Migraine Not Responding To Sumatriptan

What Do You Do If You Take A Triptan And It Doesnt Work

If you wait two hours and your triptanâs still not working, you might have to use another acute treatment for that attack. You could also try heading to a dark, quiet room and using home remedies to help relieve the pain.

But donât give up on that triptan altogether! Like many migraine medications, it can take a few tries to see if a triptan is going to work for you.

Tried the same triptan two or three times with no results? Speak to your doctor about trying a different triptan . Yes, it might be tempting to conclude that triptans donât work, but itâs possible that you just havenât found the right one for you.

Are You Taking It Too Often

Medication overuse can affect people who get migraine attacks, which can lead to shorter and shorter periods of pain relief. To avoid medication-overuse headaches , NSAIDs like aspirin and ibuprofen should not be used on more than 14 days a month. Drugs in the triptan family often considered the gold standard medication for acute migraine treatment should not be used on more than nine days a month.

The recently FDA-approved group of acute medications known as gepants ubrogepant and rimegepant are the first two to become available have a longer half-life than triptans, so medication overuse may not be an issue with them, says Dr. Diamond. Gepants are a type of medication that provides an acute treatment option for migraine patients who dont respond to triptans or cant safely take them due to cardiovascular risk factors.

In some studies, the daily use of gepants actually reduced the frequency of migraine attacks.

What Triptans Does Cove Offer

Cove currently offers five generic oral triptans for migraine headaches: eletriptan, naratriptan, sumatriptan, zolmitriptan, and rizatriptan, which is available as a standard tablet or an orally-dissolving tablet . We chose these triptans because theyâre FDA-approved, fast-acting, and less likely to lead to side effects. Cove doctors usually prescribe sumatriptan first because itâs one of the most well-established and commonly used acute migraine therapies. If it doesnât work, however, your doctor may choose another triptan thatâs faster acting and potentially more effectiveâthough this recommendation will, of course, depend on your personal medical history.

We know this is a lot of information on just one possible migraine treatment option. Thatâs why we work with licensed physicians to help each and every person find a treatment plan that works for them. If youâd like to speak to a Cove physician about your headaches, you can start here.

If you’d like to keep exploring your options, we recommend reading about other proven migraine treatments: NSAIDs for pain relief and beta blockers, anti-convulsants, anti-CGRPs, and antidepressants for preventative care.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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Who Can And Cannot Take Sumatriptan

Most adults with migraines can have sumatriptan tablets or injections. But the nasal spray is only officially approved for people under the age of 65.

Sumatriptan is not officially approved for children. However, a specialist doctor may sometimes prescribe it for a child over the age of 6 years.

Sumatriptan is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:

• have had an allergic reaction to sumatriptan or any other medicine in the past
• have a heart problem such as coronary heart disease, chest pain , heart rhythm problems or you’ve had a heart attack
• have circulation problems in your legs
• have had a stroke or “mini stroke”
• have liver disease or other liver problems
• have seizures or fits
• are trying to get pregnant, are already pregnant or breastfeeding
• are a heavy smoker or use nicotine replacement therapy
• have high blood pressure

You may be able to use sumatriptan if you’ve had high blood pressure in the past and it is now well controlled with treatment.

Medicines For Migraine When Pregnant Or Breastfeeding

Many of the medicines used to treat migraine should not be taken by pregnant or breastfeeding women.

• For relief of a migraine headache:
• Paracetamol is the medicine most commonly used, as it is known to be safe during pregnancy.
• Ibuprofen is sometimes used but do not take it in the last third of the pregnancy .
• Aspirin – avoid if you are trying to conceive, early in pregnancy, in the third trimester and whilst breastfeeding.
• Triptans – should not be taken by pregnant women at all. Triptans can be used during breastfeeding, but milk should be expressed and discarded for 12-24 hours after the dose .

Check with your pharmacist or doctor if you are not sure.

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Recurrence Of Headache Common Due To Short Half Life

Some patients report worsening of the headache or an unpleasant change in its character. This usually lasts for 10 to 30 minutes, but may continue for several hours. Others said the headache recurs within a few hours of initial relief and a second dose is needed after which the migraine usually subsides. Sumatriptan is short-acting, with a plasma half life of only two hours, and recurrence of the headache is common. One specialist migraine clinic gives a frequency of recurrence with subcutaneous sumatriptan of 53%.1 In a number of reports the recurrence seems like a rebound phenomenon which develops quickly and more severely than the initial attack.

