Hello,

I think there's a bit of confusion here. Fioricet isn't an abortive. It can't stop the Migrainous process. All it can do is relieve the pain for a few hours. It is sometimes used as a rescue medication when abortives fail. Nancy gave you the link to the article talking about the difference.

The potential for rebound/medication overuse is quite high with Fioricet. It's a compound of three ingredients -- acetaminophen, butalbital, and caffeine. Any of these alone can cause medication overuse headache (MOH0, aka rebound, so when you put the three of themn together. There's another issue with the butalbital. ANY use of opioids or barbiturates (such as butalbital) and frequent use of triptans and NSIADs are associated with increased risk of transformed Migraine. See Transformed Migraine - Risk Increased by Some Medications for more information on this.

You don't say why you can't take triptans. If it's because of any cardiovascular disease issue, the ergotamines will probably be out as well.

That leaves Midrin, which Naancy mentioned. Brand name Midrin has been discontinued. The medication is, however, available under the brand name Duradin, and some of our members have also been able to get a generic isometheptene/acetaminophen/dichloralphenazone.

Hope this helps!

Teri

Jill,

You're very welcome. As far as I know, triptans aren't an issue because of PFO. Triptans and ergotamines are an issue because they have some properties to constrict blood vessels to offset the vasocilation that occurs during a Migraine. Only your doctor can really tell you whether you can take them or not.

On the PFO issue -- Unless you enroll in a clinical trial, PFO closure is not being performed for Migraine treatment. It's still in clinical trials, and those trials haven't been going all that well. Something else you should know is that even if PFO closure is performed, it can only prevent any Migtaines that might have been triggered by unfiltered blood getting back to the brain. If you have Migraines from other triggers -- fragrances, foods, lights, sleep, etc., those can't be stopped by PFO closure.

Most doctors say that Fioricet needs to be limited to two days a week. AND, since it contains acetaminophen, we can't take aceteminophen or anything that contains it on any other days that week.

Wherever you go for a specialists, I'd encourage you to choose a specific doctor and not just choose a clinic. Even within a large clinic, it's really the doctor who is most important.

Jill, I remember all too well what it was like when Migraines ruled my life. Don't lose hope. We CAN gain control over this disease.

Best,

Teri

You're welcome again, Jill!

The whole stroke issue would have your doctors looking at PFO closure under a different light.

And, stroke risk is certainly considered before prescribing triptans.

Midrin has been under a lot of discussion for quite some time. It's a great medication for lots of people. It was unavailable for a while because of a shortage. Now, it appears that the original Midrin may have been entirely discontinued by the manufacturer. I have a call in to them now to veryify. In any case, it's worth discussing with your doctor.

Please keep in touch and let me know you're doing? I so often wonder about peopole who have asked questions.

with a hug,

Teri

PS: Thanks for your comments on my book. I'm glad it's been a help to you!

No, Midrin isn't a triptan. There are seven medications in the triptan family-- Imitrex, Maxalt, Zomig, Amerge, Relpax, Axert, and Frova -- as well as Treximet, which is a combination of Imitrex and Naproxen Sodium. Triptans are selective serotonin receptor agonists. One way they work is by binding to different combinations of serotonin receptors.

Midrin is a compound medication containing acetaminophen, dichloralphenazone, and isometheptene mucate. As you know, acetaminophen is a simple analgesic, a simple pain reliever. Dichloralphenazone is a mild sedative that slows down the central nervous system. Isometheptene does have the action of reversing the dilation of blood vessels. For some reason, that's not seemed to be an issue with Midrin/Duradin. It may be that the action is less then or more gentle than with triptans. That's something you'll want to check with your doctor.

Hope that helps!
Teri

Is there a particular doctor you see there?

Teri

Thanks for posting that information. I really think it's better to choose a specific doctor than to just go to a clinic and see who you get.

Thanks again,

Teri