[F]What I'm wondering is if Percocet can be "stair-stepped" with 1)Ibuprofen 2)tylenol 2's or 3) vicodin... I have prescriptions for all 3... the percocet is the main one I have to take for chronic migraine and a degenerative neck problem... but sometimes the meds. Don't work the way they should... by "stair-stepped" I simply mean taking one of the other 2 meds listed above approximately 2 hours after initial dose of Percocet. I hate having to take meds! But when I have to, I want the pain to stop so I can get through work/kids/church etc.
Thanks!
XoXo :D
Mychele

I think the best answer is going to come from your Doctor. If he/she prescribed them all to you, then call his office and ask to speak to his/her nurse and explain your concern.

Nod Nod... I left them a message last week... He's only in my area one day a week so he's rather hard to get a hold of... just thought someone here might know =) Thanks... I'll just wait for them to get back to me, or for my appt. next week... which may, in fact, happen first... ;) Thanks!
XoXo
Mychele

Percoset has Tylenol in it. Vicodin has tylenol in it. APAP, Tylenol and Acetominophin are the same meds.

What are the strengths of Percoset, Vicodin and Tylenol? Percoset is available in multiple strengths and so is Vicodin. A sample strength for Percoset is 7.5-500. The 500 is the strength of Tylenol. Also certain strengths of Percoset are available in generic and some are not.

Ibuprofin acts differently and is a totally different type of drug, so there should be no problem add that to Percoset.

Tylenol has been associated with liver damage when the maximum dose is exceeded.

Do you know what your migaine trigger is?

Off the top of my head, I know that 500 mg of Tylenol every 6 hrs is OK, but don't know the upper limit.

Ask your doc about Soma, a muscle relaxor for the neck problem.

Also ask about Neurontin/Gabapentin for both the neck problem and the chronic migraines.
For theraputic migraine prophalaxis, you can go to really large dosages, like 3600 mg/day in a divided dose, but you have to ramp up gradually. Neurontin may also be beneficial for the neck pain at lower dosages.

Narcotics are not recommended for migraine, but you seem to be already taking them. Can you describe your trigger and symptoms? If the symptoms fit, I have another drug up my sleave to ask your doc about?

Wowsers... a lot to digest and answer ;) Ok... I have Tylenol 2's 300 mgs of the actual tylenol I think and the vicodin I believe has 750mgs of the tylenol... the percocets I have to take are the smaller ones... 325mgs of tylenol... I do know the upper limit of tylenol is 4000mgs (from my family doc just the other day) and the max of ibuprofen is 2400mgs per day (from same source)

As for my migraines? The only known triggers are hormones (every menstrual cycle and they go crazy if pregnant) and stress/sleep schedules getting messed with... one other is if I get a sinus thing or allergy thing...

Been dealing with these things for 16 years... have tried just about everything and been through several docs... the neurologist I had found nothing and just kept giving me meds that I wasn't able to take... (ie. Topomax caused severe eye pain/chest pain but he kept upping the dose despite this... he also mixed drugs I found later you shouldn't mix)

Anyway... suggestions are welcome! Don't be surprised if I've "been there, took that"... :)
Thanks!
XoXo
Mychele

OK, the Tylenol thing is covered.

Meststrual Migraines. Talking to my doc, I'm not female, but he prescribed a drug for me to try for my migraines which he said was used for menstrual migraines. This drug is Frova. It needs to be taken a few day before the expected migraine.

Sinus and allergy, you need to treat with sinus and allergy meds.

Topamax is know by some users as Dopamax. I'm included in that group. It didn't help either. I'm in the same boat with migraine meds. I probably took that.

I HAD a really cool doc and have been to two headache centers. Me and the cool doc used to bounce things off one another. We used side effects and cost and probability of working. I now have one tall potent cocktail available at my disposal for weather-triggered migraines. I even tried Botox at "our" expense. About 30 injections total in the forehead, neck and shoulders.

You didn't say how the migraines feel to you. In other words, describe what they feel like.

Frova... blech! That was one of the too-many-to-name meds I've been given, tried and had zero luck with... this neurologist I saw was horrible... I went in to see him weighing 130... he prescribed many meds... within one year I weighed 175 and was still climbing! (being a recovering bulimic, that is NOT a good thing) He'd yell every time I went in wanting to know why I was gaining so much weight, calling me fat and telling me I was lazy and needed to eat less, move more... (DUH) then after I ended up in the E.R. because of an erratic heart rate that was due to a medicine (Elavil) being mixed with caffeine of all things that dr. suddenly recalled that Elavil causes weight gain! Went off that med. And it took me 2 1/2 years to get back to 125! That was the least of his "crimes" ;)

Anyway-for now I'm waiting on another round of MRI's in February with another neurologist... we'll see how that one goes... not much to do for the migraines from the aspect that I simply cannot take any triptan medication... raises the blood pressure sky high and causes chest pains... I'll take the pain vs. the stroke, thank-you-very-much!