Treating Nausea And Vomiting Due To A Migraine

Migraine attacks may cause a feeling of sickness or cause you to actually be sick . The nausea makes it harder for your body to absorb migraine tablets into your body. If you take painkillers, they may remain in your stomach and not work well if you feel sick. You may even vomit the tablets back. Tips that may help include:

• Use soluble painkillers. These are absorbed more quickly from your stomach and are likely to work better.
• As mentioned, one brand of diclofenac comes as a suppository. This may be useful if you usually vomit with a migraine.
• You can take an anti-sickness medicine in addition to painkillers. A doctor may prescribe one – for example, domperidone, prochlorperazine or metoclopramide.
• Like painkillers, anti-sickness medicines work best if you take them as soon as possible after symptoms begin.
• An anti-sickness medicine, domperidone, is available as a suppository if you feel very sick or vomit during migraine attacks.
• Prochlorperazine comes in a buccal form which dissolves between the gum and cheek. This can be useful if you feel sick and do not wish to swallow a tablet.

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Some Drugs Should Rarely Be Used

Migraine attacks can last for hoursor even days. They can cause intense pain, nausea, and vomiting. They can make you sensitive to light or noise, and they can affect your life and work.

To treat migraines, you may get a prescription for an opioid or a barbiturate called butalbital. These are pain medicines. But you should think twice about using these drugs. Heres why:

Why Migraine Medication Stops Working

Its not clear why medication becomes ineffective, reports neurologist Noah Rosen, MD, director of Northwell Headache Center in Great Neck, New York. It may be related to a higher frequency of use, individual variability, or characteristics of the medication itself. For instance, some medications have higher rates of migraine resolution and are more likely to provide 24-hour relief, whereas partial treatment may lead to recurrence and eventual loss of efficacy.

Acute medications with more specific effects, such as triptans, ditans, and gepants all of which act on receptors in the brain may have a greater likelihood of stopping migraine attacks and a lower chance of tachyphylaxis than non-specific migraine treatments like nonsteroidal anti-inflammatory drugs , opiates, or barbiturates, says Dr. Rosen. This is part of the reason its good to have an appropriate diagnosis, a good abortive strategy, and good communication with a health care provider to adjust meds as needed.

When it comes to adjusting medications, a commonly suggested strategy is to try another medication within the same category when your current treatment stops working for instance, giving one of the other six triptans that are available a shot if the one youre taking begins to fail.

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Contraindications Includes Ihd & Prinzmetals Angina

Chest pain or tightness is a common complaint with sumatriptan, occurring rapidly after injection with most episodes lasting 5 – 30 minutes, but sometimes for several hours. The IMMP data show that throat tightness is often linked with chest pain or tightness.

The reason for these events is unknown, however, sumatriptan is a potent vasoconstrictor and may cause some vasospasm of the coronary arteries. It is therefore contraindicated in patients with a history of ischaemic heart disease or Prinzmetals angina, and should not be used in patients with risk factors for IHD without prior evaluation for underlying cardiovascular disease. Where cardiovascular disease is absent, and a trial of sumatriptan prescribed, the first dose should be given under supervision. There are a few reports in the literature of myocardial infarction, some fatal, in patients with known or unsuspected coronary artery disease taking sumatriptan. There are no such reports in New Zealand, but there are two reports of angina.

Sumatriptan is also contraindicated for 24 hours after using ergotamine preparations, and ergotamine should not be used within six hours after using sumatriptan. The combination may be strongly vasospastic.

Reduction Of Migraine Triggers

Patients should avoid factors that precipitate a migraine attack . Encourage patients to use a daily diary to document the headaches. This is an effective and inexpensive tool to follow the course of the disease.

Patients may need to discontinue any medications that exacerbate their headaches. If an oral contraceptive is suspected to be a trigger, the patient may be advised to modify, change, or discontinue its use for a trial period. Similarly, when hormone replacement therapy is a suspected trigger, patients should reduce dosages, if possible. If headaches persist, consider discontinuing hormone therapy.

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Strategies At Ed Discharge

If the patient is pain free, no further therapy is needed. It is important to provide the patient with the tools they need to successfully treat their next headache at home, regardless of whether it is a recurrence in the next 24 hours or their next episode. Oral sumatriptan 100 mg is effective for acute migraine in general92 and is also quite useful for recurrent headache within 24 hours.51,9395 Naproxen 500 mg is equally useful for recurrent headache,93 and adding naproxen to sumatriptan is even more effective at preventing recurrence.96 If nausea is a significant component of the patients migraine, an oral or suppository formulation of dopamine receptor antagonist should be prescribed.

