Migraine advice needed

Standard disclaimer: you are not a doctor. If you are a doctor, you are not my family’s doctor (unless you’re Dr. Williams, in which case, hi). We are under a doctor’s care already.

Here’s the sitch: 17YO EtherealFreakOfPinkness (who happens to be my daughter) has suffered migraines for years. In the past, Excedrin Migraine (or the generic equivalent) has worked fine for her, and she’s accustomed to only taking one at a time. Recently, though, her migraines suddenly got A. Much more severe and B. Much more frequent. I called our family doctor (the abovementioned Dr. Williams) and he said he wanted her to have an MRI before he prescribed anything. She had the MRI, and it showed everything in her brain is normal (which begs the question of why she’s such a freak. Don’t look at me like that. It’s right in her username, which she picked herself). So we saw Dr. Williams to go over the results of her MRI and he prescribed her: Imitrex, as well as Xanax (since she was also diagnosed with General Anxiety Disorder, and the two seem interconnected somehow; IOW, her migraines and her anxiety episodes/panic attacks increased about the same time).

So, Tuesday night she got a migraine (they’ve been almost daily lately) and she took an Imitrex. Two hours later, in accordance with instructions, she took a second one. The first one seemed to quell the headache for about an hour, but then it came back. The second one did nothing, or if it did something, it made her headache worse. The Excedrin, though still at a dose of one, does nothing for her any more.

I called Dr. Williams’ office and told them the Imitrex didn’t work, and could he prescribe something else? He made an appointment for her with a neurologist, but the neurologist can’t see her until Sept. 9th! I hate the idea of her going through the entire summer haunted by these migraines. But Dr. Williams is (understandably) hesitant to prescribe anything narcotic, because she’s young.

I’ve suggested that A. She start taking the Excedrin two at a time and B. She take a Xanax at the first sign of a migraine, in case the migraines are stress-related. She says she does not like the way the Xanax makes her feel, and I can sympathize with that. However, I’d think it’s preferable to the way a migraine makes her feel.

Any input or advice would be appreciated, we will not hold you responsible or liable for any harm resulting in said advice, etc. etc. etc.

Could these be hormone-related? Perhaps some sort of hormonal birth control might help.


She’s already on birth control pills because for the past couple of years she’s had The Periods From Hell (seriously, about every other month they were bad enough that she was puking). But she’s been on the pill for about four months now, and has only had this sudden increase in migraines for about a month.

I did a search of the boards, and came up with the idea that some people see an increase in migraine activity with seasonal changes, so that may play a roll.

Norine - It might be that a different Pill would be better. Don’t they all have different hormones?


A dumb question, but does she eat regularly? In the days when I had migraines all the time, meal-skipping was a frequent trigger.

  1. Has she tracked the occurrence of her migraines with her menstrual cycle? She may be suffering from estrogen withdrawal that coincides with the end of her period. Birth control pills could alleviate this significantly.

  2. Has she tried to identify other migraine triggers? This is a difficult time of year for people who suffer from mold allergies and who are sensitive to sudden changes in barometric pressure. There are many publications about food and environmental triggers.

  3. If Excedrin Migraine isn’t paying off for her, she might want to switch to naproxen (Aleve, etc.), which is an anti-inflammatory. She’ll want to be careful, if she uses a lot of caffeine, not to abruptly stop.

  4. Acupressure (pressure between the thumbs and index finger) is said to help, though I’ve tried that one only for hiccups, and biofeedback (I’ve had some luck with imagining that my hands are extremely warm) have advocates.

One of the first things the neurologist will want her to do is make a headache diary. I’d advise her to get a headstart (ha!) on that and do it now. Get a regular calendar and write down when she has a migraine, the severity of it (1-10 scale), if it’s in a particular area of her head, how long it lasted, what she took and if it worked, how long it took to work, if she’s nauseated or had sensitivity to light and sound; if she’d eaten or drunk anything unusual, if she’d been in an unusual place (like someplace where they’d been painting or having a campfire). She should put on when her period starts and ends.

ETA-- Well, I’m a little late with the Pill thing. But she might be on the wrong one, or the wrong dose.

I have gotten horrible headaches for most of my life that have been alternately diagnosed as tension headaches and migraines. The doctors just can’t tell the difference. They usually last 3-5 days, they are usually on one side, they don’t throb, they do radiate into my jaw and ear and down my neck and into my back, and they usually but not always correspond to my period.

