Naratriptan Safety and Botox Protocol for Migraine?

Health Professional

Full Question:

I have over 15 migraines a month. For preventive medication, I take amitriptyline, propranolol and topiramate. When I have an attack, which is about 15 a month, I take naratriptan. Used to take Amerge, now I take naratriptan 2.5 mg. Is naratriptan harmful? I have been taking it for years. Also, how does the Botox protocol work for patients? Thank you! Debra

Full Answer:

Dear Debra:

Two questions in one!  Love the efficiency!  You have a lot of migraines but your willingness to reach out and be your own best advocate is a great step. I'll try to answer your questions below, but first I have a question for you that you may want to talk about with your provider:  Are the three preventive medications you are currently using being used to their fullest potential?  For example, are you on the maximum tolerated dose for you and are you taking them at the best times and frequencies for you?  I can't answer those for you, but please consider talking it over with your specialist.

Now, to your questions. Naratriptan, the generic of Amerge, is generally considered safe as long as you don't have certain medical conditions, such as uncontrolled hypertension, coronary artery disease, a history of stroke or transient ischemic attack (tia), or peripheral vascular disease. However, it is not generally recommended to take triptans like naratriptan more than three days per week unless you are working closely with your health care provider.

OnabotulinumtoxinA (Botox) is currently the only FDA approved treatment for chronic migraine (CM), defined as 15 headache days per month lasting 4 hours each and at least 8 days of migraine as part of the 15. I think it is a very good option for many folks with CM.  The data from the PREEMPT trial showed significant reduction in migraine days and hours with migraine. My experience, anecdotally, is that about 1/4 of my patients have a very dramatic benefit, 1/2 get good enough benefit to continue the injections, and 1/4 don't get enough relief to warrant the cost and discomfort of the procedure. So if you are interested in trying it, be sure to find a migraine and headache specialist who has experience with the injections and largely follows the PREEMPT protocol. If you need help finding a specialist, take a look at Migraine and Headache Specialist Listings.

I hope this is helpful and wish you the best in continuing the battle.

Thanks for your question,
David Watson, MD

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About Ask the Clinician:

Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. He and Lead Health Guide Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about _ Dr. Watson_ or more about _** Teri Robert** _.

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