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10 January 2010 @ 10:29 pm
The ickiest cure...  
Why is it that some of the best cures are the ickiest? I'm not sure, but it seems to be so... Many of you know that I am a proponent of the disgusting but effective neti pot for nasal/sinus issues (colds, allergies, sinus infections, etc), but it was brought to my attention that I've not shared one of my most important tips about migraine treatment. (Gross-out warning - the last tip is icky. Not horrible, but fair warning.)

If you have a migraine, your best bet is to take a triptan (sumatriptan/Imitrex or one of the other flavors). If you get migraines and do not have a prescription for a triptan, hie you to the doctor and get one. They are the currently best option for stopping a migraine once it has started. The trick? They are most effective the earlier in the migraine they are taken. If you take a pill when you start getting the migraine or when your aura starts, they are really very effective. If you wait until you are rolling on the floor in pain, they are significantly less effective, down to 20% or worse! So, don't "wait to make sure" it's a migraine - it can then be too late. Yes, even the generic sumtriptan/Imitrex is expensive, but how many of you would not pay $10 to avoid a migraine? Hopefully the price will drop as more generics are available, but I think even that price is worth it.

If you do not have access to triptans for whatever reason, most people resort to analgesics like Excedrin, Ibuprofen, or Vicodin. These will often work, but can irritate the stomach, especially if you are already nauseated, and do more to block the pain than stop the migraine process. These are inferior to triptans, but necessary in some cases. Little tip: the difference in pain control between 600mg and 800mg of ibuprofen is marginal and the difference in level of stomach irritation is huge. While I know none of y'all would be exceeding the labeled maximum dose of OTC ibuprofen (*stern look*), keep this in mind and save your already pissed off little tummy the aggravation and don't fall into the "more is better" mindset. I'm just saying. Also, if you are taking pain meds more days than you are not, you may be experiencing something called "rebound headache." This is a particularly miserable situation where your body essentially gets dependent on the analgesics and gives you a headache when it doesn't get its fix. The only way out is to slowly wean yourself off the analgesics... So, don't get into this mess. Don't take analgesics too often, unless under the advice and supervision of a doctor. If you "need" them that often, talk with your doctor, you may already have a problem.

If you are getting frequent migraines, there are prophylactic therapies available and some of them are even really quite benign and cheap. They range from blood pressure meds to epilepsy meds to antidepressants and can produce spectacular improvements in many people. You may have to fool around with meds and doses until you find something that works, but leaving frequent headaches untreated tends to make them worse, more frequent, and harder to treat. If you are getting frequent headaches and don't have health insurance, please consider getting in at a free clinic or similar as this is an issue that can spiral out of control and seriously impact your quality of life.

Lastly, if you don't have access to any of the above, or if the above items fail, and you are rolling around on the floor, miserable, in pain, and nauseated, you have one (free!) option left...


Yup. Giving up on fighting the nausea and just letting your body throw up (or making it throw up) will often clear up the worst of the symptoms. Now, I won't lie to you - puking with a migraine is categorically Not Fun. However, it is effective. Gross, but effective. If I get to that point and know that it needs to be done, I'll often crunch down a few Tums (it seems to help with the acid burn) and then chug a glass of warm water or warm salt water (which pretty reliably puts things in reverse) and then just ride out the last few minutes of intense misery. I don't know of any studies evaluating this as a treatment, I just know that it actually does work for many people. Again, gross, but effective. :P

...and this has been your EithniCare(tm) PSA for the day! 
Current Mood: sicksick
rufiniarufinia on January 11th, 2010 04:45 am (UTC)
I adore my amitriptalyne. Or however you spell it. I've been able to reduce it to 25 mg every three or four days to keep the migraines away.

Now if I could find something that would allow me to drink booze once in a while....
berzerker_primeberzerker_prime on January 11th, 2010 05:05 am (UTC)
You can call me exhibit A on that last option. The getting better took roughly a minute.

