? for Migraine sufferers

[WilliamsEph]

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I've been getting migraines the last two years. I get a visual scotoma+intense pain that only goes away after I lie down in a dark room for about 20 minutes. Luckly haven't had one during school exams except one time, and it was misery to get through.

I'm scared to death I'm going to get one during the Step1 exam. Are there any effective prescription drugs for prophylaxis? Right now, I just take Excedrin migraine when I get an episode, but was wondering if there are better prescription drugs out there. Thanks.

 

[Stingarov]

Both Topiramate and Valproate are options but to some are sedative. Both modulate Na+↓ and GABA↑. Other first-line options include Amitryptiline and beta blockers. See here.

 

[WilliamsEph]

Thanks, do you take any of these? Obviously, don't want to be sedated taking the exam. Would be interested in getting some first hand accounts.

 

[beatsbydre]

Both Topiramate and Valproate are options but to some are sedative. Both modulate Na+↓ and GABA↑. Other first-line options include Amitryptiline and beta blockers. See here.

Get Sumatriptan in your locker -- it'll help if you get a migraine and still need to continue the rest of your test. And it's a 5-HT1B/1D agonist that vasoconstricts. don't use with coronary vasospasm.

 

[Stingarov]

Thanks, do you take any of these? Obviously, don't want to be sedated taking the exam. Would be interested in getting some first hand accounts.

My mother took all migraine medications imaginable. MOST PEOPLE do not think Topamax is that sedative from what I was told by her doctor (I haven't looked into the data), but she personally could barely drive home. Valproate also causes major weight gain.

Thats all I know about it, sorry!

 

[Choo]

I looked on pubmed for meta analyses or reviews a couple years back, and it showed that propranolol (and no other beta blockers) at a certain dose was the most effective at migraine prophylaxis when compared to all the other prophylactic medications. The other beta blockers were proposed to be next to useless for migraines because they are significantly less lipophilic than propranolol. I think there were mixed findings on Ca++ blockers and topiramate. Most studies found that antidepressants did nothing.

For abortive: sumatriptan injection aborted the migraines and the NNT was 3 (to actually abort one); while the NNT for the pill was 20 if I recall correctly. There is some confusion about whether to take the sumatriptan at the onset of aura or pain. It would seem to make more sense to take it at the onset of pain when the rebound vasodilation occurs, and not during the aura when the perfusion is lower (according to the studies of cortical spreading depression). One study found that it is better to take at the onset of aura, but their controls took the medication in the middle of the headache hours after it started, so I'm not sure their findings are convincing.

 

[hardee17]

For abortive: sumatriptan injection aborted the migraines and the NNT was 3 (to actually abort one); while the NNT for the pill was 20 if I recall correctly.

Awesome plan, shoot up in the bathroom between blocks

 

[wanderer]

Go see a doctor to get treatment specific for your needs. Just knowing you have treatment to rely on can sometimes lower the chance of migraine. Until then try to keep a migraine diary to see what your triggers are. Also try to avoid medication abuse headache.

 

[CDI]

I get migraines w/ aura if I don't eat properly. I took food, but as a pre-emptive measure, I popped tylenol during the exam prophylactically between 4th/5th and again between 5th/6th just to be on the safe side. I felt fine though cause I made sure to eat here and there and drink gatorade on breaks.

 

[runlearnplay]

Get Sumatriptan in your locker -- it'll help if you get a migraine and still need to continue the rest of your test. And it's a 5-HT1B/1D agonist that vasoconstricts. don't use with coronary vasospasm.

I would not drive or take an exam after taking Sumatriptan. I feel foggy for about 45 minutes after taking it, it is a fairly common side effect.

 

[bbake87]

Inderal, valproate and Topamax are FDA approved for migraine ppx. From my experience Triptans are not too sedating. Some give a short course of Prednisone for abortive therapy (usually used in status migrainosus). PM me w ?'s.

 

[wanderer]

I would not drive or take an exam after taking Sumatriptan. I feel foggy for about 45 minutes after taking it, it is a fairly common side effect.

As with any medication you should test it out a few times prior to the actual test, including at least one time under testing circumstances. Most people don't experience side effects with triptans.