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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for recurrent migraine

Answered by
Dr.
Dr. Vinay Bhardwaj

Neurologist, Surgical

Practicing since :2006

Answered : 544 Questions

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Posted on Mon, 14 Apr 2014 in Brain and Spine
Question: I have recurrent migraines. They have diminished lately, but now come in clusters. I do not want to take triptans and analgesics too foten, but I need relief. What would you suggest? I now take Axert 12.5 and fioricet as an abortive. I weaned myself off Excedrin migraine.
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Answered by Dr. Vinay Bhardwaj 16 minutes later
Brief Answer: triggers and behaviour modification Detailed Answer: Hi. Thanks for coming to HealthCareMagic. I see that you are aware of the medications that can help you manage and mitigate your Migraines. Have you ever been able to find a trigger for your migraines? Do you keep a small notebook and note down when you have them? That can help you identify what the triggers are for the migraines and how you might avoid them. For some people, the trigger is bright lights, other people, strangely enough, a certain smell, etc. Avoiding the trigger means avoiding the headaches. Of course, it doesn't work for everyone. In many cases, you might be forced to fall back on using the triptan class of drugs. They have been very well studied and there are many different ones available now to choose from. They even come in nasal spray form for quicker relief. If the triptans aren't working, then we might need to look into putting you on a neurogenic pain agent like lyrica or neurontin.. but that's really stretching it. So look into your triggers for these migraines. If that doesn't work, it's probably best that you head to your neurologist and get your self on a low dose triptan. I hope this helps. Feel free to follow-up whenever you would like to. Take Care and thanks again for coming to HealthCareMagic.com
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vinay Bhardwaj 14 minutes later
I do know about triggers. I think I had an irregular sleep situation that may have triggered this particular cluster. I have seen a neurologist and have been diagnosed with Classic Migraines. I have had them all my life. With the introduction of the triptans, it has enabled me to continue with my career and be able to function. The problem is that when I get these cluster of migraines, the triptans work, but the following day or the second day, it is back. I do take a preventative which has lessened the occurance but not eliminated them. I do not want to get into the habit of taking triptans for several days in a row. I did not receive an answer to this question.I do know about triggers. I think I had an irregular sleep situation that may have triggered this particular cluster. I have seen a neurologist and have been diagnosed with Classic Migraines. I have had them all my life. With the introduction of the triptans, it has enabled me to continue with my career and be able to function. The problem is that when I get these cluster of migraines, the triptans work, but the following day or the second day, it is back. I do take a preventative (Propranolol) which has lessened the occurrence but not eliminated them. I do not want to get into the habit of taking triptans for several days in a row. What would you suggest?
doctor
Answered by Dr. Vinay Bhardwaj 7 hours later
Brief Answer: Regularize sleeping habits, small dose of excedrin Detailed Answer: Hi, I'm guessing you don't like taking alot of excedrin and the like and I can understand why. But over all, in this case. To control this cluster, a few doses of the excedrin might go a long way in controlling it and getting you past this situation. The Propanolol was my next suggestion, so that seems to be put to good use. Have you been able to get some rest and catch up on sleep. That would be the most natural way to help yourself through this particular cluster. I'm guessing this will come as no surprise, but since you know that a lack of sleep brought this on, is ther anyway you can regularize your sleep cycles a bit? I'm trying to avoid mentioning the Triptans.. but may I ask why you are against their usage? Thanks for following up.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vinay Bhardwaj 8 minutes later
I was under the impression that it was not advised to take triptans more than twice a week. Is that not the case? I had been taking excedrin more than once a day and I was told it can bring on REBOUND headaches. What is your recomendation of that?
doctor
Answered by Dr. Vinay Bhardwaj 10 minutes later
Brief Answer: Your right, using for more than 10 days. Detailed Answer: Overall, you are right. Intake of any combination of ergotamine, triptans, analgesics and/or opioids on 10 or more days/month on a regular basis for more than 3 months can lead to transformation of the headache and worsening. And Triptans alone should not be used more than 4 times in a month since the usage in that amount has never been studied. The last thing I would probably try in this is case is Ergotamine. Have you ever taken ergotamine for a cluster? It also works pretty well and you can get a prescription for a limited course for this clsuter alone. That would limit your use of the Excedrin and the Imitrex (triptans). That make any sense? I hope this helps, Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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