Migraines. What are the best treatments these days?

[Hyacinth]

I’ll try to be brief: 

I've had migraines pretty much my whole adult life. They’re almost certainly related to my cycle. 
For about a decade, I took Imitrex, which worked beautifully. 
Until it didn’t. 
For the next decade, I took Zomig, which worked beautifully. 
Until it didn’t. 
Which is where I am now. 
Last night I had the worst night of pain, complete with vomiting, and I’m afraid of it happening again. 
I’m 51, so I’m sure perimenopause is messing with me. 

Are there new triptans I should investigate? 

How are the preventatives?

Is it worth looking into HRT if migraines are my only significant symptom? 

I eat well, limit sugar, and exercise nearly every  day. Sleep is not very restful. (I think perimenopause messes with me there, too.) I’m not eager to take meds, but I’ll do just about anything to avoid another migraine event like last night. 

Obviously, I’ll be talking with my doctor, but until the office opens, I’ll take advice from the Hive. Thanks!

Edited September 28, 2020 by Hyacinth

[melmichigan]

My neurologist says Maxalt (brand) is best, especially if you have nausea.  If that doesn't work there are new injectables that are given once a month. These drugs work by blocking the action of a protein fragment called calcitonin gene-related peptide (CGRP). Otherwise there are a number of preventives to try.

[Spryte]

What really helped me was seeing a neuro who specializes in headaches.  I now take a preventative.  That has cut down on the frequency.

I take Axert at the first sign, sometimes paired with Advil.  It’s not perfect, but makes things tolerable.
 

Migraines are awful, I hope you find something to help.

 

ETA: neither imetrex nor maxalt helped mine, so I think it all depends on the type.  Mine are related to Trigeminal Neuralgia (aka the Suicide Disease) and make a sort of unending loop if they get out of hand.  Everyone is different.

Edited September 28, 2020 by Spryte

[Vintage81]

I’m sorry you’re struggling with migraines. 😕 I’ve also suffered from migraines for 20+ years, so I understand the frustration. 

At the moment, I take Maxalt to help once I get the migraine, but I’ve also taken Imitrex, Zomig, and many others. So far, the Maxalt is working fine. I believe there are other triptans out there that your doctor can discuss with you. 

For prevention, I’ve been taking a monthly shot called Ajovy. There are several different brands, but I think they’re all fairly similar. It’s been a game changer. I was having 2-4 migraines per week, now I have 1-2 per month. I highly recommend talking with your doctor about the monthly shot as a preventative option. 

Good luck to you! I hope you get to feeling better soon. 

[Farrar]

My doc indicated that there were a bunch of triptans, so I don't think you've exhausted them all. But also that if they didn't work, that shots would be in order, but she was vague about what exactly because we didn't get there. I'm still on Imitrix, so... what you're saying is basically my biggest fear. Mine are also definitely cycle related at this point. I'm hoping the cycle ends before the Imitrex stops working. I feel like I'm old enough and menopause is early enough in my family usually that this seems hopeful...

[J-rap]

We're a huge migraine family (on my dh's side).  My dh can't take Imitrex -- he had a weird psychotic reaction the first time he used it (thus it was the last time).  The main thing that has helped him once it's full-blown is Midrin.  It's not really recommended much anymore, but it's really what has helped my dh when nothing else does.

Other than that, diet changes help.  The book Heal Your Headache has been a HUGE help regarding how to handle diet and explaining migraines in general.  I'd really recommend that!!  Oh, my dh also tried Maxalt once, and, well -- it didn't end well.   Really, not many prescription drugs have been helpful.  (I think that's unusual though.)

Our dd has migraines, always.  What helps her is to keep a gentle life-style -- enough sleep, gentle exercise, fresh air when available, low-stress, low stres diet -- including GF and mostly simple, pure foods.  Another dd has found that when a severe migraine kicks in, the typical dentist-recommended pain formula can knock it down:  3 ibuprofen and 2 Tylenol all at once.  

I'm really sorry for your migraines.  They can be so rough!!  Two other dd's (besides the ones above) had them quite severely for years (mostly in high school), but they've improved so much with time and a healthier lifestyle.  