As to what my migraines feel like... Starts with the white light that'll float down the left or right side of my periphial vision (depending on what side the migraine will strike) Then I get an intense throbbing behind either eye that spreads to the back of that side of my head, sometimes into my neck... when the pain gets extreme, my face (on the side of pain) will get numb and tingly... basically, they suck... I'm at a loss anymore. It seems like there are no viable solutions out there for me... :(

Good luck with your migraines! I hate to hear of anyone who has to go through what I know is a living hell at times! Keep the suggestions coming, if you have any! If I hear of anything I'll be sure to throw some your way as well!
Thanks again!
XoXo
Mychele

Not that headache. That one I've had once in my life when I had the flue. The famous "ice pick headache".

I'll fess up and give you what I have to chose from in order from least to most effective:

Magnesium suppliments.

1) Neuontin 900 mg up to 4x/day
Lessens the intensity
2) Fiorinal (Aspirin/Cafeine/Barbituate sedative)
Up to six per day
My version of Aspirin
3) Percoset 7.5-500
My version of an evening medication. Won't keep me awake like
Fiorinal might because of the cafeine.
4) Oxycontin 10 mg. 0-30 mg 2x/day; 12 hour relief possible
Very Narcotic

5) Zomig
Cerebral blood vessel reducer - Will only help on the worst headaches only. Often
combined with an ice pack.

6) Ativan - taken rarely when headaches interfere with sleep

So, there you have it. A pretty impressive cocktail which is not well liked by most physicians.

The tried meds:

Frova –
Works, but too difficult to manage
Namenda – (Dud)
Botox – Not beneficial enough for the cost
Lyrica 50mg Try to dose to 3 tablets 3x//day
(Interferes more with ED)
Hydromorphone/Diluid 2 mg (Oxycontin better)
Amtirpyline 10mg – 50 mg
Lyrica 50 mg
Side effects: Not better than Neurontin, side effects worse
Ambilify 10mg
Doxepin 25 mg
Biofeedback script Deemed not a candidatel
Kepra 500 mg 2x/day Side effect: Short Temper
Oxycontin 10 mg x 3 Works.
Cymbalta 30- 60 mg
Zoloft 25 mg
Wellbutrin 100 mg
(100 mg 2x/day does counteract Neurontin male side effect)
Lexapro 10 mg
Zonegran 100mg
Depakote –
Zyprexa –
Prozac –
Effexor – (unknown) severe stomach burning)
Imitrex Injection and Imitrex tablets
Relpax – Similar effectiveness as Zomig
Topamax –
Suplements

CoEnzime Q10)
Vitamin B6)

So there you have it.

EDIT: Ativan Added to list on 1/4/07

Very interesting list of meds KISS. Just watching the thread basically to see if I can learn anything.

I did notice that you have been treated with antipsychotic meds for migraines? Hmmm, really interesting.

See previous post - EDIT: Added item #6: Ativan

J-9:

Antipsychotic and anti-epeleptic meds are supposed to be candidates for preventatives.
Namenda is the really odd one - An Alheizmers drug.

The trouble with migraines is that there is no flowchart to follow based on type of migraine, It's a try this, try that sort of approach.

Do you have anything to add for weather migraines?

I have them pinned to the absolute value of the magnatude of the second derivative of barometric pressure vs. time exceeeding 0.040 in/hr^2.

Interestingly enough, that's about what I have my son's weather related asthma pinned down to. :p

I was particularly interested in the Abilify, as one of the side effects is headache, as well as the more serious side effects that tend to accompany it.

As for the weather, for my son it helps, and I notice it helps my headaches (I am not a migraine sufferer though) to keep the house high in humidity when I see this coming on. With my little one I get some early signs, such as a cough (you might get auras), that warns me to check the weather. If humidity is going to rise, I get the dehumidifier going, if it is going to fall... I start humidifying immediately.

Don't know if it will work for migraines, but anything is worth a try.

