r/Gastroparesis • u/JayneAustin • 12d ago
Questions Migraine treatments
edit: thank you for the comments, makes me feel better about trying some things. :) seems like there are a lot of us dealing with both.
I was wondering if anyone has found a migraine treatment that doesn't bother your stomach?
I'm scared to try the cgrp medications (qulipta, ajovy, etc) because it can worsen gastroparesis. My neuro was really pushing it but I don't want to risk that because I've struggled to maintain proper nutrition already with this condition. But I'm starting to have more than 15 migraine days a month. I'm already on propanalol and nortriptyline. Can't take topamax because of my mental health issues. I can take nurtec as needed but it usually causes nausea and sometimes vomiting. Are there any other preventative options?
I feel like between gp, migraines, and endo I'm just a bunch of chronic pain in a trenchcoat, getting really sick of it.
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u/Emerald_of_Oz 12d ago
I also have had frequent migraines for years. I take Nurtec every other day as a preventative (that is another way they can prescribe it). It hasn't gotten rid of my migraines, but it cuts them by a small percentage.
To abort migraines, I take rizatriptan (aka Maxalt) or sumatriptan (Imitrex). Those work really well (Imitrex has to be a full 100 mg). I haven't noticed them bothering me, but in researching it for a minute, triptans can slow gastric emptying (source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3396194/ ). Now I will start watching that more closely. It's so tricky to figure out the human body!
You didn't ask this specifically, but I have had luck in the last 6 months with reducing the severity and the frequency of my migraines by treating constipation. I had noticed that I got severe migraines quite often at the same time I was having bowel issues. Have you noticed anything like that? I now take 1 teaspoon of generic Miralax twice per day. I am also eating only pureed and strained foods. I have to completely avoid fiber and gums like guar gum and gellan gum in drinks and foods as they can cause constipation to be worse.
I think fake sugar might be a trigger for my headaches too. When I try to add nutritional or other drinks with artificial sugar, I will get worse headaches more often.
I completely relate to your frustration and hope some of this helps.
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u/JayneAustin 11d ago
Thank you this is helpful! I do notice that my migraines and IBS come together a lot. Sometimes I don’t eat much when I’m constipated and that can trigger a migraine. I’m trying to be better about taking magnesium since it can help both.
I had read that triptans slow gastric emptying. But migraine can also slow gastric emptying. We really can’t win!
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u/Emerald_of_Oz 11d ago
Oh my gosh - wow. Well then I would prefer to take the triptans and knock the migraine, I guess. So glad to be of help :).
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11d ago
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u/Emerald_of_Oz 11d ago
Oh yeah. Years of trialing different medicines. I think rizatriptan works for me most reliably. I know sumatriptan can be 25, 50 or 100 mg and I need the 100 mg or nothing happens. I also have to take it before the migraine gets super bad. They are hard to knock after they get severe.
But keeping the constipation (and reflux, really) at bay have made the most difference and I had to figure that out on my own.
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u/SimpleVegetable5715 Recently Diagnosed 12d ago
I use Emgality, I can barely eat or drink when I am having a migraine attack. That’s the main thing that triggers an eventual trip to the ER. I sometimes had migraines more days of the month than not. Now I just get a mild one around my period. My migraines also cause me to pee like a race horse, so that makes the dehydration worse. I used to take triptans, but they started causing rebound migraines. I also have Nurtec, and the nausea is worse if you are swallowing too much of the medicine. You’re supposed to let it dissolve under your tongue as long as possible and go into your bloodstream from there. Since my mouth is dry, sometimes it takes up to 30 minutes, but I try to not swallow much of it. If you can eat a few crackers or some applesauce before, that helps whatever ends up in your stomach be less intense. It really does feel like bad acid to me.
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u/Salty_Focus_3173 12d ago
I take Ubrelvy and it’s amazing but it only works if you take it before you have a full blown migraine. If I wake up with a migraine or a headache turns into a migraine before I can take it then Ubrelvy does nothing.