If the patient still has some residual head pain, providing reassurance that they are heading in the right direction and encouraging them to sleep when they get home can be helpful. Admitting for acute migraine has many downsides, and even repeated dosing of DHE as an inpatient is no guarantee of rapid success in ending the headache.97 It would be preferable to give an additional dose of DHE or dopamine receptor antagonist in the emergency room, if needed, instead of admitting the patient. Hospital admission is likely to prove disruptive to the patients sleep pattern, and in a shared room setting likely to involve significant ambient noise and light that can exacerbate photophobia and phonophobia.

Alternate Strategies May Be Required For Overcoming The Treatment Resistance Of Certain Types Of Migraines

Oliver R, Taylor A. Treatment-resistant Migraines. Pract Pain Manag. 2004 4.

Triptans have been available since 1992 and are now generally accepted to be the most predictable of treatments for migraines. However, triptans do not work for everyone. The fast acting oral triptan preparations all work in approximately the same percentage of patients varying from 60 to 70% in different studies. The 30 or 40 % of patients that do not respond to one triptan may well respond to one of the other triptans.¹ Eletriptan has been found in one study to be effective in patients who found oral sumatriptan to be poorly effective or to cause side effects.¹ In another study, the 30% of the participants who failed with oral sumatriptan for migraine treatment responded to Zomig 71% of the time and to Maxalt 81% of the time.² Use of other formulations, such as Imitrex or Zomig nasal spray or the Imitrex injection, also increases the percentage of patients that may respond.

There is still a percentage of migraine patients that are triptan non-responsive. This article will deal with possible reasons for treatment-resistant migraines.

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Give Your Preventive Migraine Medication Time To Work

There are two concepts that are helpful in understanding how long you need to take a medication to find out whether it will work for you, which is time of onset and peak duration, says Rajneesh. Time of onset is when you first start noticing the beneficial effects of a drug, and peak action is when it reaches its peak efficacy, he explains.

One way to understand this concept is to imagine you are walking toward a hill in the distance, says Rajneesh. When you start your walk, that is like starting your medication. Once you reach the base of the hill, thats the time of onset, and when you reach the very top of the hill, that is the peak of onset, when the drug will be most beneficial, he says.

The time of onset and the peak of onset varies for different migraine medications, says Rajneesh. Preventive migraine medications such as beta-blockers and antidepressants may take at least 15 to 20 days to start working and then peak around three months, he says.

What we tell patients is ideally wed want to try any medication for at least three months to determine if its working, but there can be exceptions, and so you should always discuss this with your doctor. If there are adverse events we may stop or switch medications earlier, says Rajneesh.

Treatment Of Menstrual Migraine

Abortive therapy for menstrual migraine is the same as for nonmenstrual migraine. Patients with frequent and severe attacks may benefit from short-term, perimenstrual use of preventive agents . Patients with menstrual and nonmenstrual migraine who are receiving continuous preventive therapy and experiencing breakthrough menstrual migraine headaches may benefit from perimenstrual elevation of the dose of the preventive medication.

Patients who do not respond to standard preventive measures may benefit from hormonal therapy. Perimenstrual estrogen supplementation with estradiol may be beneficial. A study by De Leo et al of oral contraceptive use in women with menstrual migraine without aura found that a regimen of 24 ethinyl estradiol/drospirenone pills and 4 inert pills was more effective than a regimen of 21 active pills and 7 inert pills.

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Be Mindful Of Migraine Triggers

Many migraine patients can identify specific things stress, sleep irregularities, hormones, diet, alcohol, light, and smells are common culprits that make it more likely for them to experience a migraine attack. Migraine can be challenging to treat because there can be so many triggers, says Dr. Diamond.

Regardless of what medication youre on, its important to remember that managing or avoiding triggers through diet or environment can help increase the effectiveness of your treatment, says Dr. Diamond.

If you arent aware of your triggers, keeping a migraine diary can help you determine whats setting them off. It often takes a combination of triggers, such as having a glass of wine when youre under a lot of stress, to provoke an attack. But once a pattern emerges, it should be easier to avoid things that trigger your migraines.

What Drugs Are Good For Migraines

If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.

If you have migraines often, or if they are very severe, ask your doctor about drugs to prevent headaches.

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What Are The Treatment Options To Prevent Menstrual Migraine

Medications used to treat menstrual migraine are the same as those used to treat other forms of migraine. However, your doctor may recommend other treatments to be take regularly, in order to prevent or reduce the severity and frequency of menstrual migraines.

To find out more, see the separate leaflet called Migraine Triggered by Periods.

Important Information About All Medicines

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