I have recently begun seeing a new (to me) doctor. While covering my migraine history, I was very specific that I awaken with a full blown migraine at least 95% of the time; it is very rare that I have any warning. When I do, though, I have found that Butalbital/APAP/Caffeine is usually effective in warding them off. She nodded wisely and gave me a prescription for Butalbital/Aspirin/Caffeine. I’ve tried that in the past and found it completely ineffective. In spite of telling her about that, she insists that I try it. For those occasions when I awaken with a full blown migraine, I’ve taken Fiorinal #3 for years and for a simple reason: it works. She (the new doctor) insists that three Tylenol Super Strength along with two regular aspirin will work; after all, it works for her. I haven’t tried it yet but I suspect that when the time comes, I will end up in the closest ER, where I will wait for hours in agony before being seen.
My attitude is that I am nearly 68 years old and I’ve had migraines since I was about twelve; I pretty well know what works for me and what doesn’t. I know I have to be wary with the Fiornial and I am. But I don’t at all understand why she insists I try Butalbital/Aspirin/Caffeine instead of Butalbital/APAP/Caffeine. When asked, she more or less avoided the question.
Is there something about Butalbital/APAP/Caffeine that is addictive or dangerous?
Why do all/most/a lot/ of doctors want to change medications that have proven to be effective for a give patient?
Louis, is the new 'script missing the codeine? That could explain why Fiorinal #3 works and the new 'script doesn’t. AFAIK, Fiorinal #3 has codeine in it.
I bet it’s the codeine in the Fiorinal #3 that she wants to avoid prescribing.
Current recommendations are that opiates are to be avoided in chronic migraine treatment.
I prescribe a lot of caffergot. It can be quite helpful, if you get a warning migraine aura and take it quick, before the headache arrives fully.
Migraine treatment is almost an art form, frankly. And many meds which can give short-term relief have been found to contribute to rebound migraines, and have been discouraged as a result.
Do you take prophylactic meds, which prevent the migraine from coming on in the first place? If one’s migraine frequency is high, those meds can be quite helpful.
If I am understanding correctly, she wants to substitute the tylenol for aspirin. The rest of the incredients are the same. The addictive property is the Butalbital so it isn’t about her wanting to take you off of a potentially addictive medication as they both have that.
I would ask her. I don’t know why if you did well on esgic or fiorocet she would insist on fiorinal but it could be she is concerned about your liver functions with too much tylenol as stated above.
Doctors hestitate to write for controlled substances when other medications may work for the obvious liability issues which is why pain management specialists are popping up all over. Someone needs to treat these chronic pain people effectively since so many primary care shy away from writing narcotics.
That being said, it seems you have a reasonable doctor who isn’t concerned with abuse of the Butalbital. Maybe it IS as simple as she likes that mix better and feels it will work better for you.
Oh and IANAD…just suffer from migraines myself since I was a teen and have tried every mix available.
Prophylaxis in the medical sense just means any kind of medical procedure/drug/item which is intended to prevent something. The term popularly is used to refer those item; they’re used to prevent disease and pregnancy.
In this case, prophylactic just means any medication you might take regularly to prevent migraines (i.e., “for migraine prophylaxis”), versus a drug you might take to stop one in progress. QtM is asking this because it might be more effective in this case, where LouisB has them upon waking.
If you’ve been taking F-3, you’ve haven’t been taking APAP at all; if you’ve been taking Butalbital/APAP/Caffeine, you weren’t getting F-3. Given that you may have been receiving a generic substitute… which was it?
[headachy hijack] From the trenches, QtM, I’m an Imitrex girl, codeine doesn’t work for me very well, either, but occasionally there are circumstances when it does and I want a few in my toolbox. I want to be very clear, I am not talking about recreational use or abuse – if I take 10 of 'em in a year, that would be a very bad year – I’m talking about emergency, last resort pain control.
I understand why a doc wouldn’t want to prescribe codeine in large amounts or would want to find something that works better, but when we tell them what does work for us, and it’s within safe parameters, I expect that our experience will be considered – especially those of us who’ve tried just about everything and have been dealing with these things for years on end.
As to the idea behind switching meds that are clearly working, I’ve had doctors do that with my arthritis meds because they thought that it put stresses on different organs, or at least put different stresses on the liver. I’m not sure if that’s a good assessment or a good plan, but I’ve had two different doctors do it. They thought of it roughly as crop rotation to keep the field from being depleted.
