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Shortage of Migraine Drug DHE-45

DHE-45 (dihydroergotamine mesylate), an injectable migraine abortive, is currently in short supply and is on back order at all three labs who make the drug. It looks like the soonest the drug will be available is the end of February, though two of the three manufacturers have given no estimate of it’s return.

Migraine Medications — DHE 45 Injection Shortage from Ellen Schankenberg gives all the details.

If you rely on DHE, call your pharmacy to see if you can scoop up what remains in stock and contact your doctor for alternative medications. Migranal, the nasal spray of dihydroergotamine mesylate, may be an effective alternative.

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Migraine Remains After Migranal-Induced Nausea

A killer migraine knocked me down yesterday. I gave myself over to Migranal, the abortive that my headache specialist recommended last week. It reduced my head pain, but magnified the nausea tenfold. This is a common side effect. I just didn’t expect it to happen to me.

The migraine worsened in the night and was unbearable by 6 a.m. Advil, my old standby that has been useless in the last month, reduced the pain a bit. Attending my morning yoga class was an impossibility, so I turned off the alarm and slept until 10:30.

I still feel awful and am more nauseated than usual. I’ll be spending the rest of the day on the couch.

Researching Migranal for this post, I found some studies have shown it decreases nausea. Migranal is the nasal spray of dihydroergotamine (DHE). Maybe the side effect is more of an issue with the injectable form of DHE. Anyone know?

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A Visit to My Headache Specialist: Migranal, Seroquel, Biofeedback & Headache Management

Another visit to my headache specialist, another round of medications and therapies. This is the first time I don’t have any anticipatory excitement that one (or some) will help. It’s not that I don’t think there’s a chance, I’m just too tired to get caught up in what ifs.

The prescriptions I left with are for Migranal, an abortive, and Seroquel, a preventive. I’ve never tried Migranal as on-the-spot abortive. I did use it when a three-week intensive treatment of injectable DHE caused muscle pain. (DHE and Migranal are essentially the same drug, just in different delivery forms.) That three-week treatment was cut short after I failed to respond even the tiniest bit.

Seroquel has been on my mind since reading this success story. I know what works for one person doesn’t always work for another, but I needed to ask. Since I’ve tried multiple meds in all the classes of drugs used for headache with no success, my doctor and I decided it was worth a shot. It can be sedating, but I have to wonder if being sedated with less headache would be better than the exhaustion that accompanies a migraine. (I need to read the full side effect profile before I fill the prescription.)

Biofeedback and headache management therapy are the other two treatments I’m going to try. That’s right, I have never tried biofeedback. I feel like an impostor writing a headache blog without trying it. I’ll be able to shed my shame soon.

Even though I don’t really know what it is, headache management is what I’m most excited about. Apparently I will learn tricks to help when I have a bad headache, like massage and neck exercises.

As I write this, my head is bad so my outlook is bleak. Whenever I have a low migraine, low pain, high energy stretch, like I did last week, I return to “normal” with a thud. Having had a total of three good weeks in the last two months, I now believe I’ll have more migraine-light days in the future. But I quickly grow impatient for the next time to arrive.

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Migranal Spray Redesign

At last week’s American Headache Society conference, Valeant Pharmaceuticals showed a redesigned Migranal spray mechanism. The complicated assembly of the mechanism has been replaced with a vial and a ready-to-use pump. No studies have been done to see if the new delivery system changes how well or how quickly the drug works. At the very least, you’ll have less to fumble with and think about before you get some relief.

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Enough is Enough: Rebound Headaches

News anchors, journalists and medical websites have warned that “painkillers might be causing your pain!” too many times to count. OK, OK, rebound headaches are nasty; so are chronic daily headaches and migraines. I want to know how much is too much. Not vague amounts, but clear, precise doses.

In comes the conflicting advice. One doctor said to rotate Imitrex, Migranal and Advil every three days to avoid rebounds. Another said that it’s perfectly fine to take a triptan a couple days a week and an OTC painkiller another few days. Of course, no doctor knew just how much Advil I took because I was afraid to admit the amount to myself, much less say it out loud.

When dignity took a backseat to pain relief, I stopped the painkillers. Four years later, I can barely remember how much better I felt when I took occasional painkillers. I often forget that it’s even an option. But I do remember my headache specialist telling me that the goal of my treatment is to make me feel like I do when I take Advil*. Lately, the forbidden drug has started calling my name.

Because my headache specialist, who I think is terrific, relies on the International Headache Association’s standards, I’ll do the same. IHS’s bottom line is that rebounds are likely if you take painkillers or migraine abortants more than once or twice a week or more than 10 times a month. As you well know, nothing is one size fits all, but these are good guidelines.

Think you might be in rebound? Here are some frequently prescribed meds that can cause rebound headaches. You’ll be miserable if you stop them cold turkey, so get your doc’s advice first.

Triptans: Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig

Ergots: Cafergot, D.H.E. 45, Migranal, Sansert

OTC Painkillers: Acetaminophen (Tylenol, Excedrin, Vanquish), Asprin (Bayer, Bufferin), Ibuprofen (Advil, Motrin), Naproxen Sodium (Aleve)

Prescription NSAIDs: Indomethacin (Indocin), Ketorolac Tromethamine (Toradol), Naproxen Sodium (Anaprox, Naprelan, Naprosyn), Piroxicam (Feldene)

Opioids: Fentanyl (Duragesic, Actiq), Hydrocodone (Vicodin, Lortab, Lorcet, Norco), Morphine (MSIR, MS Contin, Oramorph), Oxycodone (Roxicodone, OxyContin, OxyFast, OxyIR)

The scariest part about stopping the meds is that your headaches might not change or may even worsen.The underlying condition that prompted you to take them in the first place is probably still there. Even if you don’t get immediate relief, your headaches may be easier to treat in the long run with fewer drugs getting in the way. And your kidneys will thank you.

*Advil doesn’t get rid of my headaches, but it sometimes reduces the severity of the pain. For me, feeling “much better” is having pain that’s below threshold that would keep me in bed.