Only a doctor or neurologist can give you a diagnosis for your symptoms, so be sure that you have seen your neurologist recently and updated him on your recent symptoms and their severity. If your migraine pattern ever changes, it is important to let your neurologist know that.
Some people get migraines chronically. That means that they happen more then 15 times a month. It is possible that you have chronic migraines. Chronic migraines require preventative medication as well as acute medication. You are currently taking a preventative medication and you also have an acute medication.
The Nortriptyline is a preventative medication. There are four classes of migraine medication. Botox can also be used as a preventative treatment The four classes of migraine medication are: anti-depressants, anticonvulsants, beta blockers and calcium channel blockers. Nortriptyline is a tricyclic antidepressant. The tricyclic antidepressants are the most effective of all of the antidepressants for preventing migraine, so nortriptyline was a good choice to start with but it does not work for everyone. Since your current preventative treatment plan is not working to control your migraines, I think you should talk to your doctor about trying a different type of preventative medication. If the next medication you try does not work, there are still many other types of preventative medication and one will likely work for you.
If you find that your acute treatment plan is not completely relieving your migraine symptoms, then you also need a new acute treatment plan. Imitrex is one of the most popular triptans, but in the tablet form it is also one of the most statistically ineffective. There are 7 triptans that are currently on the market. The most effective triptans are the ones that are in fast-acting delivery methods, such as a nasal spray, a quick-dissolve tablet or an injection. You should ask your doctor about switching triptans. Zomig Nasal Spray and Maxalt-MLTs (quick dissolve tablets) are some of the most statistically effective triptans. Imitrex Injection also works very well, but it is rarely prescribed since it is an injection. Although if you find that no other triptans work for you, then your doctor may prescribe Imitrex Injection.
Combination treatment is also statistically much more effective then any single treatment alone. Only combine medications if a doctor tells you to, and never combine medications without first checking with a pharmacist. Taking a triptan along with Naproxen (an NSAID) is very helpful for many people. You are sort of already doing something similar to this when you take Imitrex and Excedrin at the same time. Since your migraines are chronic, Naproxen may be a safer medication to use as it will not cause rebound headaches even though it is an NSAID. Taking over-the-counter medication can cause rebound headaches. You may want to ask your doctor if taking a fast-acting triptan in combination with naproxen would be helpful in your case. Another often prescribed combination is the antiemetic Metoclopramide combined with either a triptan or a pain killer. When Metoclopramide is prescribed with a pain killer, it is most often combined with Tylenol. It is my personal opinion that combining it with Naproxen is safter for those with migraines, since Tylenol can cause rebound headaches. I often use a combination of Zomig Nasal Spray (triptan), Naproxen (NSAID) and Metoclopramide (antiemetic). Metoclopramide is a very useful antiemetic for those with migraines, since it stops nausea/vomiting and also increases the effectiveness of other migraine medication such as triptans and pain killers.
Sometimes people do have to go to the Emergency Department or Urgent Care Centres for their migraines. I have had to do this on a number of occasions. Thankfully, now that I have an effective acute treatment plan, I rarely end up in the Emergency Department. But, until you have an effective acute treatment plan do not hesitate to go to the hospital if you are in severe pain. How they are currently treating your migraines at the hospital is very normal emergency treatment for migraines. An IV of pure saline will help replenish any liquids lost due to vomiting. An IV of pure saline can also improve migraine symptoms for many people. If you have not already taken a daily maximum dose of your Imitrex, then they might give you an Imitrex Injection at the hospital and that can sometimes stop the headache. Always let the doctors and nurses know if you have or haven't taken your maximum dose already. Pain killers delivered by IV can also be effective in either stopping the migraine or dulling the pain. Morphine can have some nasty side-effects that are similar to migraine symptoms and so although this medication works well for some, it doesn't work well for everyone and can make some people feel worse. There are other narcotic medications that do not cause an upset stomach or vomiting, so next time you are at the hospital you may want to ask for something other than morphine if you did not find morphine effective before. Hydromorphone is an example of a drug that is similar to morphine, but with less side-effects. If you found that the Zofran was not effective during your last hospital visit, you may want to ask about Metoclopramide given by IV. The metoclopramide should stop the nausea and vomiting, and it will also make other migraine medications they have given you, including pain medications, much more effective. Don't hesitate to suggest a different emergency treatment plan to a doctor at a hospital, just be clear on why you are making the requests (i.e. "That didn't work last time." or "That made me feel worse last time.") and be willing to accept their advice on matters as long as their advice is reasonable.