 

[Catwoman]

2 hours ago, Spryte said:

What really helped me was seeing a neuro who specializes in headaches.  I now take a preventative.  That has cut down on the frequency.

I take Axert at the first sign, sometimes paired with Advil.  It’s not perfect, but makes things tolerable.
 

Migraines are awful, I hope you find something to help.

 

ETA: neither imetrex nor maxalt helped mine, so I think it all depends on the type.  Mine are related to Trigeminal Neuralgia (aka the Suicide Disease) and make a sort of unending loop if they get out of hand.  Everyone is different.

Are you good at recognizing the first sign? I am such an idiot that I often convince myself that it’s not really a migraine coming on, when anyone in their right mind would take medication right away. I’m always thinking, “Well... maybe it’s not a migraine. Why take a pill when it might be nothing? I should probably wait and see if it’s nothing.” And then... BAM. Migraine. 

I am my own worst enemy.

[Junie]

3 minutes ago, Catwoman said:

Are you good at recognizing the first sign? I am such an idiot that I often convince myself that it’s not really a migraine coming on, when anyone in their right mind would take medication right away. I’m always thinking, “Well... maybe it’s not a migraine. Why take a pill when it might be nothing? I should probably wait and see if it’s nothing.” And then... BAM. Migraine. 

I am my own worst enemy.

You are not alone.  I do the same thing all.the.time.

[Junie]

8 minutes ago, Junie said:

You are not alone.  I do the same thing all.the.time.

Several minutes later Junie realizes that she actually has had another migraine coming on for a while now and she hasn't done anything about it.

Be right back...

 

Edit: OK, took meds. :)

Edited September 28, 2020 by Junie

[Junie]

Thank you for this thread.

I need to take notes and schedule an appt. with my neuro.

We've tried several things... and then my headaches got better, so we didn't continue searching for something that would really work.

In the past month or two the migraines have come back pretty strong.

The last time my neuro tried to prescribe a preventative (2 or 3 years ago) he couldn't prescribe what he wanted to because I have kidney stone issues.

Does anyone know if there is a preventative that can be taken with a history of kidney stones?

[Spryte]

32 minutes ago, Catwoman said:

Are you good at recognizing the first sign? I am such an idiot that I often convince myself that it’s not really a migraine coming on, when anyone in their right mind would take medication right away. I’m always thinking, “Well... maybe it’s not a migraine. Why take a pill when it might be nothing? I should probably wait and see if it’s nothing.” And then... BAM. Migraine. 

I am my own worst enemy.

I do the same thing  All. The. Time.

But when I do catch it in time, life is good.

Edited September 28, 2020 by Spryte

[Tap]

DD21 has horrible migraines. She uses Maxalt during a migraine, but she recently started Emgality and it is helping her more than anything else ever has!!!! It is a once a month injection and she noticed a difference the 1st week. She already does all the recommended preventatives (due to her other extensive health issues) so trying the injection, was the next step. She gets 8+ migraines a month and her last ones were so bad that we were concerned she had a brain issue and she ended up in the ER.  She was diagnosed with migraines at 6yo, so she is pretty good at treating them at home, but these were completely new presentation. 

If you aren't seeing a migraine specialist, definitely see one. They really can make a difference!

[Spryte]

21 minutes ago, Junie said:

Thank you for this thread.

I need to take notes and schedule an appt. with my neuro.

We've tried several things... and then my headaches got better, so we didn't continue searching for something that would really work.

In the past month or two the migraines have come back pretty strong.

The last time my neuro tried to prescribe a preventative (2 or 3 years ago) he couldn't prescribe what he wanted to because I have kidney stone issues.

Does anyone know if there is a preventative that can be taken with a history of kidney stones?

I have had many kidney stones, and I take propranolol.  I don’t know if that is one of the usual preventatives, but it’s been miraculous for me.  I haven’t noticed any change in stone frequency.  Though I’m not sure if my neuro asked me about stones.  It’s been years, and I don’t recall.  

Edited September 28, 2020 by Spryte