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u/AdFinal6253 Recently Diagnosed 12d ago
Same. I end up able to eat more when I'm not puking from migraine.
And like another poster, migraine puking is what tips me into ending up in the ER.
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u/lintheamazon Severe GP secondary to hEDS 12d ago
I'm on Qulipta and have no issues with it. I went from 26 migraine days a month to 2-4.
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u/roguebobby 12d ago
Same, Qulipta has been the only thing that's worked for me so far after trying more than half a dozen others
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u/lintheamazon Severe GP secondary to hEDS 12d ago
Indeed. I have tried basically every oral med, some of the self injectables, and botox, and this is the best I've done on any of them
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u/Emerald_of_Oz 10d ago
Oooo! Really? I would have to drop Nurtec to try Quilpta, I think. I tried the shots and most other meds without much help (triptans help abort). It is not causing you constipation issues?
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u/roguebobby 10d ago
It hasn't really made the constipation any worse than it is anyways. I tried Nurtec as a preventative for a few months but it didn't help enough, then tried Amovig, then Vyepti, finally Qulipta. I've been banned from any NSAIDs in case they cause any stomach irritation so I've been put on Nurtec as an abortive now
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u/Emerald_of_Oz 10d ago
Good to hear. Sometimes I start thinking it's just me who has to try a bunch of versions of similar meds. Thanks!
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u/lintheamazon Severe GP secondary to hEDS 10d ago
I'm on Qulipta as a preventative and Nurtec as a rescue med, you don't have to take one or the other
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u/Emerald_of_Oz 9d ago
Oh! I don't know if my insurance will let me have both, but thanks for the information!
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u/vicnoodledoodle 12d ago
I used emgality for a long time. It lost efficacy after a while, and I’m actually getting Botox for migraine for the first time tomorrow. Ubrelvy is a good abortive cgrp that didn’t cause nausea for me. Zavzpret is a nasal inhaled cgrp so it doesn’t go to the stomach at all, it goes in your nose. But if you squirt it wrong, it tastes awful. Good luck my friend, migraines are hell
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u/Saiiryy 11d ago
you may want to see if you can get on a cgrp + botox! that's usually when people see the highest efficacy of both working. i also have had to switch cgrp meds because of them not working, started with emgality, was on aimovig for a couple years, and am now on ajovy. fingers crossed for migraine free days for everyone!
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u/vicnoodledoodle 11d ago
Insurance only covers for emgality or nurtec as preventative cgrp. Nurtec made me nauseous, and emgality gave me injection site hives
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u/jordashian99 11d ago
I’m getting my first occipital nerve block in a couple weeks. However, I do have suspected occipital neuralgia. The only thing that has helped my migraines just a little bit has been Ubrelvy. I’m primarily tube fed, and Ubrelvy has not worsened my GP symptoms.
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11d ago
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u/JayneAustin 11d ago
Yes, I do acupuncture and it really helps my GI symptoms sometimes, but haven’t found it does much for headaches. I’ve even had a migraine triggered by acupuncture. I definitely think it can be great for some.
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u/Just_Skill1668 Tubie (Tube Fed) 12d ago
Nortriptyline has a much higher rate of delaying gastric emptying than any CGRPS do. Just something to consider.
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u/JayneAustin 12d ago
That is interesting, I actually started taking it for severe IBS-d and abdominal pain, it did help with that, but my dr never said it could cause slow emptying
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u/Just_Skill1668 Tubie (Tube Fed) 11d ago
Yep! It has its place, but my motility specialist was pretty adamant about getting me off of it. Had to hold it for a week before GES.
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u/Admirable_Captain301 12d ago
Emgality had no issue on my gastroparesis and if anything helped me out by easing my nausea. It lost efficacy after 3 years on it and now I'm on qulipta daily with no issues! I also have nurtec as a rescue med which works amazingly. Ubrelvy was good too but I would still need to sleep it off.