Sheeshy! That is quite the impressive list! Err... cocktail ;) I'm lucky to have the percocets I have... although there is talk of possibly going to Oxycontin... that one, to be honest with you, scares me... heard too many horror stories I guess... but at this point I'd be willing to try it... I am having such a hard time maintaining my job on top of being a mommy and wife who someday wants to write a book... (no more nursing school for me, but that's a whole other sordid tale)... take this past Christmas... Christmas Eve-E.R. able to make it through the day and evening of wrapping and preparing for the early morning rush. Christmas Day-spent entire day on the couch totally incapacitated until my husband took me back to the E.R. only to find the same doc who did little to help the day before, only now he's upset because I'm there again... day after? I start my period... managed to get through most of the work day... by 5 I'd thrown up at work twice and had to leave only to make yet another trip to the E.R. This doc gave me the usual injection of 50mg demerol and 25mg phenegren... came home, went to bed and literally had to drag myself to work the next morning. This is typical for me. Honestly I'm at the point that I just don't know what to do anymore... used to be able to smile and laugh my way through the countless docs and meds... now? I barely smile or laugh, period. (no pun intended ;) )

I've been on the following: (bear in mind I KNOW I'm forgetting some)
Inderol(spelling?)
One other high blood pressure med I can't remember/beta blockers I can't remember :)
Zoloft
Celexa
Serzone
Elavil
Xanax
Prozac
Wellbutrin
Frova
Imitrex
Relpax
Zomig
Maxalt
Lyrica
Topomax
Depacot
Ambien (for sleep purposes only... still take on occasion)
Klonopin
Neurontin (not sure why but was given for one month and taken off)
Demerol 50mg and 100mg injections (prescribed)
Compazine
Some new anti-nausea med... Tigaine? Tigan? (currently taking)
Tylenol 2's and 3's
Darvocet
Vicodin and Vicodin ES
Lorcet
Percocet (currently taking-5-325 tabs.)

Ummm... I THINK that's it... prolly not though ;) after 16 years it's hard to remember all you've had to take... I know there was another drug that my neurologist said wasn't FDA approved but he had me taking to a day for a few months... cannot for the life of me remember what that one was... apparently it was supposed to be for women with severe PMS cramping?? No idea...

At times it is extremely frustrating... with all the narcotic hype doc's are becoming more and more rigid in what they'll prescribe... to date that is all that helps me... find me something that works and I'll be happy... until then? Could you please just help with what you've got?

My next appt. is Jan. 9th... I'll have to let you know if anything changes... for now I'm stuck with the nausea med I can't remember the name of and 3 percocets per day max... I also have the ambien 10mgs if needed (rarely) and take 2.5-3 xanax (.5mgs each) per day for panic/anxiety disorder... that be it sir... :) Nothing like your cocktail!

I will have to run that list past my doc just to see the apoplexic (spelling?) fit it sends him into! :D
Thanks!
XoXo
Mychele

Looking over your list: Celexa, Serzone, Maxalt? Ambien, Klonopin, Demerol, Compazine, Lorcet I haven't tried. Ambien I have no desire too.

I've tried the other's of yours in some capacity even though they were not on my list. Your list is impressive too.

I can see that you definitely have a problem with intensity. I have a problem with frequency (~ 1/3 of the year) Mine is worse in May and Sept. I've never gone to the ER.

I'll tell you this though. I believe that there is minimal danger with the high-power narcotics if your trigger is present. Take the drug when no trigger is present - all bets are off. BTW, Ocycontin really has no toxicity level. It's just too much causes respiratory depression in people. The value of "Too much" is differerent for everybody.

You might be able to surgically stop yours. I might be able to stop mine if I move. Where I don't know.

I only gave you the migraine meds. I'm on a lot more for other conditions, Try 23+ prescriptions; some refrigerated injectables (max 6x/day). And I get most of them in 90 day supplies. The migraine meds though, are PRN (as needed).

KISS

Here is one I came up with for you to ask about trying:

An Option to Explore for Preventing Menstrual Migraine

See? Told you I'd forget some! I've tried the "pill" approach... that was very early on... made my migraines go craaaazy so my doc said absolutely no more hormone treatments of any kind! See, typically I will get hit pre-during-post menstrual... that leaves me about one week of "ok" time... which at times isn't really OK... when you get the severe migraines you can feel
Like your recovering from the flu for 1-3 days after which sometimes left only 4 days a month I'd feel OK... my husband even (1/2) jokingly suggested I get a hysterectomy and my doc about had a fit... said that we don't have any idea what menopause is going to do to my migraines so to "force" the menopause could severely set me back and there is no point in doing that at the age of 34 (at the time... 37 now)...
I've also had nerve block injections... 8 in the neck and then just recently 1 in the nerve above my left eye... that one SUCKED soooo bad! I had such a bad reaction to that (headaches and swelling in the nerve and left side of head) doc decided no more of that.

