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Is Imitrex Advisable For Migraine Headaches When Diagnosed With Diabetes?
Question: I have had migraine headaches since I was 12 years old; I am now 65 years old. Everyone in my family has them, both maternal and paternal sides. We can trace them back to my great-grandmother. I have been using Imitrex since it came on the market. I started using the injectable then switched to tablets when they became available. I take 50 mg. when I have a migraine. Nothing else works for me. I recently developed Type 2 diabetes (A1C was 6.8). Now my neurologist refuses to renew my Imitrex prescription because of my age and the diabetes. I would like your opinion. Thank you.
Brief Answer:
Caution is needed, but might be continued if no other risk factors
Detailed Answer:
I read your question carefully and I understand your concern.
Your neurologist does have a point, that extra caution is needed with triptans like Imitrex in patients with potentially affected blood vessels. They cause constriction of blood vessels and in an already narrowed vessel that may cause an infarction, a heart attack. Age and diabetes are two such risk factors for such conditions. So other alternatives should be tried, and preventive medication should be given the most importance.
However, if all other alternatives have been tried and failed, while caution is needed and the patient must be informed about the risks, I am not sure that he isn't overdoing it by refusing to prescribe the medication. While you have two risk factors that alone is not a contraindication, doesn't mean that you have necessarily an advanced vascular involvement. It is in cases where there is a history of angina pectoris, myocardial infarction, stroke etc where it is officially contraindicated. Otherwise if you have only these 2 risk factors, age and diabetes, then I would continue to prescribe it when really needed. Perhaps I would ask for a cardiac evaluation periodically, but not deny the treatment just like that.
I remain at your disposal for other questions.
Caution is needed, but might be continued if no other risk factors
Detailed Answer:
I read your question carefully and I understand your concern.
Your neurologist does have a point, that extra caution is needed with triptans like Imitrex in patients with potentially affected blood vessels. They cause constriction of blood vessels and in an already narrowed vessel that may cause an infarction, a heart attack. Age and diabetes are two such risk factors for such conditions. So other alternatives should be tried, and preventive medication should be given the most importance.
However, if all other alternatives have been tried and failed, while caution is needed and the patient must be informed about the risks, I am not sure that he isn't overdoing it by refusing to prescribe the medication. While you have two risk factors that alone is not a contraindication, doesn't mean that you have necessarily an advanced vascular involvement. It is in cases where there is a history of angina pectoris, myocardial infarction, stroke etc where it is officially contraindicated. Otherwise if you have only these 2 risk factors, age and diabetes, then I would continue to prescribe it when really needed. Perhaps I would ask for a cardiac evaluation periodically, but not deny the treatment just like that.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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