Avoiding food triggers can really help some people with migraines and it can even stop migraines for some people. But, statistically, the amount of people who have food triggers is quite low. There is a higher probability that your migraines are not triggered by food. If you find that avoiding specific foods is unhelpful, don't continue with the unsuccessful diet. These diets are restrictive and can be very stressful. It takes extra effort to get all of the vitamins and nutrients you need with such a restrictive diet. A very restrictive diet can make you sick, and any stress to the body like that can just cause more migraines. If you have noticed a direct relationship between a specific food and your migraines, then avoid that specific food. Keep a journal so that you can identify and eliminate specific foods that trigger your migraines. But only eliminate foods where you can see a direct, obvious and clear relationship between the food item and your migraine. Ask your neurologist to confirm this advice before changing your diet.
To summarize... I think you should change your preventive treatment plan by having your doctor prescribe a different class of preventative migraine medication. I think that you may want to consider switching to a different triptan. You might also want to consider asking your doctor to add naproxen and metoclopramide to your acute treatment plan.
I hope that information helps and I also hope that you and your neurologist are able to get these chronic migraines under control! Keep in touch!
HI Mariee-I just want to say a big thank you for your feedback and taking the time to write all that information. I am going to bring up the metoclopramide to my doctor today. I do agree with you about the morphine-I am up now because I feel like i have a terrible hangover from all the drugs they gave me I also was given toradol-imitrex and oxygen (the last which I think was most helpful). fortunatley I have some excedrin and phenegran which is taking the edge off the side effects. Anyhow, ihave tried other preventative meds-both verapamil and inderal both made me feel very dizzy and made the headaches worse. I heard topamax is effective but have a long history of kidney stones-which is the only pain worse than migraines so out of the question. Do you know of any others I could try? I also was wondering how you afford your meds? The doctor prescribed a nasal spray called migranol-I tried it once and it gave me some relief but was $250 for eight vials-which I cannot afford. My son has some seizures and is on meds and have high bills for him which of course take precident right now. Do you know of any programs that can help with the price of the migraine medications?
thanks so much again for everything and good luck to you as well.
I will think of other types of preventative migraine medications that you have not already tried and list the ones that are most effective as well as their common side-effects... but it may take me a day or two since this is a busy week at school and at work.
I live in Canada so our medications are usually partly covered by our government health care, although we do have a small amount of co-pay that comes out of pocket. In my situation, about half of my monthly paycheque goes towards student loan debts, and at least 1/4 of my pay cheque goes towards medications, although it can be quite a bit more than just 1/4 as well depending on the month. This means that I cannot afford rent, so although I am 27 I currently live with my parents. Regardless of money, I probably couldn't live in my own anyway. My migraines got severe enough that I was spending more time in the hospital then living on my own, and due to the severity of the pain, I was at risk and being alone was dangerous. I am lucky because I am able to live with my parents. If my situation changes and I found that I could not continue living with my parents, I would have to go on disability-pay (which is not more than I am making now, but more health benefits are covered so it would even out in the end) and I would try to find a safe place to live where I was not on my own.
Since triptans are the first-line migraine medication, that means the government is required to supply coverage for them. But, many of my preventative medications are not covered by government health care. So, in this case, I do what many Americans do, and that is buy extended-health insurance (or, I guess it would just be called health insurance in America). My employer allows me to buy affordable extended health insurance, and my college requires me to buy very affordable extended health insurance. If your employer offers health insurance, then that is one of the most affordable ways of buying it.
Sometimes your health insurance may not cover a specific drug since the insurance company believes there are cheaper alternatives to the medication that your doctor has prescribed. If your insurance company refuses to cover your medication, then have your doctor write them a letter explaining why they have prescribed this medication. With a letter from your doctor, the insurance company will often then cover the medication.
Some employers do not offer health insurance, or sometimes the plan they have picked is still too expensive for their average employee to purchase. If your employer does not offer health insurance OR it is out of your price-range, then there are government programs (in the States) as well as private programs that the pharmaceutical companies offer. Most websites for individual medications also offer coupons for those medications if you do not have health insurance and do not qualify for a government program. The programs that are available usually depend on which pharmaceutical company makes the medication. Usually these programs are only offered to individuals in the United States who make below a specific amount of money a year. If you confirm that you live in the states, I would be happy to help you find programs for specific medications.
