My wife is afflicted with Migraines, and she has first-degree relatives with stroke and Migraine. Her gynecologist prescribed Midrin some years back. A few months ago, her prescription was filled with an insurance copay with absolutely no problem. This month she was told that the medication would cost $390. Why all of a sudden is there a problem with filling this prescription without prior authorization from the insurance company? Why would a simple weak sedative cause such a problem?
Is there anything else can she take for Migraine with a her first-degree family history of stroke? (Prodrin does not fit the bill.) Thank you for any help you can give us, Douglas
Unfortunately, we have no way of knowing why there’s a problem with insurance coverage for this prescription. Insurance plans vary greatly, and covered benefits can change over time. You’ll have to ask someone at your insurance company that question.
There have been many issues with Midrin and Midrin equivalents the last several years. Part of the issue is that Midrin was first produced before the current FDA process for approval of new medications. In an email, the FDA told me:
“The original Federal Food and Drugs Act of 1906 brought drug regulation under federal law. That Act prohibited the sale of adulterated or misbranded drugs, but did not require that drugs be approved by FDA. In 1938, Congress required that new drugs be approved for safety. In 1962, Congress amended the 1938 law to require manufacturers to show that their drug products were effective, as well as safe. As a result, all drugs approved between 1938 and 1962 had to be reviewed again for effectiveness. To be consistent with current regulations and to ensure that all drugs have been shown to be safe and effective, all new drugs are required to have an approved application for continued marketing.”
The company that made Midrin didn’t submit an application for continued marketing, and it was pulled from the market. Brand name Midrin will not be coming back to the market. There are a few companies that have been producing medications with the same ingredients, and we refer to them as Midrin equivalents.
Midrin equivalent medications are more than a “simple weak sedative.” These medications contain acetaminophen, isometheptene, and dicloralphenazone. The acetaminophen is a simple analgesic. Dichloralphenazone is a sedative, but not a simple sedative. It’s related to chloral hydrate, and that prompted the DEA to classify it as a Schedule IV drug in 2001. Isometheptene is intended to reverse the dilation of blood vessels that sometimes occurs during a Migraine. For this reason, some doctors feel that these medications are not safe for patients with a history of stroke or heart disease.
Abortive treatment options are somewhat limited for people with a history of stroke because both triptans and ergotamine Migraine abortive medications are contraindicated for them. Some doctors are comfortable prescribing the Midrin equivalent medications; others aren’t. Other medications aren’t going to abort a Migraine attack, but there are medications you and your wife can discuss with her doctor to give her symptomatic relief. The most frequently used of these is prescription strength NSAIDs such as indomethacin. They’re often given in combination with an antiemetic medication to treat nausea. Muscle relaxants may also be helpful.
Another option is the single pulse transcranial magnetic stimulation (sTMS) mini device, which is FDA approved for the acute treatment of Migraine with aura and prevention of Migraine with and without aura. You can find more information on this device in FDA Approves sTMS Device for Migraine Prevention.
All in all, we suggest that your wife consult a Migraine and headache specialist. Gynecologists seldom have much experience treating Migraine, and with a family history of stroke, your wife needs someone educated and experienced. Although you mention a family history of stroke, some doctors do prescribe Migraine abortive treatments for such patients. This, of course, is dependent on a full examination and a discussion of risks and benefits. For more about Migraine specialists, including how to find one, please see Why, How, and Where to Find a Migraine Specialist.
Thank you for your question, Dave Watson and Teri Robert
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Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.