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No NSAID's, can't find anything else!
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No NSAID's, can't find anything else!

Hello all,

My first order of business upon getting a migraine was always to take 2 ibuprofen with a full glass of water, and then sit perfectly still, preferably in a dimly lit room.

But, I can no longer take NSAID's due to my lithium levels (the interactions are UGLY!). Does anyone have any other medication suggestions? I have never tried anything prescription for my migraines, and I think it would be helpful to hear some first hand stories before I go to the clinic.

You see, I have no insurance, and have to use a free clinic. They are pretty much useless over there: if you don't know what you need before you get there, there is a good chance you'll come out with the completely wrong thing.

Any help is greatly appreciated.

Thank you!

--Juniper
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Avatar_dr_f_tn
Hi Juniper,
How are you? Aside from NSAIDs, another over-the-counter pain group that comes to mind is Acetaminophen. It can help provide relief as well as it can be used safely by most people. However, It can cause liver damage in people who take very high doses or who already have abnormal liver function . To reduce this risk, never take more than the recommended dose of acetaminophen: maximum of 8 extra-strength or 12 regular-strength pills a day.  Make sure you tell your doctor about any OTC medications you take regularly. If the pain persists, you may need to consult your doctor and have a prescription medicine. Take care and do keep us posted.
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768044_tn?1294227036
Hi Juniper!

First-line acute migraine medications are triptans. There are currently 7 triptans on the market, plus one triptan that is also mixed with an NSAID called Naproxen. I believe that fast acting triptans are the best in most situations because they work the fastest. Fast acting triptans come in orally disintegrating tablets or nasal sprays. I personally use Zomig Nasal Spray and find it works extremely well. I also have found great success with Maxalt-MLTs. Although, everyone is different and all of the triptans on the market have been proven effective in clinical trials, so please discuss with the doctor in the clinic which triptan would be the most appropriate in your situation.

Although, if you want to go in suggesting something... I'd personally suggest getting a few triptan prescriptions or samples at once if possible due to the fact that you do not have insurance and triptans can be very expensive and you may want to be able to have a selection of price-points to choose from once at the pharmacy.

The fast acting triptans such as Zomig Nasal Spray and Maxalt-MLTs are some of the best triptans on the market, but they are also the most expensive triptans on the market. If you could get samples of the fast acting triptans and prescriptions for the fast acting triptans as back-ups in case the generics do not work for you then I think that would be a good idea. But, due to cost constraints, I would suggest getting a prescription for the cheapest generic triptan which is called Sumatriptan tablets. The Sumatriptan tablets work well for many people, so if they work well for you then that would be excellent and you can just stick to them as your only prescription. Although, due to the extremely low bioavailability of Sumatriptan tablets, they do not always work well for everyone (although Sumatriptan is still the most prescribed triptan on the market). Zomig Nasal Spray has the highest bioavailability, followed by Imitrex Injection (but Imitrex Injection isn't a suggestion except in severe situations). Anyway, because of superior bioavailability of the more expensive triptans is why I suggest getting the back up prescriptions for the Zomig Nasal Spray and the Maxalt-MLTs just in case the generic Sumatriptan tablets do not work for you. But, for cost reasons, fill the generic Sumatriptan tablet prescription first! (as long as the doctor at the clinic agrees) And, try to get samples of what ever triptans the clinic has to hand out if possible, regardless of the brand.. all triptans have been proven effective in clinical trials, so they are all worth trying as long as your doctor agrees, especially if it is a free sample.

If you do get a prescription for one of the brand name triptans and find that it is expensive, let me know which triptan and I can probably point you in the direction of a coupon for the medication (usually the coupons are only $5 or $10 off, but still... worth it to use the coupons I figure).  

As I said before, I use Zomig Nasal Spray and I find it works amazingly well for the majority of my migraines. In the past I used Maxalt-MLTs, and they worked really well for me for a long time too. A lot of my friends use Maxalt-MLTs with great success. Although, Zomig Nasal Spray has got to be my favourite triptan on the market.

Other acute migraine medications include analgesics and antiemetics.

You mention you can't take NSAIDS anymore, so I guess that would rule out the prescription medication Naproxen which is quite a popular migraine analgesic. It is often advised that over-the-counter analgesics should be avoided since they are usually not very effective and can often cause rebound headaches. Although, there are other analgesics that can be used if the headaches are very severe such as barbiturates and opiates. These medications are not usually as effective for migraine headaches, and they can have high side-effect profiles and high-dependency profiles. Also, I am fairly sure that barbiturates can cause rebound headaches too. But, for some people these medications can be very useful. If you are prescribed an opiate, then certain opiates tend to be better than others for the treatment of migraines. Usually opiates with lower side-effect profiles are better for migraine headaches than those with high side-effect profiles. Morphine, for example, is usually NOT a good opiate for migraines since it has a high side-effect profile and will increase the nausea and vomiting that usually goes along with migraine headaches. I personally have used an opiate medication called hydromorphone for my most severe migraine headaches and found that medication very useful for my most severe migraine headaches, as hydromorphone has a low side-effect profile and usually does not cause nausea or vomiting, and it also has a low-dependency profile.

Antiemetics are useful if vomiting and nausea are symptoms of the migraine headache, and they can sometimes be useful even without these symptoms too. The antiemetic Metoclopramide can be taken for nausea and vomiting, but it can also be taken for migraine pain. Metoclopramide can also be taken along with other migraine medications, such as triptans or analgesics, in order to increase the effectiveness of the other headache medications. Metoclopramide is a useful part of my acute migraine treatment plan, I often take it if both my Zomig and my Naproxen fail to completely relieve my migraine pain. I will also use my Metoclopramide if I am feeling nausea due to my migraines, and the Metoclopramide completely takes away my nausea symptoms.

Let me know what you end up getting. I'm interested in how it works out! Keep in touch!

- marilee :)
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1102283_tn?1257821072
WOW that's a lot of info!

Thank you a ton for this. I'll go talk to them at the clinic this week and see what I can do. Hopefully I can come out of there with something that will help.
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