Refresh my memory about Imitrex

At least, I think it was Imitrex I read about here in some old thread I can’t find now.

I’m vaguely remembering something like “You have to take Imitrex at the very first glimmer of a migraine or it doesn’t work at all”. Is this the case?

I’ve been prescribed it for migraines, but mine typically come on in the very early morning hours. I tried it once a few day ago when I woke up at 3 a.m. right in the middle of a doozie; it did nothing at all. If you have to take it when you first feel the headache coming on, it doesn’t do me much good if I’m asleep at that point.

What’s the skinny, if anyone knows?

I get migraines as well and am also prescribed Imitrex.

In my experience, it’s always been more effective when I take it at the first signs rather than when the migraine is full blown. Once my migraines become severe, the only thing that slightly alleviates the pain is sitting cross-legged on the floor of my shower while letting extremely hot water rain down on the part of my head that hurts.

I know you can take it “at the first sign or when a migraine has already begun.” That probably doesn’t answer your question. An exBF of mine had chronic migraines and considered Imitrex when it first came out but held off after reading the labeling (which at that time pretty much said “may cause spontaneous death.” As it turns out very serious complications are quite rare once the (numerous) risk factors have been eliminated).

Anyway, I found the complete labelling here, hope it helps. You’ll note it states,
“For any attack where you have no response to the first tablet, do not take a second tablet without first talking to your healthcare provider.” (p 22).

In my experience with Imitrex, it is immensely more effective if you take it at the very first sign. Unfortunately, my signs are pretty subtle, especially if I’m working hard and concentrating, so typically I don’t get that opportunity unless the first sign is a scintillating scotoma, which is very noticeable and thus gives me about a 20 minute head start. My neurologists did give me permission to take a second dose an hour later if the first didn’t work, but it’s still not nearly as effective as if you got the dose in quickly before it really starts.

I read that part of the labeling as “may cause spontaneous combustion” which, during the worst throes of a migraine, seemed an acceptable (or even preferable) risk.

My husband is on Imitrex. He also can’t take it at the first sign as he wakens with migraines. If it’s not an intense migraine, Imitrex will work within an hour. If it’s a really bad one, he doesn’t necessarily get relief - and a second one might help a bit, but by then he’s in pretty bad shape. Imitrex causes fatigue for him too, so a second one makes him twice as fatigued.

He’s having really pretty good results with a preventative he’s on. Instead of almost daily migraines (as he has for the past 40 years – yes! 40 years!) he might have only a couple a week or even a week without any - which is miraculous in his eyes.

This is what my imperfect memory of these discussions is trying to recall. I have my blister pack of Imitrex here at work, so I’m going to pop one if I start hatching up a migraine during the course of the day. However, they mostly come on in the middle of the night while I’m asleep, so I don’t know what I’ll do about that, other than take Ibuprofen at high levels.

Talk to your doctor about something more effective or for a preventative. For a while I was on a preventative that worked pretty well for me, but stopped eventually. Explain that the Imitrex isn’t helping because you get them during sleep.

I think there may be a US FDA approved version of Imitrex that’s injectable, which IIRC works even for full-blown ones. The Wiki page isn’t clear on whether it’s approved in the US or just the UK.

Ferret Herder, do you find preventatives work for 2 weeks or so and then start to work less reliably? I have a theory (admittedly half-baked and without authority) about the body/brain adapting to the preventative fairly quickly, thus ruining it’s efficacy.

I also wonder whether your preventatives have been off-label but at higher than low-dose? I have a theory about that too -

I was only on one, years ago, and I can’t remember now if it was amitriptyline or nortriptyline - I think it was been the latter. It did become ineffective after a while and had to be increased in dosage over time, more than once. I started at a much lower dose than would be common for prescription for depression (their approved use). My doctor finally said ‘forget it, this is getting silly’ and discontinued it completely.

I take Topamax to prevent migraines. I started off on Midrin, switched to Neurontin and then to Topamax; each successive change was for the better.

I have taken Imitrex pills and I also take the injections. I agree that the earlier you take the medication, the better it is at breaking up the migraine. However, if you wake up with the migraine as I often do, it’s more difficult for the medication to do its job. I was allowed to take two pills; I’m surprised to hear that caution. Once when I had a truly devastating migraine, we called and was told to take a third one. (Unfortunately, it was too late; that was a trip-to- the-ER-for-Demerol night).

Also, migraines often are accompanied by vomiting, and if you can’t keep the pill down, it will do no good. That’s where the injection helps. Imitrex comes in a nasal spray, but I’ve never known anybody who’s used it. My doctor doesn’t prescribe it and says people get addicted to it (?)

After about 15 years with Imitrex pills, I noticed a lessening of the effectiveness (and I don’t really take them that often; maybe 2 a month). My neurologist changed me over to Maxalt, of which I can take 3. Maxalt also comes in a rapid-dissolve that can’t be vomited up.

