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Suggest Treatment For Severe Migraines
Question: i was given a drug butal/apap/caff/cod#3 for migraines and this medicine has worked to relieve the migraines.I have been taking this for 2 1\2 years. ive been on numerous meds for the migraines and this is the only thing that has worked but the insurance company wont pay for that drug. is there something else that will help me I have been with my doctor for 29 years and have had mri,ct of the head
Brief Answer:
Preventive medication should take priority.
Detailed Answer:
I read your question carefully and I understand your concern.
While you seem to have interrupted it due to insurance issues I think it is a good thing you are off it, the use of that medication is not recommended for prolonged periods due to potential for addiction and abuse.
Regarding alternatives for it the most common ones are triptans. You seem to have tried one in Maxalt but patients respond differently to different triptans, you may have more success with others like sumatriptan or zolmitriptan.
Another possibility would be ergot derivatives class like ergotamine.
However instead of focusing on such drugs to treat the attacks I think you should focus on preventive treatment. It is always advised in cases with frequent migraines. The aim is to reduce the frequency and the severity of the attacks. Also apart from becoming rarer the attacks may be more controllable by common painkillers until now unsuccessful.
There are several classes available like antidepressants (amitriptyline), anticonvulsants (valproic acid) or antihypertensives (propranolol, verapamil). Apart from medication there are also alternatives like botox injections to prevent the headaches (when medication doesn't work).
I remain at your disposal for other questions. I read your question carefully and I understand your concern.
While you seem to have interrupted it due to insurance issues I think it is a good thing you are off it, the use of that medication is not recommended for prolonged periods due to potential for addiction and abuse.
Regarding alternatives for it the most common ones are triptans. You seem to have tried one in Maxalt but patients respond differently to different triptans, you may have more success with others like sumatriptan or zolmitriptan.
Another possibility would be ergot derivatives class like ergotamine.
However instead of focusing on such drugs to treat the attacks I think you should focus on preventive treatment. It is always advised in cases with frequent migraines. The aim is to reduce the frequency and the severity of the attacks. Also apart from becoming rarer the attacks may be more controllable by common painkillers until now unsuccessful.
There are several classes available like antidepressants (amitriptyline), anticonvulsants (valproic acid) or antihypertensives (propranolol, verapamil). Apart from medication there are also alternatives like botox injections to prevent the headaches (when medication doesn't work).
I remain at your disposal for other questions.
Preventive medication should take priority.
Detailed Answer:
I read your question carefully and I understand your concern.
While you seem to have interrupted it due to insurance issues I think it is a good thing you are off it, the use of that medication is not recommended for prolonged periods due to potential for addiction and abuse.
Regarding alternatives for it the most common ones are triptans. You seem to have tried one in Maxalt but patients respond differently to different triptans, you may have more success with others like sumatriptan or zolmitriptan.
Another possibility would be ergot derivatives class like ergotamine.
However instead of focusing on such drugs to treat the attacks I think you should focus on preventive treatment. It is always advised in cases with frequent migraines. The aim is to reduce the frequency and the severity of the attacks. Also apart from becoming rarer the attacks may be more controllable by common painkillers until now unsuccessful.
There are several classes available like antidepressants (amitriptyline), anticonvulsants (valproic acid) or antihypertensives (propranolol, verapamil). Apart from medication there are also alternatives like botox injections to prevent the headaches (when medication doesn't work).
I remain at your disposal for other questions. I read your question carefully and I understand your concern.
While you seem to have interrupted it due to insurance issues I think it is a good thing you are off it, the use of that medication is not recommended for prolonged periods due to potential for addiction and abuse.
Regarding alternatives for it the most common ones are triptans. You seem to have tried one in Maxalt but patients respond differently to different triptans, you may have more success with others like sumatriptan or zolmitriptan.
Another possibility would be ergot derivatives class like ergotamine.
However instead of focusing on such drugs to treat the attacks I think you should focus on preventive treatment. It is always advised in cases with frequent migraines. The aim is to reduce the frequency and the severity of the attacks. Also apart from becoming rarer the attacks may be more controllable by common painkillers until now unsuccessful.
There are several classes available like antidepressants (amitriptyline), anticonvulsants (valproic acid) or antihypertensives (propranolol, verapamil). Apart from medication there are also alternatives like botox injections to prevent the headaches (when medication doesn't work).
