Sunday, October 26, 2008 Anjann asks

Q: naproxen sodium new "magic bullet for migraines?"

UGH help! I'm so tired of hearing this! I live in Virginia, I am 37, have had migraines since I was 16. I left my neurologist in August because he cut my zomig back to 8 a month from 12 and insisted that I take alleve when I got a headache! hello! don't these doctors think we are smart enough to have tried NSAIDS before resorting to seeing a doctor? I would have gone to the grocery store and bought a bottle of Alleve if THAT would have worked instead of wasting my time arguing with him! Well after waiting 6 weeks for an appt with the only other neuro in this town, the new guy tells me the SAME THING.... That Zomig, and all triptans for that matter, are heart damaging and that if I can't get by on 8 a month I just need to take Alleve. OK, ..I guess.. UGH UGH UGH UGH!!! please help me understand why Alleve, a mere NSAID that has been out for at least 10 years OTC probably more, is now all of a sudden this wonder cure for migraines? Other than an unlabeled treatment for vascular headaches I found in one of my nursing books, My only other guess would be because the 10 year generic patent amnesty on imitrex is getting ready to run out in december (I think) and the drug co. needed to re-invent imitrex/alleve as the new wonder drug, since plain imitrex will now be available in generic. Please tell me this is not the only reason I am being handed a script for naproxen and shown the door.

Is anyone else getting handed this bull sandwich? Because any MD who has ever had a real migraine for 3 days and thrown up from it would know that you could eat a whole bottle of Alleve and it wouldn't matter. Well, if I can't have my Zomig, (8 a month is grossly deficient at times and no it's not because of rebound or nsaids) and if Alleve isn't going to work, what exactly am I supposed to do?

The other thing I'd like to point out here is that I don't like Alleve in particular because you can't take any Advil within 12 hours of taking Alleve, so if the alleve doesn't work, you can't take anything for 12 hours, no more alleve, and no advil at all!

I brought this to my MD's attn, and now, all of a sudden it is ok, to start mixing advil and alleve and tylenol, because the makers of alleve are pushing this so hard! I still feel mixing these would not be a good idea, and ripped up the naproxen script.

Can you tell me why there is such a big naproxen push right now, such a big triptan backlash right now, and whether or not advil, tylenol and alleve should be mixed together? as a nurse, I know this is ridiculous, but both of these md's told me that it is "ok" and I can only assume that it was the drug co that told them that.

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Answers (4)

Teri Robert, Health Guide

11/ 2/08 1:58am

Anjann,

I don't see how the release of Treximet would have anything to do with your doctor reducing your Zomig and telling you to take Aleve. If his decision were related to the release of Treximet, he'd have given you samples of Treximet and a prescription for it.

Really, I haven't heard of a big naproxen push other than the release of Treximet, and in clinical trials, the combination worked quite well. Drug reps would have no reason to be discussing mixing over-the-counter medicaitons with doctors.

Here's a question for you -- are you sure it was the doctor's decision to limit your Zomig? Could it have had anything to do with your insurance coverage. Most insurance companies are limiting triptans to 6 to 9 doses per month.

I have known some doctors to reduce the number of triptan doses they prescribe per month if patients won't work with them on finding effective preventives. Were you and your doctor working on finding preventives that work for you?

Obviously, I can't know what your doctor was thinking. As a nurse, you probably already know that using triptans more than two or three days a week can lead to medication overuse headache, aka rebound, but even at that rate, you could go through your original 12 tablets with no risk of rebound.

At this point, the best suggestion I can offer is to find a good Migraine specialist. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.

You're clearly in a tough situation. If you'd like some additional support, come join our discussion forum. You'll need to register again once there because it's a separate membership database, but you can use the same member name, email address, and password that you used here. You can find our forum at http://forums.healthcentral.com/discussion/migraine/forums.

Sorry I don't have a better answer for you.

Teri

Anjann

5/ 8/09 11:46pm

Hi Teri, Thanks for your reply.

This neurologist I was seeing was new for me. I started seeing him in Jan 2008 before the Treximet was released. My previous doctor had made a medical mistake that ended with me having my left arm surgically reconstructed, so I was left scrambling for a new migraine doc. This new neuro I started seeing is the guy that was pushing the Naproxen really hard and absolutely refused to allow any more than 8 Zomig a month when I had been getting 12-18 Zomig for years from the previous doc.

As a nurse on the floor, the Zomig and tons of Advil was really all that I could take besides the preventive Topamax I was on.

This new neuro was just adament about me using NS and literally told me to stop having so many headaches as if it were something I could control. I clearly know what rebounds are and how to avoid them, but he seemed to think my advil ingestion was perpetuating the cycle. I was trying to figure out why he was so stuck on this NS until a few months later when I saw an ad for Treximet while flipping through a magazine and the light bulb went off in my head that maybe the drug reps were pushing this idea to sell more treximet.