I, too, find some relief in a hot shower, but only at the very outset of a migraine. When it’s gotten bad, that’s no help. Some people are the other way – cold compresses work for them.

I suggest you ask your doctor about Imitrex injections for entrenched migraines, especially if yours are accompanied by nausea. Or if the pills aren’t doing the job and you have no nausea problems, try switching to Maxalt.

I was prescribed Maxalt to arrest my migraines but it did not work. I was also told to take it at the very onset. But I also have always gotten “regular” headaches as well and my migraines were slow in onset so I wasn’t always sure when I was getting a migraine over a more minor headache until it was bad and too late for the pills. And the pill made me feel “off” and was not cheap so I did not want to always just take one whenever a migraine was likely cause I’d have to sleep the pill off and spend all that money per pill.

I started taking a beta blocker (propranolol) as a daily preventative. I still get headaches and honestly I think I get MORE headaches but all of them are less severe than my migraines were before. Every month I was pretty much guaranteed 3 straight days of severe pain now I may have one night of severe pain but not as severe but I also have more regular minor headaches that are mostly just really annoying but not debilitating. Often even now a longer nap may even end a headache. Before I took OTC sleep aids and did my best to sleep for 3 days during the pain. So it is an improvement but still sucks. And one month of m beta blockers is the same as 1 Maxalt tab was for me and I was able to take 2 Maxalts per headache.

I recommend trying a preventative course, there are multiple options and one may work. I may still in the future try another one but for now I’ve gotten some real improvement.

I tried Maxalt and experienced a similar outcome.

Are we talking Imitrex tablets? I have the Imitrex nasal spray, and 90% of the time, it’s effective no matter when I take it. In fact, I usually take it after I’ve tried other medication first.
There are times when the migraine is so terrible, nothing makes any difference.

Is the nasal spray version available in the States?

I had about two weeks of terrible migraines right after my daughter was born. Hormone crash, I think. I was prescribed Imitrex and would occasionally put off taking it so I could breast feed. It still worked if I took it an hour or two into the migraine. In fact, I don’t think I ever took it with the first sign of the headache.

Imitrex never worked for me, but Maxalt did. I could take Maxalt in the middle of a full blown horrible migraine and I’d be 100% better within 30 mins, with the sharp pain stopping almost immediately.

My husband is having encouraging results with Topomax. Initially the dose was too high and he had an allergic reaction (severe itching everywhere). He’s had low dose Amitriptilyne and Propranolol, neither worked for long.

I’ve forgotten the term for the migraines he gets, but one eye lid droops with the severe ones, and vomitting is standard. He is so glad to have found Imitrex, as previously a migraine could last 3 days and be entirely debilitating. When he was a kid, he’d rub Vick’s vaporub into his eye to distract himself from the pain in his head. I can barely type that without shuddering.

Mine are the results of coming off of decades of birth control pills, as I’m by now menopausal and it’s time to stop. The OB/GYN called it “estrogen withdrawal”. That term could cover a multitude of issues right there.

I’m hoping that the headaches will come to an end as my body gets used to the idea that there’ll be no more estrogen coming its way, ever.

Oh, here’s a funny thing - I know that several ibuprofen and a couple of stiff espressos will vanquish my early morning headache, but I’m not about to get up at 3 a.m. and start pulling myself shots. So I stick it out for an hour or two, gritting my teeth, and sometimes I’m able to doze off. This morning, I slept uneasily through some of the pain and I dreamt I was in a strange house trying to unsuccessfully figure out how their complex espresso machine worked. Even my subconscious knows that caffeine is the bane of (my) migraines.

I went from rare migraines in my twenties to nearly daily migraines in my late thirties. Midrin worked until I developed a tolerance to it. Imitrex pills took two hours to work, and then it didn’t usually kill my headache. I had to take a second dose. I did try the nasal spray, but it caused such a horrible rawness in the back of my nose and such a foul taste that lasted for hours, it was almost as bad as the migraine I took it for. I had the best luck with a combined dose of ibuprofen and hydrocodone. Mind you, I wasn’t really good for anything for about four hours after taking it, but at least I wasn’t in pain.

What finally killed the migraines for me was going completely off wheat. Lots of other symptoms - stomach pain, joint pain, hayfever, and exhaustion - improved almost immediate. The migraines took about a month to wind down. And, of course, if I accidentally eat any wheat at all (like the put half a baguette on my salad when I asked for chips), I get stomach pain and head pain. Also . . . no more Oreos. sigh

Still worth it.

All the triptans work for me to varying degrees, but since Imitrex is now a generic it’s my very, very favorite. A veritable gift from the Sweet Merciful Big Pharma Headache Gods, it works anytime during the headache as long as I can keep it down for 45 minutes or more.

who remembers the bad old days of Amitriptyline, Darvon, Compazine suppositories and 48 hour barf-fests