This is a blog post in response to a study looking into triptan non-compliance. As in why do those silly migraineurs just not take a triptan as soon as they get a migraine like they are told? The Daily Headache: Why People Don’t Take Triptans for Every Migraine Attack
Medscape article: “Thomas N. Ward, MD, professor of neurology at the Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, said, “It’s quite clear that they had less disability on the days they take their triptan, which then, of course, begs the question, why don’t they take their triptans on other days? It’s complicated, and this study doesn’t really address that,” he added. “This little bit of behavioral information is very interesting, and obviously needs more study.””
Yes, the study does not indeed address the issue of why patients are behaving this way. And to patients, it is pretty obvious. Especially with chronic migraines. And it is something we are very, very aware of as an issue with chronic migraines when it comes to the treatment of migraine.
We are explicitly told, over and over and over again, by every neurologist we have ever seen to not overuse triptans (or anything) more than two times a week. Therefore, if we get a migraine every single day, we are left with 5 days we simply cannot use a triptan. So why is it any surprise we are, in fact, not using a triptan on those days? We can’t.
Yes, indeed, if you take a triptan at the first sign of a migraine it has the best chance of working. However, if you cannot take it for every migraine you are left with a tad of an issue. Which migraine to take it for? And how do you determine right away which migraine to take it for? And let’s say you just guess that every migraine will be brutal and do as you are told taking it right at the first sign… bravo… still left with 5 days of untreated migraines. Explain the whole non-compliance on those days when it is literally impossible for the person to take a triptan when they are explicitly told not to exceed two times a week?
This is literally the brutality of chronic migraines. The very fact we cannot treat every migraine. Hell, I’d love to since not every triptan even works, but I can’t. I have to endure five days of untreated pain every week.
Are a real joy in the States. I live in Canada so I have not experienced this issue. When I exceeded 9 triptans a month I merely had to get my doc to sign off on it… as a ‘risk.’ Granted even here insurance companies are getting more douchy. But in the United States they limit triptans to generally 9 a month. No matter how many migraines you get and keep in mind chronic is 15 a month minimum you can only take a maximum of 9 a month. It is possible to take more than one triptan a day if the first does not work, however, why would you do this if you only have 9? And you would be extra cautious of when you used them if you only had a limited amount. Only workdays for example. Only migraines during work hours. Only ones that feel debilitating. The system is set up that way. Even if you know taking it right away makes it more effective you are going to hesitate because you Know you have way more migraines than medication and the Next migraine could be much more severe.