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am on amitriptolen,75 mg, verapimil ive triedand propranolol have been on with no success and this was a drug of choice to try by a neurologist not by my pcp and botox really scares me
I'm having migraines about 2 times per week and my dr,pcp that I have never abused any drugs that are additive. ive had to had shots to knock me out to get rid of them but since ive been on this drug,i don't have cluster migraines and the migraines are not as frequent as they use to be
I also have a history of hypertension since I was 21 and the beta blocker I'm currently on is the last beta blocker that has kept my heart rate below 170 and a normal blood pressure
I should also tell you that the headaches normally[99percent of the time ] I am awaken by the headaches ,once in a while during the day i get a headache but ibutrpofen takes care of the normal headaches
I'm having migraines about 2 times per week and my dr,pcp that I have never abused any drugs that are additive. ive had to had shots to knock me out to get rid of them but since ive been on this drug,i don't have cluster migraines and the migraines are not as frequent as they use to be
I also have a history of hypertension since I was 21 and the beta blocker I'm currently on is the last beta blocker that has kept my heart rate below 170 and a normal blood pressure
I should also tell you that the headaches normally[99percent of the time ] I am awaken by the headaches ,once in a while during the day i get a headache but ibutrpofen takes care of the normal headaches
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional information.
While not ranking as high on the abuse potential as some opioids, the medication you have been taking contains butalbital and codeine, both having a potential for creating dependence. So should be careful in taking them too often. I as well have happened to prescribe them but only when sure that nothing else works.
I wonder if you've inquired if all versions aren't covered by insurance company. There is also the version without Codeine, perhaps that is covered and carries less dependence risk. Also there are two versions the one with aspirin and the one with acetaminophen. You seem to be taking the one with acetaminophen (Fioricet), perhaps the one with aspirin can still be taken (Fiorinal).
Excedrin an over the counter containing aspirin, acetaminophen and caffeine should also be tried if it hasn't been already, contains two of the same ingredients.
Other alternatives remain the same triptans and ergots.
As for the preventive medication you seem to have already tried 2 of the main 3 classes of medications. In terms of drugs the remaining option is antiepileptics like valproic acid or topiramate.
If those fail as well then botox injections would really be justified, it is very safe and I do not see any reason to fear it if available. There is also in recent years the option of transcranial stimulation, a noninvasive therapy, through a portable device sending brief magnetic pulses. Not available everywhere though, not sure if you can obtain it.
Let me know if I can further assist you.
Read below
Detailed Answer:
Thank you for the additional information.
While not ranking as high on the abuse potential as some opioids, the medication you have been taking contains butalbital and codeine, both having a potential for creating dependence. So should be careful in taking them too often. I as well have happened to prescribe them but only when sure that nothing else works.
I wonder if you've inquired if all versions aren't covered by insurance company. There is also the version without Codeine, perhaps that is covered and carries less dependence risk. Also there are two versions the one with aspirin and the one with acetaminophen. You seem to be taking the one with acetaminophen (Fioricet), perhaps the one with aspirin can still be taken (Fiorinal).
Excedrin an over the counter containing aspirin, acetaminophen and caffeine should also be tried if it hasn't been already, contains two of the same ingredients.
Other alternatives remain the same triptans and ergots.
As for the preventive medication you seem to have already tried 2 of the main 3 classes of medications. In terms of drugs the remaining option is antiepileptics like valproic acid or topiramate.
If those fail as well then botox injections would really be justified, it is very safe and I do not see any reason to fear it if available. There is also in recent years the option of transcranial stimulation, a noninvasive therapy, through a portable device sending brief magnetic pulses. Not available everywhere though, not sure if you can obtain it.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much for your help in this matter,i am a 26 year retired paramedic and I don't like taking anything as far as meds go but the three that i take atenolol, the med in question and aspirin a day.....i have had heart cat several years ago because of chest pain and changes in my ekg, nothing was found and stress test reveiled my heart likes to go faster sometimes than it should so that is the reason for the atenolol.still as early as lst weekend my heart rate went up to 180 and i took another atenolol and shortly my heartrate slowed back to a normal heart rate,the closest hospital is 55 miles away and that is why i contacted my pcp at the first of the past week and let him know what happened. i will relay all this to my pcp and hopefully can get treated with something to take care of my problem, i live in a small community and i can have longer meetings with my pcp if needed. thank you very much XXXXXXX
Brief Answer:
I hope you'll feel better soon.
Detailed Answer:
You're welcome. I hope things will get better soon.
I hope you'll feel better soon.
Detailed Answer:
You're welcome. I hope things will get better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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