No Midrin available -- now what ??

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Lillyp
New Member


Date Joined Feb 2011
Total Posts : 3
   Posted 2/18/2011 10:51 PM (GMT -6)   
For the last few years, I've managed my frequent migraines with tramadol or Midrin. I previously used Imitrex nasal spray, but it became too expensive and lacked effectiveness after several years; that's when I was switched to Midrin, which helped only somewhat, but did alleviate climb-the-wall pain. Recently I learned two things: Midrin has been discontinued by the brand and generic manufacturers; and (2) Imitrex nasal spray has a generic equivalent, which remains quite high in price.

My goal was to use the very pricey (even with liberal co-pay) generic nasal spray for the worst of migraines and try to manage the rest with tramadol. The pharmacist said there was a serotonin reaction and did not know how it would affect me individually. I'm also on 30 mg of Prozac, which already has a SSRI serotonin connection. I was shattered.

I'd stop the tramadol, but then I'd have to use too many generic sumipitran nasal sprays, which I don't want to do for many reasons, financially and for my health. Tramadol or OTC analgesics don't touch the tough migraines.

What can I do? My next consult with my migraine neuro is in a month, but I'm wondering if anyone has any ideas. I get extremely frequent migraines.

For what it's worth, I've seen at a leading headache clinic for years and have tried countless preventives (none worked) as well as the full array of complementary therapies more than once and often 5+ times (Botox, acupuncture, biofeedback, physical therapy, counseling, etc.), all of which had no effect. In fact, the Botox worsened my migraines.

Thank you!

cynthiaz
New Member


Date Joined Jan 2011
Total Posts : 16
   Posted 2/19/2011 1:32 AM (GMT -6)   
Hi, Im sorry about your pain. Im also seen in a leading headache clinic. I started a topic a few days ago. The nurse practioner that I see recommended Peppermint oil ( over the counter). You put it inside your nose, on your forehead, back of your neck when you feel a migraine coming on. She tried it when she ran out of
Max Alt MLT and it stopped the migraine. The small bottle cost $6.00.  I use it first when I feel the pressure of a migraine (or if I think it may be a migraine). Many times it works, if not then I take a Imitrex. You by the bottle at a health food store.

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/19/2011 1:35 AM (GMT -6)   
That's a really tough situation to be in. It sounds like you're a migraine Pro by this point, but I 'm going to ask some basic and probably stupid questions. Just humor me for a bit.

What's your official diagnosis? CDH, Chronic migraine, ect.? Since you go to one of the big headache centers I assume they performed a differential diagnosis to rule out things like NDPH, comorbid neuralgias (occipital and sub-orbital) and secondary headaches. Have they ruled out some of the less common triggers like cerebrospinal fluid pressure issues, PFO's, etc?

How often do you take analgesics? I know some people have to take pain meds daily and there is just no way around it, but have you ruled out rebound headache as an exacerbating factor?

I know you've been through plenty of med trials. If your interested you can list them and we can try to brainstorm some others to try.

OK with the basics (sorry) out of the way...

Sounds like the pharmacist is worried about serotonin syndrome. Talk to your headache specialist. You may still be able to take triptans. I wouldn't completely rule it out yet. I've taken triptans (higher doses) and ssri's (moderately high dose) concurrently in the past.

For really bad pain, I believe there is some type of time released morphine capsule. There's marinol as well. A consult with a pain specialist may be warranted.

What about semi-frequent I.V. treatments (e.g. magnesium, depacon, DHE, etc.)? I know a lot of migraine clinics have their own, in house blends.

They are coming out with or have just come out with a DHE nasal spray.
There are also the older ergot based abortive drugs.

If you really want to go for the gusto, they have some relatively new medical devices out. E.g. Vegus Nerve Stimulators, TENS unit, occipital nerve stimulators, transcranial magnetic stimulators (I think there may be a home/portable unit available now).

I assume you've done the elimination diet thing. There are some anecdotal reports to suggest using some of the epilepsy diets could be helpful. I.e. ketogenic diet (need to be monitored), low glycemic index diet, modified atkins diet, GARD diet.

I hope you find something that is helpful!

Post Edited (EvilFluorescents) : 2/19/2011 12:28:46 PM (GMT-7)


Lillyp
New Member


Date Joined Feb 2011
Total Posts : 3
   Posted 2/20/2011 7:22 PM (GMT -6)   
To Cynthiaz and EvilFluorescents -- (love the name....yes fluorescents ARE evil !!)

Thank you SO much for the tips and suggestions. Since I was no longer purchasing the pricey Imitrex nasal spray, and my migraines last 3 days, I would usually go for the Midrin the first day and then try to get by on Ultram the next day or so. I've been told by my specialist I'm not in rebound. The Ultram also puts me at additional risk (along with the Prozac) for serotonin syndrome, so I'll discuss that with my headache specialist's office. I need something to work with before my upcoming appointment.

I'm looking forward to calling my headache specialist's office to determine the current status of the "go for the gusto" devices and to ask about options for migraine treatment before my appointment. At my last exam, devices were discussed and I was agreeable to trials of the the portable (non-invasive, non-surgical) treatments, but the home unit wasn't available yet. I'm hoping that status has changed. I'll certainly be tried on another preventive regimen. I've been on Prozac at moderate dose and Imitrex NS in the past with no problems with serotonin syndrome, but you never know.

Oddly enough, I used to do okay with the Imitrex nasal spray (never aborted, but helped), but over the years it started to work only as well as Midrin, so I stopped shelling out the pricey co-pay. Now the generic form of Imitrex nasal spray is available, but still quite pricey. Has anyone tried it?

I'll be sure to pick up some peppermint oil as well. I appreciate the time you both took. It was very kind of you !

cynthiaz
New Member


Date Joined Jan 2011
Total Posts : 16
   Posted 2/20/2011 11:58 PM (GMT -6)   
I presently use generic Imitrex tabs and have found them to be just as good as the brand name.
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