Thursday, July 14, 2011

What Do You Think?

Not sure but I think I'm cheating on my meds today. What do you think?

Here's the thing. My headache doc has instructed me to not take more than 9 of my rescue triptans per month. He says that the preventative meds can't work if I'm overusing the rescue. Not that the preventatives have managed to prevent anything, but that's beside the point. I've committed to his plan and have been following it to the letter.

Yesterday I knew fairly early on in the day that a migraine was inevitable but, as always, I needed to determine if I was going to treat this one or call my body's bluff and try to make it through the day with just Tylenol (which might as well be a M&M for all the good it does). I decided to call my bluff and not treat it. Unfortunately, I made the wrong decision as yesterday's migraine turned out to be super bad. It was somewhere around 4pm when I finally broke down and took my triptan but of course by then I was all kinds of nauseous and in more pain than even the triptan could get on top of.

After about 3 hours the worst of the pain has gone down. As expected the triptan wasn't enough but at least the pain was tolerable and bedtime was only a few hours away so I decided to see what a good night's sleep could do for the migraine. Waking up with the same pain that I went to bed with was pretty disappointing. With the whole day ahead of me I was fearful that today would take the same path as yesterday so I decided to go ahead and take another triptan.

Here's where things get tricky. You see I'm allowed to take up to 2 triptans within a 24 hour period and if I do that, those two triptans only count as one because I'm treating 1 migraine day. Since I took yesterday's triptan around 4pm and I woke up about 6am I figured I can count today's triptan as part of yesterday's as they were taken so close together and I really was treating the same migraine that I never got on top of yesterday.

I've never taken this approach before. Usually I just count each day as 24 hours no matter what and rarely do I take more than one triptan in a day. I've already taken 5 triptans this month and I don't want to take a 6th (though technically I did) as that would only leave me with 3 for the rest of the month and I will likely need more than that when my period comes.

What do you think? Is this fuzzy math on my part? Am I trying to justify breaking the rules or is this a reasonable argument?


  1. I think it is a reasonable argument. You are allowed to take 2 in a 24 hour period, so in reality you aren't taking more than you are supposed to.

    Chronic headaches, and everything you are experiencing are fibro symptoms. Maybe a fibro med will help. When do you see a doc again?

    Check this out

  2. I have the same problem - only 9 of the triptan med allowed per month, which leaves me with as many as 8 other migraines to manage without medication. And I, too, must decide - usually based on the level of pain I anticipate and whether I have an activity coming up for which I know I'll have to take the triptan in order to function - which migraines to medicate. Wish I had a crystal ball, because that is a really hard decision to make.

    As far as your math, I used to struggle with the same calculations, but have recently found it easier and just as effective (i.e., not very) to
    1. Try never to take triptan med two days in a row;
    2. Try never to take more than two per week;
    3. Learn, after what my doctor called a rebound headache (from hell, I add), how many triptans I can take per day and per week without rebounding;
    4. Accept the fact that no way of trying to cram 18 migraines into 9 pills is ever going to succeed;
    5. Learn other pain management techniques (I blog about this at

    My sympathies are with you: it's a terrible Catch-22, and one that cannot be avoided under these circumstances.

  3. Yeah! I can comment on my blog again!

    Yeah, I'm just now beginning ot really learn about Fibromyalgia and trying to figure out life in this new light. I haven't even had a chance to really talk to a dr about this yet. That's a great website you recommended -thanks!

    Carol, wow, yeah, that all sounds like me :) Those are great tips and I'm so glad to now be following your blog! Thanks

  4. It's such a difficult decision, especially when you can see the day ahead of you and know it's going to be perfectly awful. I'm sorry that yours was.

    I'm allowed 12 per month as that is all that my extended health care drug plan will pay for, and I couldn't afford more even if I wanted them.

    Also, my doc said the same thing re: rebound and triptans. I tend to go with the "no more than twice a week" plan, with the option to take 2 for a single migraine as needed.

  5. Well, none of the triptans have really helped, so I'm on a different abortive medication... but, similar rules apply. I can only take it so many days per week.

    Some people ask me why I don't just take my medicine, when I hurt bad. They don't understand that it happens so often that it's difficult to determine when it's actually "worth it" to use one of your limited days/supply of medicine.

    I actually asked a similar question to my mother-in-law (a few months ago)... I was trying to determine if a week was Sunday through Saturday, or a rolling 7-day period of time because it determined if I could or couldn't take my medicine that day. She thought it was ridiculous that I was trying to "play the system." Others just can't understand chronic pain.

    I hope you're doing alright, dear. Blessings.

  6. I'm in a different boat. My migraines transformed from episodic to chronic daily migraines. I've been refractory to all preventatives (so far tried 18 in 10 years). When I get a migraine, the severe pain lasts up to 36 hours, sometimes more. So riding them out would make it impossible for me to function daily. So, my neurologist has prescribed (here in Montreal, Quebec) triptans (Amerge) as a daily rescue. I take 2 a day (4 halves over the course of the day) starting at 8 a.m. and finishing the last quarter around 7 p.m. I also often have to add an anti-inflammatory (Ketoprofen). So I take 60 Amerge a month! This does make it harder to break rebound. Not ideal. So occasionally I go on corticosteroids to try to break the chronic cycle but it only gives me temporary relief. My meds are covered by our health care system. So at least I'm able to have a life even though I can only work sporadically. Onwards and upwards. Keeping my spirits up for the most part!

  7. Thanks for writing about this because it is one of the things I have obsessed so often about!

    And like some have mentioned, I get so frustrated when non-migraineurs say, "have you taken something?" No matter how I explain, they just don't get the complex rationing that goes into a migraineur's life.