would be inclined to say speak to your Dr before you take a different Triptan so you can at least get an idea if the benefits outweigh the possible risks. Maybe someone else on here has taken eletriptan and could give you some positive results but I havnt tried that one yet. Good luck.

[micks_missus]

Have you tried Rizatriptan? (Maxalt melt) Zomig stopped working for me so the consultant swapped me on to this. I find the side effects a little uncomfortable at times (the draggy, heave feeling in the neck and shoulders) but they are no worse than the Zomig.

The consultant also suggested using a 100mg dose of Dicolfenac suppository (not nice but works far more quickly and effectively than tablets) AT THE SAME TIME as taking the Maxalt. He was right - it doubles the effectiveness and can stave off an attack in less than an hour.

I generally wake up with my migraines so if I can get the drugs into me quickly enough I can often clear an attack in time to be able to function for the day - I've lost far fewer days to this horrible condition since starting on this combination of meds. I also take Topirimate and clonidine every day and am on HRT.

Hope you find something that works for you.....

[Hidden]

Hi there, having been a migraine sufferer for the past 15 years, and a constant Imitrex user, so I completely understand your worries (I have actually tried every single triptan on the market). I used to get them monthly for 7-10 days long, for the past 4 years I get chronic daily headache and take 1-2 100mg Imitrex tablets daily. I have gone through your thoughts and have switched up the medications to try reduce "rebound" headaches, but to no avail. All of the triptans are slightly different, but the warnings are all the same. In actual fact, they really don't know what the long term effects of these drugs are. I started on them at 18 and I really wonder what they are doing to my body, but what choice do I have?? I could be in bed 24/7, vomiting and on constant narcotics, as I was for 3 years, seriously.

Depending on your severity, I would try the Relpax and see how it goes. I can't remember how they come, but you can always cut them/bite them in half if you feel the dose is too high. What do you have to lose? A short break on something else might be just what you need. As a side note, my neurologist has said that I DO NOT have rebound headaches, and that the term is actually over-used... ugh! We sure have drawn the short end of the stick on this one!

Other things to try, if you think you have rebound headaches are DHE a 50 year old drug, which, for me also works to abort migraines and is very safe - it currently only comes as a self-injectable, but Eli Lily is working on an inhaler version. Furthermore, depending on where you live and who your doctor is you can have and in hospital treatment of it to try stop the cycle. I was VERY lucky to have the neurologist that I have who could get me into hospital in January. I was able to do a 5 day course and while it obviously did not stop the migraines, I have not needed any narcotics since. It also allowed the Imitrex to start working for me again.

The other thing to try is a steroid called Prednisone. I had a HORRIBLE experience with this, as I had a 7-day course of it and it wiped out my immune system, and again, did nothing to help my migraines. However, it does help some, and most at a much lower dosages.

The last thing that I do is have monthly nerve blocks. They help with the severity of my migraines, which is all that I can ask for. While this is a rare procedure, my neurologist concedes that there is nothing else out there to help me, so I use a combination of all of the above and just get through life. I am still unable to work though.

I have also tried Botox, which is expensive, but again I have an awesome neurologist who was able to try it on me. Again, it works for some, but not me.

This is one heck of a complicated DISEASE - I SO wish that the world would recognize this. I think that most of us have found that the only way to combat this is with multiple different approaches... and even then we are just getting by. Sorry for such a long post, but I wanted to give you as much info as I could. I have much more to share if you are interested.

All the best!

xxx

[Sybille]

Hi, I didn't quite get why you think you shouldn't take Relpax. Like you after trying several triptans it was suggested to me that I should take Relpax as it causes less rebound headaches. I am happy with Relpax but the migraines still come back as fast though.

[vspeirs]

Hi Patti. I have recently changed to Eletriptan (Relpax) from Rizatriptan (Maxalt Melts) and they seem much preferable. I don't feel nearly so spaced out and fuzzy like I did on the Rizatriptan. The apparently high dose doesn't really worry me as I suppose I have to trust my doctor and since all painkillers except Paracetamol tend to give me gastritis, the Eletriptan is just about all I can take. On another note, I obviously hate taking prescription drugs so have been consulting a naturopath and we have been working on blood sugar control as a means of controlling the headaches which always start in the early hours before I am supposed to be awake - but of course they wake me, characteristically at around 3 30 or 4 and keep me awake. Then I am pretty zombie-like at work but at least the triptans enable me to function! Anyway I didn't have a headache for quite a few weeks but did a huge cycle ride on Saturday for around 6 hours and probably let my blood sugar levels get quite low because on Sunday I woke up with a scorching head which nothing - not even the triptans - would move and it's now Tuesday and I still have it although not as severe (but still had to take the Relpax this morning). I have also been taking Feverfew and Magnesium with B6 daily which you can buy from any Healthfood store - they are meant to be preventatives - and am also taking an extra high quality multivitamin - I feel this strategy has helped and I certainly feel much better in general. I was a bit careless over the weekend with my eating and supplement taking and I feel that this probably propelled me into another headache. I am quite hopeful of this more wholistic approach which I think will help me reduce the number of times I have to resort to triptan with the target of coming off it altogether (ha ha!) Stress is another issue which jetisons me into a migrainous state for days on end and if I practiced what I preach, then meditation or mindfulness is certainly a useful tool - for the headaches as well as all the other physical dis-ease caused by an overactive brain! Other peoples' comments on wholistic approaches would be good to hear! Regards to all, Vicky

[000000]

I greatly sympathise with you! i have been having migraines for 40 years now. I went through most of the painkillers, etc. after imitrex injection, i started using zomig. I now switch off between zomig & relpax. Most of the time they work in about 15-20 minutes. When one doesn't work i take the other & if i still cannot get rid of it I take a fiorocet.( i got the ok from my neurologist). Good luck! Jeannette

[Pattipan]

I posted that I was considering Eletriptan eight days ago and in those eight days I have taken all six of the 40mg tablets my GP was willing to let me have without discussing them with me.

Basically, they didn't really affect the speed with which a headache/migraine recurred - the longest I went was 41 hours. The benefits were that - apart from after taking the 6th tablet which didn't kick in till after three and a bit hours (- not sure exactly as I went to bed and fell asleep), the headaches cleared much more quickly - within half an hour on one blissful occasion. This is much quicker than my Zomig Rapimelt (2.5mg) which almost invariably take a minimum of two hours to kick in. I didn't get any side effects at all (I don't get any adverse effects such as those listed by others) - but I don't after Zomig either. I didn't have to repeat medicate, just one tablet cleared the pain for a minimum of 21 hours. My GP isn't back for another week, so I will have to wait to discuss this with her and meanwhile resume taking Zomig when the next one strikes.