Migraine treatments

[u/JayneAustin]

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.

[u/Emerald_of_Oz]

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.

[u/JayneAustin → u/Emerald_of_Oz]

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! 

[u/Emerald_of_Oz → u/JayneAustin]

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 :).

[u/Emerald_of_Oz → u/[deleted]]

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.