I just came back from my headache appointment with some odd information. The RN who saw me told me I should take a Sumatriptan every time I have a headache. I asked her what I was supposed to do when I used up all 9 pills from the month in three days and she said she would order me another refill. My past neurologist was very against me taking anything for pain for more than two or three days a week because of the possibility to have a rebound or medication overuse headache. Who should I listen to? I am getting extremely different answers from my past and current medical providers and I'm not sure what I should do until I have my next appointment in two months. I know you can't dispense medical advice but could I at least hear the pros and cons as to what my newest practitioner is suggesting?
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Hi theresadz,
Two to three days a week is the max to use triptans to abort a Migraine attack. They won't work for headaches. They are Migraine specific medications. Not to complicate things according to Dr. Goadsby "There is now substantial evidence that all drugs used for the treatment of headache may cause MOH in patients with primary headache disorders.
The current information on MOH from the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II) is this:
"MOH is an interaction between a therapeutic agent used excessively and a susceptible patient. The best example is overuse of symptomatic headache drugs causing headache in the headache-prone patient. By far the most common cause of migraine-like headache occurring on more than 15 days per month and of a mixed picture of migraine-like and tension-type-like headaches on more than 15 days per month is overuse of symptomatic antimigraine drugs and/or analgesics... continue reading: Medication Overuse Headache - When the Remedy Backfires.
If we have more than three Migraines a month, we need to discuss Migraine prevention with our doctor. If we need more than nine abortive pills a month, then that may mean our preventive medication is not working properly and we need to have a conversation about adjusting the dose of it. Does that help?
Let me know
Nancy
Hi, Theresa,
Beyond the medication overuse issue, we don't know a great deal about other safety issues of taking triptans daily. Since they aren't meant to be taken daily, there haven't been any large long-term studies of daily triptan use. There have been a few of short-term daily use, but nothing long-term.
My personal feelings are that given the evidence showing that too frequent use of triptans can indeed induce medication overuse headache and the lack of evidence of their safety in daily use, I wouldn't want to take them daily. I'd want my doctor to keep working with me on preventive options.
Keep us posted?
Teri
I use 20 mg Relpax and have always been told that overuse could damage my kidneys. I do go through spurts where I take more than is prescribed (i.e. more than three times a week), but I always have bloodwork done on my kidneys and liver every year in my physical to make sure everything is okay there. That's a tough one because although I don't take it every single day, it always works when I do take it, at least for that day. Sometimes my migraine will come back though when I wake up the next day.
I am on the last Triptan in the family - Axert - all the others either have not worked at all, or have only worked for short periods before my body rejected them and they went into the MOH category. This in spite of the fact that I was very diligent about not using them more than twice a week and usually tried to keep it to once a week or week and a half and if I was lucky on a two week rotation with a couple of other medications that I used for migraines. However with the migraines coming 4-5 times a week, my pain tolerance was just not able to hold it all together with just ice, hot packs and various other things like that - no herbals, so I did have to go eventually to 2x a week and that spelled an early demise for the first triptan that worked for me which was Zomig. Relpax, Maxalt, Imitrex, Amerge all had no effect on me. Frova worked once and then never again. I am now on Axert and that is working like Zomig so I am protecting it like I did with the Zomig, but I only have Stadol and MS Contin as back-ups and I am in constant pain - especially because it is winter and the barometric pressure drops all the time can be very disturbing. I am doing the best I can, but am in bed most of every day. I am hoping to get an app't soon with a new migraine doc to see if I can expand the daily treatment meds, but I have tried so many over the years. I am modestly hopeful. I NEVER take triptans daily and anyone who says it is safe is someone who is not educated on this medication and should be crossed of the list of people to ask for advice. I agree with all comments above.
I also take tripatans for my migraines and only get 9 pills a month through my insurance. As of right now I seem to be getting less now since my Neurologist has put me on 1,000 mg. of Depakote. This seems to be a preventative means in case any one is interested to try it out.
I took depakote in the early nineties - so you know how long I have been at this, and than was not the first drug that I tried. I was up to a fairly high dose at 1750 mg and it seemed to be working well as a preventative, but my hair started to fall out in clumps, which is a side effect in about 10% of the population, so we discontinued it. I hope it continues to work for you and you are not in the minority 10%. Thanks for the suggestion! I do appreciate it.
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Thanks for your response, Nancy! You basically just stated in a nutshell all the information I knew which proves to me even further that I should never see this RN at this 'headache clinic' again. She specifically refused to relook at my diagnosis and said that migraines or regular headaches she treats them the same (HUGE red flag). I will continue to only take my triptans twice a week as my original doctor prescribed and just wait the two months to see my 2nd opinion doctor. I've been working on preventative medications for almost two years now and I am still getting daily headaches. Hopefully this next doctor will have some suggestions on which meds I should try next since I'm doing as much as I possible can with alternative treatments as possible (tai chi, weekly massages and chiropractic appointments, elimination diet, consistent sleep, etc).
Thank you again for responding and confirming my gut reaction to the information the RN gave me.