I’m sure it is the codeine she wants to avoid; I’ve been very candid re my history of codeine addiction/abuse: But, I’ve asked her to prescribe the things in very limited numbers like maybe five to ten caps at a time. Plus, she knows my darling Marcie very well and knows that Marcie would take control of the caps and dole them out as needed. What I really want to have is Butalbital/APAP/Caffeine for those occasions when I have some warning that a migraine is on the way----those occasions are very few and far between; I nearly always wake up with the migraine fully developed and it is then that I need/want the Fiorinal #3.
I have taken cafergot in the past; I don’t know if it was helpful or not—I continued to have migraines but I don’t know if the cafergot kept me from having as many as I might have had without it.
Anyway, at this point in my life, I don’t have nearly as many migraines as I did during my 30s, 40s, and early 50s. But, although the frequency has declined, I think the intensity is worse—pretty subjective judgment, I know.
What is a rebound migraine? I’ve had migraines that lasted two to three days but those are very unusual; if I have pain killers that allow me to sleep, I usually wake up with the headache gone-----until I have another which might be a week or a month or longer in arriving.
I have been taking Butalbital/APAP/caffeine on the very rare occasions when I have warning that a migraine is stalking me; it is usually effective in stopping the thing in its tracks.
I have taken Fiorinal #3 when I awaken with a full blown migraine. Once the thing is fully developed, the Butalbital/APAP/Caffeine isn’t effective.
In short, I’ve taken two medications, depending on the circumstances.
i suffered from migraines for decades (teens 20s 30s and into my early 40s), took a pharmacy’s worth of product available at the time - including fiorinal - and none of them did a thing – until imitrex arrived on the scene. re koeeoaddi’s post, evidently it’s still very much in use.
imitrex certainly worked for me. it was astonishing. before god, i’ve never had a drug work so quickly or so well. what had evolved within a couple of hours into a level of pain that would have had me banging my head against the wall at home had i not been in the doctor’s office, literally within 10 minutes of the injection was gone as if it had never existed.
blessedly as i aged into my late 40s the migraines disappeared, never to return (tied to menopause if i were to hazard a guess).
I agree. Codeine and Demoral don’t do a thing for me, but Vicodin does. And I can function while taking it. Demoral knocks me out and makes me dopey.
I like having a few Vicodin around for just-in-case, for the minor migraines, to get me through the day.
To second what Scubaqueen said, Imitrex is a Godsend for the full-blown killers. When it kicks in, it’s like turning a corner. Suddenly, the excruciating pain is just … gone. It’s amazing.
I’ve had migraines since I was a teen and am now 41.
My triggers are a variety of food, stress, weather and the ever popular hormonal migraine and everything else plus some.
I was taking correg as a preventative and for a couple of years, it was working fine with imitrex injectible when I needed.
However, my body chemistry hates me and has decided to have severe hormonal migraines and it has forced me to re-evaluate my MO. My uterus, I’ve decided, controls the weather as well and since the turn of this year, my period has brought in REALLY CRAPTACULAR WEATHER. We are talking about a tsunami of blood and pain. I hate being a woman, sometimes.
I’ve recently decided to try supplements as a preventative:
I get the coQ-10 in a Theragram M Premiere which was the cheapest form of actually finding COq-10 anywhere and I needed to get a multivitamin as I was running out of them. (bought a 365 caplets at walgreens for $19.99.)
I added an extra magnesium supplement as the vitamin only gives 25 percent RDA.
It’s been about two weeks and so far so good. The real litmus test will be when my period hits.
Wow, Shirley, that was a fun trip down memory lane. Add amatriptiline, topamax, beta blockers, hypnosis, a thousand different analgesics, biofeedback, nutrition counseling, ergotomine, physical therapy and leeches and we’d be twins.
Okay, so I haven’t tried one of those …yet.
I tried to respond earlier today; around 1:00 AM, to be precise and was unable to even open this website. Thanks for all the inputs.
I’ve mentioned that I deliver medications to nursing homes; this morning I prevailed on one of our pharmacists to check on the butalbital. I won’t see her again until tomorrow at 3:00AM; if she didn’t forget to check, maybe I’ll know more then.
Maybe my biggest problem is that I am old and set in my ways but the real point is that I KNOW from years of experience that Fiorinal #3 WILL relieve the damn migraine; I DON’T KNOW if the other stuff will. Those of you who suffer from migraines will understand when I say that I FEAR the damn things and would do almost anything to keep them at bay.
Thanks for the comments so far and please keep those cards and letters coming.
Before I had my hysterectomy and went off BCP, I had hormonal migraines, every month. I took imitrex. It gave me the weirdest sensation of tightness in my neck/throat area. I had a migraine today, though, and I’m not sure it’s not weather-related. Or maybe stress. I don’t know.