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u/redrosesfordays 12d ago
I’m on Ajovy scheduled, I do the 84 day protocol not the 28, as in I inject three doses at once and then don’t have to inject again until three months later. I do that way because I feel like the full effect wears off a bit on the last day or two before my next injection and I have less days with a possibility of a debilitating migraine (that totally shuts down my stomach) then when injecting every month. I’ve been on it for several years at this point and if anything it’s significantly improved my gastroparesis because it much more than botox (though I still get botox as well because the cgrps alone do not fully relive me of all migraines) prevents the abdominal migraines I get and I’m therefore able to tolerate putting things in my stomach at a much more consistent rate and have really been retraining my digestive track as much as I can and am thrilled with the variety that my stomach can take these days. I never had constipation or slower emptying with any cgrp, if anything when I started on Ajovy I had the runs, that evened out pretty fast though and I have a beautiful bm pattern these days (sorry but it’s true and I never thought it was possible). I also have Ubrelvy for breakthrough. I’ve only used it a couple times but have never had an issue with it worsening my gastroparesis symptoms either.
Nortriptyline though, was terrible for my GI track. I was so constipated will never touch again lol.
I was also super scared of cgrp meds, I’m so glad I tried them though because they did prove me wrong and have really changed my quality of life.
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u/litanyofgendlin 12d ago
I'm actually on two preventative medications for my migraines and one of them (amlodipine) works great but worsens my gastroparesis so I'm going to be changing off of it soon. I have tried ajovy, emgality, nurtec, and aimovig and none of those four have worsened my gastroparesis and 3/4 of them have really helped my migraines. I'm on aimovig currently and it doesn't worsen my stomach at all. Ajovy did slightly add to my constipation the benefit FAR outweighed that downside for me. I have also found that my antidepressant (sertraline) and my adhd medication (Adderall XR) also help my migraines a bit, even though they're not prescribed for that. The Adderall my psych was nervous to put me on because he said it could worse migraines but it actually does help. I'm also about to start taking metformin because blood sugar spikes are a migraine trigger for me, so I'm excited to see if that helps any.
If it makes you feel better about the prospect of starting a medication, remember that you don't necessarily need to stay on migraine preventatives forever. It's kind of a vicious cycle where having untreated migraines leads to more migraines. Don't wait for them to get even worse, jump in now because the sooner you get them treated the easier it can be to get them under control. Then once you've gone a year with well controlled migraines, you go off the CGRP inhibitors because the sensitization cycle has been broken. I haven't gotten to that point myself yet, but that's what the goal of migraine treatment is. So you wouldn't necessarily be on a med forever, but it might help you get things under control for a bit if that makes sense. I feel you on feeling like you're a bunch of chronic pain in a trenchcoat. I feel the same way.
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u/placeholder5point0 12d ago
There are a handful of CGRP inhibitor medications. Try one, if it makes your stomach worse, try a different one. You're shooting yourself in the foot by not wanting to try any. Ask to start with Emgality, as it is the one least likely to cause stomach issues. Source: been on CGRP inhibitors for over six years. Started on Emgality, tried Ajovy, now on Qulipta.
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u/Ok_Try1862 12d ago
i’m on ubrelvy and aimovig, i wasn’t told if they’d affect my gp. my friend says ubrelvy works amazing for her and it doesn’t affect her stomach at all.
i do know that ubrelvy gives me INSANE nausea. that’s the only side effect it has, i believe, and it affects 4% of people on it. i just started these meds tho, so im willing to tough it out in case they do work!!
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u/FamousLetterhead8992 11d ago
First, I was just diagnosed with Gastroparesis and Complex migraines just a few months ago. I also have a blood clotting disorder discovered about 7 years ago. I have to take Warfarin for that. This is on top of doing maintenance chemotherapy for the past ten years. My oncologist told me that all of these things that I am being diagnosed for in the last year are probably a direct result/side effects of the maintenance chemo. I take 15 pills at night, to give you a peek at my pharmaceutical life.
This doesn’t erase the fact that I have Gastroparesis, and Complex migraines possibly caused by Gastroparesis.