The migraines aren't nearly as frequent as they used to be... now it's typically 1-3 days before with the peak on the first day of the period... at times I'll get hit as the cycle winds down... but I can honestly say that I can't remember the last time I didn't have a headache. I get one every single day... just got to try to figure out, do I take the Percocet? Is it going to explode? Or is this just a headache and 800mgs of Motrin will work? That's probably one of my biggest issues... never knowing... a simple headache can and often will turn into a migraine if I can't control it...

Ahh well... "suck-is-life" ;) No, I don't mean all of life sucks either... just the headache/neckaches/migraine part... the no answers part... I've really tried to keep positive throughout all this (tho it's been getting much harder here of late)... no point in getting down about it... not going to solve it and then I'm just that much more frustrated and miserable :)
Thank you KISS... seriously! Any input you (or anyone has) is tremendously helpful and appreciated!
XoXo
Mychele

Forgot to address this one... (oops! Sorry!) WoW... that's about all I can say! That is a lot to have to take daily! Do you find it hard to maintain the discipline required and/or the responsibility required to take all of those things? I barely take anything compared to that and I keep a very strict journal that I write what I took and when so I never forget or get stuck in a spot not knowing for sure what it was I took and when...

This question kind of goes along the lines of the thread currently going about staying on our meds and why we go off them knowing the consequences :) But seriously... how do you do it?
XoXo
Mychele

I find it hard managing the "Pharmacy store" and the FSA re-imbursements, It takes a lot of effort. Type II insulin dependent diabetes with complications, Asthma, Migraine and allergies to ragweed and tree pollen are the biggies. Many meds are PRN and some the doses have to vary.

It's important to be able to "stair-step" as you call it and it's important to trea at the first sign of migraine. Oxycontin comes in 10mg tablets so you can determine how much you need. You can take the standard "n tablets" and probably add 1 every 30 minutes until you get relief. They work for 12 hrs. My diary is not as comprehensive. It includes how much, but not when and something about the event that caused it.

My "arsenel" is mostly rescue meds while "we" search for preventatives. I should be searching for a new doctor. My best one moved 300 miles away.

That would be ideal, wouldn't it... to finally be able to prevent the pain so the rescue isn't needed or needed as often!? It's the search that is becoming so frustrating... so to your need to find yet another doc? Lord have mercy and good luck! Seriously! I truly hope you are able to find "the one" quickly w/o too many hit-n-misses!

Question-I didn't understand when you said above "you can take the standard 'n tablets' and probably add 1 every 30 minutes until you get relief."

What's the standard "n tablets" refer to? :)
And I thought you couldn't take anything (except ibuprofen) once you took the time released Oxy pill.. :)
Thanks!
XoXo
Mychele

Ah. My doctor search is not so urgent because my PCP will prescribe all current meds. And I usually let him do so with permission from all the other docs. The neurologist always communicates with him anyway. I am seeing another neurologist in the same office which isn't very helpful. He's one of those non-believers. Says until you get rid of "the stress", I don't want to try anything else. My old neurologist gave me some leads, but I haven't followed up on any of them. One is about 1-1.5 hours away. One 45-1 hr away. One about 45 min away. And one within 30 min. And if I wanted, my old Neurologist about 300 miles away.

The standard "n"

Oxycontin comes in 10, 20, 40 and 80 mg. YOU CANNOT SPLIT OXYCONTN - EXTREMELY DANGEROUS. We determined that 30 mg would generally get rid of the headache. i.e three 10 mg tablets.

If I want to take 10 mg and 30 min later take 10 more and 30 min later take 10 more, so be it. If I want to take three 10's at a time, no problem. My standard "n" is 3. Three 10 mg tablets. I might only use oxy for one or two 24 hour periods then I get a rest (maybe days, maybe weeks unless it's May or September. I'll mix Fiorinal and Oxycontin at onset because the Fiorinal will start to work before the oxy kicks in.

Example from my diary: April-May (4 wks): Seventeen 10 mg oxycontin over 7 days, 2 mg lorazepam over 2 days, 0 percoset, 0 Zomigs. I don't count Fiorinal.

Ativan and oxy - no way. I can only take Ativan at bedtime.

I came up with Oxycontin when I purchased "Professional's Handbook of Drug Therapy for Pain". Springhouse. ( www.springnet.com ) at Borders Books. `