If you are already part of an insurance program offered by your state and they are refusing to cover specific drugs, do the same thing you would if you had private insurance and that is have your doctor write the insurance program directly.
If you cannot find a State program or a Pharmaceutical program that you qualify for, and you find that coupons are not enough to make a difference, the you can always write directly to the pharmaceutical company and explain your situation.
The last thing you can do is get free samples from your doctor. If your personal doctor does not offer free samples of medications, then a walk-in-clinic might. Explain to your doctor that you cannot afford the medications, and ask if they have samples. Your doctor may not have samples of the specific medication you want, but if you are asking for triptans then your doctor will likely have at least one or two different brands. Almost any triptan is better absorbed then Imitrex Tablets, so no matter what triptan your doctor gives you as a sample, it will probably work better than your current triptan. If your doctor has multiple types of samples to offer you, take all of them... because they'll probably run out quickly if you have chronic migraines and it doesn't hurt switching which triptans you take from day-to-day (you just may find that one works a lot better than the others).
Another thing is that sometimes specific pharmacies over-charge or just have a different price-tag for a medication than other pharmacies. The most expensive triptans shouldn't cost more than $50 a dose and usually they cost around $25 each. With a coupon $25 could go down to $20 or less.
Migranal is an ergot alkaloid. Ergot alkaloids used to be the first line treatment for migraines prior to the 1990s. Triptans replaced the Ergot alkaloids because triptans worked just as well but didn't have any of the side-effects of Ergot alkaloids. If it did give you some relief you may want to try these again once you find a good program to pay for your medications. But, if you are worried about side-effects, then trying new triptans is probably better. Of course, after we find a way to make them affordable.
I'll write back soon with medication information!
Hi Marilee, thank you so much again for taking the times to write all the information down. I went to my doctor yesterday and he took me off the nortriptyline (because of my irregular EKG) and is putting me on Depakote. He also prescribec a different med-Frova-which I have taken before which gave me a little relief. I will check online for some coupons. I do have health insurance (which took some time to get)-Canada's system is so much better, I do however have a high deductible so these meds are all going to that so I have to pay out of pocket. I do work part time but need to be full time to get insurance-which right now with my med problems I don't feel I can do-so I pay out of pocket for health insurance-and they charge a %50 increase of normal rates because of med problems. So my health insurance is just so-so-but glad to have something. Well from what I remember Frova is a bit cheaper than the migranol, so hopefully it won't be too bad. I am sorry to hear that your migraines are so bad too, but glad you are now having some relief. My doctor was very nice and really took the time to explain things to me. He is the first one I really felt did that. He is repeating my MRI (which was done about 2/3 years ago and is doing one of my neck). They also may due a spinal tap because I sometimes have a mild fever with the headaches and had some tests that may be suggestive of lupus-so we will see what happens.
thank you again for taking the time to help me. I wish you all the best.
" I am not sure what to do next" - in answer to your question I have this for you.This will help with the others medical issues you are facing and there is no cost.Start today and feel the benefit.
To to get relief from headache/migraine naturally, the full pranayam exercises are described below.Do it seriously, regularly and at the suggested duration, and you can call it a cure or control without medication.
Initially do Anulom Vilom (as much as you can) for the fist few days and then start the full set of pranayam.This works gradually, so allow time (1 week upto 24 weeks) and concentrate fully on the breathing. Avoid cold drinks and drink warm water.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after 1 minute.
Kapalbhati -(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for upto 15 minutes twice a day. Not for pregnant women. Seriously ill people do it gently.
Anulom Vilom - Close your right nostril with thumb and deep breath-in through left nostril
then – close left nostril with two fingers and breath-out through right nostril
then -keeping the left nostril closed deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 20 to 30 minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed. Remember to take deep breaths into the lungs.
Bhramri Pranayam -Close eyes. Close ears with thumb, index finger on forehead, and rest three fingers on base of nose touching eyes. Breathe in through nose. And now breathe out through nose while humming like a bee.
Duration : 5 to 15 times
Continue the pranayam once a day to stay healthy.The factors helping are the extra oxygen and the relaxation(reduced stress) you get when doing the breathing exercises.