I did in fact have a preventitive in place, Topamax 100mg daily, but was still having frequent and debilitating Migraines.

Long story short, I ended up leaving that neuro and found a new Neuro who introduced me to Elavil and THAT is what has truly knocked the migraines back to almost nothing. To this day, I have never taken the Naproxen. To me it is tantamount to using a toothbrush to paint your whole house.... takes way too long to get the job done and does a very poor job at that!

I do have to say that since going on the Elavil, I no longer wake up anticipating a HA and I no longer find myself making sure I have an imitrex in my purse everytime I leave the house. It has been very liberating. Such an easy solution and I am much happier for it. Thanks for the links and info!

Anjann

caraj

11/ 3/09 9:17pm

Oh my goodness! That is my exact story! I've had migraines ever since I was 9 and have been seeing the same doctor for 8 years. He keeps prescribing me all of these stupid preventatives, including Naproxen Sodium, that do absolutely nothing except make me groggy and irritable. Currently, I am taking 100mg of Topomax a day and am transitioning from Zomig to Treximet. I've be come completely immune to the Topomax and both the Zomig and Treximet give me horrible side affects... almost more debilitating than the migraine itself. Plus, if I take Zomig, I have to wait at least 24 hours before I can take Treximet. I feel like it's a lose-lose situation and don't know where else to turn.

Wonk

3/26/12 12:20am

1. Naproxen is not a preventive drug and taking it daily should GIVE you headahces, not to mention ulcers. I hope you're not taking it daily.

2. If you'd rather have migraine pain then suffer the side effects of the drugs you're taking now, tell that to your doctor. The drugs you're taking are not good for your body -- they take a toll on your liver and possibly your heart, increase the risk of stroke, and may irritate your stomach as well. If you want to stop taking them, ask your doctor to tell you how to stop. (You may need to taper off slowly in order to be safe.)

3. All chronic migraine sufferers should go over risks, costs, and benefits with their doctors. Doctors, for their part, need to be honest with patients. My neurologist (his PA, actually) gave me samples of a preventive drug a while back and, when I asked about side effects, said only that it was "well tolerated." When I got home, I read the fine print and learned that it had a FDA black box warning about the risk of destroying your pancreas. I didn't take the drug and haven't gone back to that doctor since.

Nebula

10/26/08 7:16pm

You should find a neurologist...I'de be surprised to find one that didn't doubt the severity of migraines

nomigraine

4/19/12 8:19pm

Hey, I don't know if this will help you - but I, too, had migraines since I was a teen (I'm now 52). I found out mine was related to sodium...too much salt in my diet. It doesn't help that I'm of Pacific Islander ethnicity- the culture has way too much salt (soy sauce, dried fishes) etc. That's fine for living in the tropics, but not here in the temperate northern US. It was getting to be debilitating- every 2 weeks, till I began to have a droopy eye, my doc told me to go to the emergency room when I got a migraine; I found my normal blood pressure had spiked to 180/90...he told me NO SALT, and that was the beginning of a new life! So much food is processed, I loved lunchmeats, pickles, junk food, anchovies, fish sauce... I also added more high potassium foods (which counteract the effects of sodium.) Thankfully, I had never used aspirin for headaches (Imitrix caused chest pains). I did it the NATURAL WAY. If you are of a African or Asian ancestry, I suggest cutting out salt. We don't sweat that much here and retain sodium very easily.

Migraineur

12/ 3/12 9:33pm

I am a lifelong migraine sufferer (aka "Migraneur"). I have seen multiple neurologists who prescribed both abortive drugs for pain, and prophylactic drugs to prevent migraines.

You likely are suffering from medication overuse headache (MOH), where the abortive drug (triptans in this case) will trigger a new headache a day or two after use. See the wikipedia article on Medication Overuse Headache for details.

For me, I was up to 12 Zomig doses per month, and then I found a world class neuroligist who specializes in clinical treatment of migraines. He switched me to dihydroergotimine (DHE) instead of triptans for aborting painful headache. It is very expensive ($125/dose street price) but is low risk for rebound.

Similarly, naproxen sodium is an NSAID which is considered low risk for rebound. The worst over the counter for rebound is Excedrine since it contains a higher risk NSAID plus caffeine. For me, aleve does not releve pain of migraine once the pain starts, but it can suppress the pain from occuring if I take aleve right when I sense a migraine prodrome symptom before the head pain starts. So the aleve seems to counter the inflammation of a migraine (nasal congestion, gastrointestinal gas, tendonitis, etc.), but it does not releve the pain once it starts. I need a vaso-constrictor like DHE to releve headache pain.

Q: naproxen sodium new "magic bullet for migraines?"

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