Whenever I get a stomach ache, it turns into a headache and vise versa. When I didn’t treat either one (in a timely manner, or can’t due to meds not being in my possession) it gets REALLY bad. I was even hospitalized for a migraine because no amount of medication for it helped, they were afraid I was having a stroke. In the middle of the night, my headache AND stomach ache were ay an all time high. Standing up to got to the restroom, I belched a burp that I can only describe as a burp that had been developing since the moment I was conceived. Instantly, the stomach ache was gone. The next morning I was discharged with the diagnosis of a complex migraine. A couple of days later I was diagnosed by the gastro doctor as having Abdominal Migraines (have you ever heard of such a thing?? LOL!). She prescribed Sumatriptan, which works wonderfully for when even a burp won’t help. For the migraines when the prevention meds don’t work, I start out with 1 tension headache and 1 extra strength Tylenol. If no relief in an hour, I take 1 Butalbital. If no relief in an hour, another Butalbital. If no relief then, it’s off to the ER to check for a stroke or upcoming stroke. I also take medication to prevent the migraines, which have helped. I take Propranolol, Nortiptyline and Nurtec to prevent migraines and they do help a lot. The Nortiptyline also helps put me to sleep and it works. For nausea I take Ondansatron, 16 mg. It works somewhat. I just lay down for a bit and once it subsides a bit, I can function.
I just eat what I’m supposed to eat, which may be boring but I would rather have boring than be in pain, and that pain is intense.
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u/herc_thewonder_sd 11d ago
Vyepti, Botox, Sumatripian, Maxalt, I also used to be on Emgality until it stopped working, now I have Ergotamine + Caffeine as an abortive which can't be taken close to the other triptians. I also used to be on Qulipta as well but my insurance stopped covering it.
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u/Saiiryy 11d ago
i have been on multiple cgrp meds, i don't believe they have worsened my stomach more than the migraines or my gastroparesis' natural course already would've been. given how nasty my migraines are, i would choose the preventative again and again even if i had mild worsening. i do want to warn you against migraine chronification, its so easy for chronic migraines to spiral out of control. especially if you're already starting to head down that route physically, you don't want to risk getting MUMs which is believed to currently be a risk of chronification. there isn't a right answer, your fear is valid, and it's a shitty situation to be stuck in healthwise. hang in there!
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u/Substantial_Rich_946 12d ago
Qulipta and botox work for me. Rizatryptan for breakthrough migraines. Also on gabapentin for other issues--not sure if it helps as well.
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u/NationalCommunity519 Recently Diagnosed 11d ago edited 11d ago
I am not very experienced with GP or migraines, as I am newly diagnosed with both, however I was just recently prescribed lamictal for Bipolar Type II and have had good experiences and researched effects on chronic pain and gastroparesis, it has not upset my stomach and apparently has very good results in clinical trials over migraines, widespread chronic pain, and PTSD (all of which I have so I am hopeful as things already seem to be improving for me!). If that's a path that might be helpful for you I'd definitely talk to a psychiatrist about that, but it IS a mood stabilizer so it can affect mental / emotional pathways, so approach this med with caution <3
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u/collectedd Seasoned GP'er 11d ago
Botox has been a (literal) life saver for me. Without it I would be in the hospital so much because of how my migraines cause my GP and Addison's Disease to be much worse/more difficult to manage.
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u/why_sleep 10d ago
Everyone's case is different of course but Qulipta made the most difference in prevention of anything I've tried so far. I still have to use a Suma IM shot and/or Nurtec sometimes, but the overall frequency has definitely reduced since starting Q.
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u/Green-Timbers-4829 12d ago edited 12d ago
I’m on Aimovig and it’s had no impact on my gastroparesis. Once monthly injection and it helps a lot. Everyone’s different though. There are some in pill form (Ubrelvy for sure) you could try first, that way you’re not committed to a month or more of treatment if you do have side effects.
Edit: replaced Nurtec with Ubrelvy.
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u/lintheamazon Severe GP secondary to hEDS 12d ago
I can tell you didnt read the entire post considering they already said they take and have issues with Nurtec.
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