holmesla: I will tell you what I take and how I take it - I actually take some pretty strong meds but I will tell you that so far, the meds I take at home have decreased my ER visits (for IV meds, including IV narcotics) down by probably 75%. There are some that completely disagree with taking narcotics for migraines but, I think all of us agree, we each have to do what works for us.
My abortive meds are Relpax, Prednisone, Lortab, Dilaudid and Zofran (for nausea/vomiting). At the first sign of a headache (little, big, medium, any heachache), I take a Relpax, 1/2 Prednisone and 1 10mg/500 Lortab. If I still have any pain at all in 2 hours, I take another Replax and then a Dilaudid. I only take the Zofran if I am nauseous. There have been times that I have had to continue taking either the Dilaudid or the Lortab for several more doses if the pain is still there but, every time, the pain has been tolerable but there. I have learned, the hard way, that if I continue to have any pain at all, I have to keep treating it until it is gone completely or it will rear it's ugly head and come on so strong that my oral meds don't help.
Also, if I know the barometric pressure is changing or I have worked all night, I take the same regime of meds. Before I started this, every single time I worked, I would wake up with a migraine and most of the time, end up in the ER.
Hope this helps. As I said, the Dilaudid, especially, is a very strong med and I don't know many docs that will prescribe it for migraines, but it works. My neurologist asked me what meds worked in the ER and once I told him it was the IV Dilaudid, he wanted to try the oral version. The most important thing about all of this is to take the meds early. My neuro doc says hit a migraine early and hit it hard with everything you have. Trying to treat a migraine a little at a time (starting with the least strong med and moving up) is the mistake that most everyone makes. His theory is to start off at the strongest med and work backwards.
Good luck and let me know if I can help answer any other questions. I probably don't have any great answers except what works for me. Right now, I am doing so well with my meds that I tend to want to shout it from the mountaintop!
DX: Migraines since June, 2006, kidney stones
RX: Daily - Verapamil, Trileptal
PRN: Relpax, Prednisone, Dilaudid, Lortab, Lidocaine Nasal Spray