First: try different medications and use whatever works. If two Excedrin Migraine tablets work, she should take two. For me, Advil works best. I have tried prescription migraine medications and they had exactly the effect you described–moderate quelling for about an hour, followed by a complete return.

Second: try different birth control pills. For me, the higher the dosage of hormones in the pills, the fewer headaches I get. (Bonus for you as a mom: the higher dosages kill my libido. Hmm.)

Third: taking medication the instant I even think I might be getting a headache is key. Don’t vacillate, don’t try to be strong, don’t hope it’ll go away. It won’t go away. Take a pill.

I started getting migraines in my mid-20’s. I had been taking the pill since my early 20’s. Going off the pill at 38 got rid of my migraines almost entirely. So I’d definitely track period vs. migraine to see if there’s any correlation.

Also, she should take the Imitrex at the first sign of a migraine. It’s not as effective if you wait until your head already wants to explode before you take it. I find Xanax has absolutely no effect on my migraines, nor does my anxiety level. Sinus headaches can become migraines for me, though, and not eating or sleeping properly is also a trigger. And I take a beta-blocker for my irregular heartbeat, which also helps with the migraines, but woe betide me if I miss one. :rolleyes:

Steam (hot rag over the face) and heat (along the neck) help some (not all) of mine - and can be worked in combination with other things.

This is very true for me as well. Back when I could afford Imitrex, I had to take the first one the instant I got that slightly nauseous feeling that a migraine was on the way. If I waited until my head hurt, the Imitrex did nothing.

I’ve been a migraine sufferer all my life. I really sympathize with what your daughter is going through.

Talk to your doctor about Topamax. (http://www.topamax.com/topamax/index.html) I’ve taken it off & on for awhile now and it really helped with the severity & frequency of my headaches. It is something that has to be taken once/day and if you miss a dose you’ll pay for it (massive headache in my case), but it’s worth it IMHO.

This is stab in the dark, but might be worth the trouble: get her tested for Celiac Disease. a friend of mine was having terrible migraines (to the point of going to the ER for demirol (sp?)). She tried everything to get them under control, but nothing really worked. Turned out she was Celiac (allergic to wheat gluten). Once she changed her diet, the headaches (and a few other problems) went away.

Speaking of diet, that could be a factor as well. I’m allergic to penicillin & ethryomycin, which are commonly fed to livestock. Once I switched to organic food, I’ve been having less headaches.

My hub suffers from cluster migraines (head/neck injury/trauma//unfixable) and uses Imitrex injections which work much much much better for him than the pill form. He once took 8 Imitrex pills when he had to work which didn’t knock out the migraine and the doctor told him A. he has a very strong heart and B. neverneverneverever do that again. The injections use a stat dose pen and are easy for anyone to administor but are spendy.

Yes, I take Topamax (before that, Neurontin; before that, Midrin) and both Imitrex pills and injection. The injection is for when I can’t keep the pills down. Yes, it is expensive but they work. I understand this sort of drug is now coming out in a dissolvable under-the-tongue strip, which will be good for those of us who suffer severe nausea with migraines but who sometimes are too out of it to work the injection by ourselves (my husband always helps me).

I also second the motion for steam and hot cloths; a steamy hot shower often will help me in the short run if I catch the migraine soon enough. Once it’s established, it’s too late. TAKE the pill.

Oh, the injections make him vomit and pass out but when he wakes up, he feels much better (“tolerable headache” versus “where’s my gun?”)! The migraines make him vomit, anyway, and he usually wants to pass out…

FYI - Excedrin Migraine is the same as regular Excedrin Extra Strength. 250 mg acetaminophen, 250 mg aspirin and 65 mg caffeine.
I got migraines as a kid and it took years to identify their onset. Mine are always the 3rd of 3 headaches. They start out as a sinus headache, which triggers a back neck tension headache (there are sinus cavities at the back of the head). If these go unchecked I get a migraine which starts out as a small but sickly headache. I have about 20 minutes to do something about it.

Excedrin has caffeine in it, which will often alter blood vessel constriction. I accelerate that effect by taking Sudafed with tea (for the caffeine). The problem with Sudafed is that the side effects differ 180 degrees between people. For me, it relaxes my neck muscles and generally makes me mellow. It makes other people jittery. But by reducing neck muscle tension and constricting blood vessels I can stop a migraine in its tracks. So my regiment would be as follows: 2 Sudafed, 2 ibuprofen taken with as much tea as I can drink. That is what I would take at the first sign of a migraine. I will also use a steam vaporizer with a towel over my head if the front sinuses are irritated. That often adds a lot of relief and will make the sinuses in back feel better. If the tension headache spreads I will rub an ice cube over every muscle in my neck and face. I simply hold it with a wash cloth.