Thank you, thank you, thank you for the emergency consult last night!
eithni: PharmDeithni on January 11th, 2010 05:13 am (UTC)
:) Glad to help. It set off a discussion of migraine treatments at the postrevel I was attending, so I decided to address it here since it was not a topic I'd covered yet.
jtdiiijtdiii on January 11th, 2010 05:31 am (UTC)
The bouncing frog icon is just way too cute for this discussion. :)
eithni: excellenteithni on January 11th, 2010 06:25 am (UTC)
I know. It's wrong and cute and fabulous. I don't actually feel sick, but I needed to use that icon. :D
EllieSamelliesam on January 11th, 2010 05:40 am (UTC)
I've only encountered triptans once, I was given a nasal spray version of Imitrex, and it made me so sick I just couldn't do it again after two different episodes. I didn't realize that there were other options. Maybe I should ask for something else.

The last/final option, however, I am familiar with. Bleh, wish I wasn't.
eithni: PharmDeithni on January 11th, 2010 06:24 am (UTC)
Ugh. I hated the nasal Imitrex. Foul-tasting nasty crap.

There are many triptan formulations on the market, including injectable, oral, nasal, and oral melts. The injectable is the fastest and best acting, but not good if you don't like needles. The oral melts are good if you don't have access to water, but actually take LONGER to work than the orals with a few sips of water.

There are even several different triptan drugs - if one does not work, another might. There's sumatriptan, rizatriptan, almotriptan, and more...

I would recommend starting with sumatriptan tablets - they're available generically and so are covered by most insurances, and it is effective for most people. Take them with a little water at the first sign of migraine.

Best of luck!
Sean: crazy talkcudubh on January 11th, 2010 01:45 pm (UTC)
Ah yes, sometimes the best remedies are the least palitable. Made me think of the newest treatment for C-diff for people with chronic infection. Ingestion of fecal matter from a healthy person to recolonize the gut with healthy flora. Fortunately for all involved it's administered via G-tube. But it's one of those solutions that seems so simple that it was overlooked primarily due to the squick factor.
gwyndlyngwyndlyn on January 11th, 2010 02:27 pm (UTC)
Amen! I loves me my rizatriptan! I bow at the feet of the scientific teams who came up with triptans!

I second (third?) the effectiveness of just giving up and puking. I don't know *why* it works, but now you've given me a way to push it over the edge when I get to the "I wish I'd just throw up and get it over with" point.
Saraidhsaraidh on January 11th, 2010 06:55 pm (UTC)
It also worked on the headache-from-hell that I'm 90% sure was mild radiation poisoning.
grnjenny / Jennifer Carlsongrnjenny on January 14th, 2010 03:13 am (UTC)
Do I want to know how you got mild radiation poisoning?
Saraidhsaraidh on January 14th, 2010 04:16 pm (UTC)
My doctor gave it to me. :-) Short version - a couple of years ago I developed a hyperactive thyroid, which is typically treated with with radioactive iodine, which accumulates in the thyroid without really hurting anything else.

I say 90% sure because my doctor's office swore the headache and nausea that hit two days later was unrelated, but the timing and symptoms exactly match the Mayo description of radiation sickness, which seems a bit of a stretch to write off as coincidence.
Petranellapetranella on January 12th, 2010 05:13 pm (UTC)
One of the wonderful things V does for me when my headaches get bad is clean the toilet. We both know I'm gonna puke, at least I get a fresh bowl. Others consider it strange, but I think it's really sweet.
grnjenny / Jennifer Carlsongrnjenny on January 14th, 2010 03:13 am (UTC)
You're right, that is strange ... but thoughtful (dunno if I'd call it "sweet") :-P
eithni: excellenteithni on January 14th, 2010 06:32 am (UTC)
Aw, that is really sweet. Anything that makes the migraine experience even a little bit better is awesome and that is such a thoughtful detail to take care of...

Saraidhsaraidh on January 14th, 2010 05:48 pm (UTC)
I totally agree. Yay, considerate guys!
grnjenny / Jennifer Carlsongrnjenny on January 14th, 2010 03:15 am (UTC)
Hmm. rebound effect... I wonder. maybe that's why I had so many headaches with (and after) my sinus infection!

I have been following your advice on the quantity of advil, and you're right - more isn't always better.