Taking medication to stop an attack prevents migraines from becoming chronic
The use of acute anti-migraine medications in patients with episodic migraine (migraine occurring on less than 14 days a month) prevents progression of episodic migraine into its chronic form, according to Dr. Zaza Katsarava and his colleagues in Essen, Germany. They followed 1,601 patients with episodic migraine headaches for two years. None of these patients were taking prophylactic medications and 151 patients took no acute anti-migraine medications. Overall, during the two years of observation, 6.2% of 1,601 patients developed chronic migraines (defined as headaches occurring on 15 or more days each month). However, those who took triptans (sumatriptan and other) had a 66% reduction of risk of headaches becoming chronic, those who took a single pain medicine had a 61% lower risk of chronification, and those who took a combination pain killer, like Excedrin, had a 40% reduction of this risk. This analysis took into account patients’ age, sex, body mass, education level and baseline migraine frequency. A possible explanation for why combination drugs were less protective is that most of them contain caffeine, which is known to make headaches worse. Another very important lesson that can be drawn from this study is that it is important to treat migraine attacks with effective medications because if left untreated these intermittent attacks may become more frequent and even daily. At least two million Americans suffer from chronic migraines and it is likely that in many this debilitating condition could have been prevented by more aggressive and effective treatment of acute attacks.
Throat or chest pain, heaviness and tightness occurs in 1% to 7% of people taking triptans and these do not signify any danger, especially it continues to occur over a period of years. Sumatriptan has the longest record of use in pregnancy and breastfeeding since it was introduced 20 years ago, while other triptans came out a few years later. So, it is very likely that other triptans are equally safe, especially during breastfeeding since only a very small amount of medicine gets into the milk. If a different triptan does not cause this side effect you can also take it and discard the milk a couple of hours after you take the medicine.
I use sumatriptan to stop about 10-12 migraines a month. I’ve used it for more than 2 years, but recently a family practice doctor told me I should stop taking it because I have the side effect of throat pain. The throat pain I get with it lasts about 1 to 2 hours after taking it and then goes away, and although uncomfortable, is so much better than a migraine. Is it actually a DANGEROUS side effect? I can’t seem to find any info on how serious of a side effect it is. Sumatriptan is the only triptan approved for use during breastfeeding, which I am currently, so this means either sumatriptan or no pain relief at all for me (shudder).
A friend, Dr Stasha Gominak, who is a neurologist at the East Texas Medical Center, gave this advice to Allison a few weeks ago:
“The instructions included in the triptan med packets are wrong, the mechanism is wrong and they are exceptionally safe meds. The mechanism of action is to drop the serotonin level in the brainstem abruptly, just like deep sleep. Don’t limit their use. Use two if one doesn’t work. Use Zomig or Sumatriptan nasal spray if two pills don’t work. They should be used for the littlest headaches sooner the better. OK to combine them with other OTC things as well.”
For twenty years this sort of triptan use has been heresy in neurology and in my opinion the insurance companies have encouraged the MOH myth to limit their payouts on triptans. But the above research shows that in doing this they may have worsened the condition of their customers and probably cost themselves more in the long run. Now that the triptan patents are starting to expire, the generic brands should make them available in large volume at low cost and help to defeat this disease and reduce the untold suffering that it brings.
I like Dr Gominak’s theory; that by overloading Serotonin feedback receptors, the triptans are “switching off” the production of Serotonin in the Raphe Nuclei. It might be that by using triptans freely and thereby repeatedly switching off the overproduction of Serotonin (that hyper-excites neurons and amplifies pain nerve signals in the trigeminal) the whole migraine generation system in the brainstem might become desensitised and the disease be given a chance to heal. If that is true, it would fit in with the results of the survey of Dr. Zaza Katsarava, detailed above.
I like your new headache category – Medication Underuse Headache; a subtype of this headache would be Triptan Underuse Headache (TUH).
Thank goodness someone has had the good sense to say this. Migraines can cause brain lesions and they can sensitise the individual to more migraines. It can become a progressive brain disease that is not benign. Eventually migraines can kill as a result of strokes.
But until we get rid of the myths surrounding Medication Overuse Headache (MOH) we are not going to make much progress in curing migraines. Doctors are going to continue to under treat the illness. My wife’s neurologist told her to take no more than one triptan per week; yet she was suffering from Chronic Daily Migraines; how ridiculous!
Now she takes as many as she wants. She once took six in a day and it did her no harm. She mixes them all up and sometimes takes two different triptans swallowed at the same time. And the result? Instead of getting MOH her migraines are becoming fewer.
So let’s start talking about Medication Underuse Headache (MUH) for migraine. If you don’t take sufficient medication to get rid of this illness it may progressive to become chronic.
Caffeine, Barbiturates and Codeine can cause MOH; I accept that. But there is no substantive evidence that other medications cause MOH and the above study shows that they do the reverse; they help to prevent the migraines from
becoming chronic.