Sudafed note: if you compare regular Sudafed to the allergy version you will see that it is simply twice the dosage. And ibuprofen is marketed as “half the prescription strength”. Use that information as you see fit.

Migraines differ wildly between individuals so my recommendation would be to concentrate on recognizing the onset of them. Its easy to ignore a small headache but if it is a migraine that is a painful mistake to make. I would often wake up in the middle of the night with the start of one and think it would go away with more rest. It won’t. Stopping a migraine early is a key to immediate relief and that goes back to recognizing them.

As far as Excedrin is concerned, I much prefer ibuprofen to acetaminophen if a tension headache is involved.

Good luck

I’ve directed EFoP to this thread; it is possible that it is either A. Caffeine related (the increase in migraines correspond roughly with the time the college semester ended; in school, she was drinking a fancy-schmancy, girly-type Starbucks drink every day; now she’s not) or weather-related). I’ve been telling her for a year to keep a migraine diary. Maybe she’ll listen to you guys.

Thanks for all the input so far!

For now, I think her best bet is to try two Excedrin at the same time, and, if that doesn’t work, two Excedrin and a Xanax (she’s on a very low dose; .25mg.)

The headache diary is the single most useful thing I ever did.

I have many triggers/factors, and it took a few years to get them all sorted out, but in doing so I was able to reduce my migraine frequency. Now that I’ve moved to a part of the country where one important formerly-unavoidable allergen is rare, I’ve reduced it a lot.

My triggers, in decreasing order of importance: anything that brings on allergy symptoms, dehydration, low blood sugar, strong odors (especially perfume), lack of sleep, major barometric change such as before a storm, and strobe-type flashing lights. Triggers I’ve been able to rule out, but that I know other people are vulnerable to, include menstrual cycle, certain foods (red wine, chocolate, and aged cheese are common ones), major change in air temperature, abrupt change in heart rate or respiration (that is, exercising too much too fast), old-style flickery fluorescent lights, and motion sickness.

As for what to do once it’s too late to avoid a migraine…

I take Zomig tongue-melty things, and while they cost way too much, they do work IF I do like everyone above says and take it at the first hint a migraine is coming. You just can’t “wait to be sure” although that is a terrible temptation when the things cost $30 each.

Cold packs on my temples and base of skull/neck help me; hot makes things worse. Obviously different things work for different people.

If I can drink water, I feel better sooner, even if I puke most of it up.

Caffeine only helps if I have not already had my morning cup of coffee. Aspirin helps more than ibuprofen. Neither acetaminophen or naproxen does much for me.

There are pressure points on my face, head, and neck that feel incredibly good to press on during a migraine, though sometimes I’ve overdone it and given myself pretty bruises. The most important ones for me are that little notch at the inside top of the eye socket, and all around the inside curve of my cheekbones–that is, alongside my nose and along the sinuses there.

Good luck!

Missed edit window: It’s important to know that weak triggers can gang up on you. Missing a little sleep, having slightly low blood sugar, being just a little dehydrated, and having one too many cups of coffee can combine to do as much damage as one massive sinus infection for me.

Could be off track, but worth a shot.

Has her eyesight been tested recently? I used to get severe headaches daily (sometimes to the point of vomitting or fainting) after months of doctors visits where he suggested everything from brain tumours to hypochondria, nothing helped. I changed jobs and things improved a little, but I’d still feel like crap most days and have a migraine about once a week.

Then (completely unrelated) I had to get my eyesight tested and discovered that I’m short-sighted - once I could see, the headaches vanished. The first job’s lighting and focussing distance were right at the point for maximum eyestrain, the next had better lighting which made the most difference.

Now whenever I start getting regular headaches, an eye check is the first thing I do.

Migraine Sufferer here also.

If Exedrin used to work and now doesn’t caffiene could have become a trigger from overuse, try taking an equivalent amount of acetaminophen and aspirin at the same time. I have had great results taking one acetaminophen tablet with a glass of Alka Seltzer, which contains aspirin and baking soda. I read somewhere once after I found this method that baking soda helped some migraine sufferers.

Ask her if she’s drinking a lot of diet soda with Aspartame which is well known for causing migraines in some people (me included). It doesn’t seem to cause one for me right away, it seem I can drink it for a while then I can’t even have one serving. Then I don’t have any for a few weeks and I can repeat the whole cycle.

Ditto on finding her triggers. I can avoid almost all migraines if I’m careful.