How much sumatritpan (or another triptan) is too much?

How much sumatriptan (or another triptan) is too much is not clear. The initial FDA-approved daily dose of oral sumatriptan (Imitrex) for the treatment of an acute migraine was up to three 100 mg tablets. Several years later the maximum daily dose was reduced to 2 100 mg tablets a day, to be taken at least 2 hours apart. There was no scientific or safety reason for the reduction of the dose. Two other triptans, rizatriptan (Maxalt) and frovatriptan (Frova) are still allowed to be taken three times a day. The maximum dose of eletriptan (Relpax) is 2 40 mg tablets, however, in Europe it is 2 80 mg tablets. Some doctors are very strict in adhering to these arbitrary limits. Some patients will tell me that they always need to repeat the dose of a triptan 2 hours after the first dose. It makes sense to have them take a double dose at once and the results can be much better – the headache will go away and will not return. It is true that the higher the dose the more side effects you can expect. In patients who are sensitive to drugs or weight less than 100 lbs, it is prudent to try half of the usually dose and in everyone else the standard dose should be used at first. If the standard dose is not fully effective, another triptan can be tried, but if none provide sufficient relief and do not cause side effects I first recommend combining the standard dose of a triptan (100 mg of sumatriptan, 10 mg of rizatriptan, 40 mg of eletriptan, and so on) with an anti-inflammatory medication, such as Migralex (aspirin/magnesium), naproxen (Aleve), or ibuprofen (Advil). Only if this combination also fails would I suggest doubling the standard dose of a triptan.
What about the maximum dose of a triptan to be taken in a month? The initial studies of sumatriptan were conducted in patients who had 2 to 6 migraines a month and when the drug was approved by the FDA no monthly limit was imposed. However, the manufacturer packaged sumatriptan tablets in a blister pack of 9 tablets. This became the unofficial limit, even though no studies were ever conducted to examine the safety and efficacy of frequent sumatriptan (or any other triptan) use. Many doctors, including headache specialists believe that taking any abortive medication, including triptans too frequently will make headaches worse (so-called medication overuse headaches). We do have good scientific evidence showing that caffeine in fact can worsen headaches by causing caffeine withdrawal, or rebound headaches. People who drink large amounts of caffeine know that if they stop their caffeine intake they will develop a headache. In patients prone to headaches, as little as 2 cups of coffee, tea, or soda can worsen their headaches. We also have some evidence that barbiturates, such as butalbital (Fioricet, Fiorinal, Esgic) and opioid analgesics, such as codeine, oxycodone (Percocet), hydrocodone (Vicodin) and other can cause worsening of headaches if taken more than once a week. However, we have no evidence that triptans or NSAIDS, or non-steroidal anti-inflammatory drugs (Advil, Aleve, Motrin, Relafen, Voltaren, etc) cause worsening of headaches if taken frequently. Aspirin (such as in Migralex) in fact may prevent worsening of migraines.
I do discourage frequent use of triptans, which usually indicates poor control of migraines. Most patients with frequent migraine attacks are better off with preventive therapies, such as aerobic exercise, biofeedback, magnesium, CoQ10, Botox injections, or sometimes even preventive drugs. A common barrier to the frequent use of triptans is the insurance company. Many insurers have been reducing their monthly coverage of triptans from 9 to 12 down to 4 or 6, while increasing co-pays. This is clearly done not out of any safety concerns, but to save money.
With all of the above said, I do have about two dozen (out of thousands) patients who require very frequent or daily intake of triptans. These patients have gone through many of the preventive treatments listed above, including Botox, and they are still having daily headaches, or what we call chronic migraines. I usually try to have them stop triptans for several weeks to see if they improve with NSAIDs and prophylactic treatments, but most do not. These patients have very good control of their migraines, have no side effects, and can function normally. I am concerned about the potential cardiac side effects of these drugs, which are well documented. If a patient has some risk factors for heart disease (post-menopausal, high cholesterol, hypertension, diabetes, smoking, obesity, family history, etc), a stress test should be obtained.
What prompted this post was an article in the latest issue of journal Headache, which reports on a 49-year-old woman with 18 years of chronic cluster headaches. Injectable sumatriptan is the only treatment approved for cluster headaches. This woman has been injecting herself with 6 mg of sumatriptan anywhere from 2 to 37 times every day (on average, 20 times) for 15 years. She had no side effects or negative effects on her heart and there was no decline in the efficacy of sumatriptan over time. She failed several abortive and preventive medications. Other doctors have published articles describing patients taking triptans very frequently without loss of efficacy or side effects, but this patient has the most frequent and prolonged use ever reported.

  1. Dr. Mauskop says: 02/08/20189:51 am

    Over the past 25 years triptans have been prescribed to millions of people (and in Europe, have been sold without a prescription) and no evidence of major risks has been discovered. The only exception is people with coronary artery or other vascular problems. I cannot give individual recommendations, but if you haven’t done this yet, I would discuss with your doctor trying the other 6 triptans – sumatriptan (imitrex), rizatriptan (Maxalt), naratriptan (Amerge), almotriptan (Axert), and frovatriptan (Frova). Frova is the only remaining triptan without a generic and insurance companies do not like paying for it. It is possible that one of these will have less side effects than Zomig. You will be a good candidate for the preventive treatment with CGRP monoclonal antibodies, the first of which (Aimovig) is expected to get FDA approval this summer or fall.

  2. Sandra says: 02/08/20181:32 am

    I’ve been disabled with migraines for over 20 years. I have daily migraines and take 1/2 of a 5mg zomiitriptan (zomig) when I have it. I have tried all the preventative RX and combinations of preventative RX, Nerve blocks, PT, Botox injections every 2 to 3 months the standard 32 injections to head, neck, face and shoulders, under went the Neuromodulation surgery with neuro-stim implants in my forehead and back of head, and got the daith ear piercing done. I had a sleep study and have sleep Apnea – so they thought that might be causing the migraines, but I sleep with my CPAP machine on every night and I still have the daily migraines. None of it has helped reduce my migraines. About 10 years ago they thought I was having rebound headaches from taking Zomig more than three times a week and I went through a week of detox in the hospital, but my migraines started back a week after I got out of the hospital. My question is would it hurt to take a 1/2 Zomig every night to try to prevent a migraine the next morning? I wish there was a rescue RX I could take that worked and had less side effects. Zomig gives me flu like symptoms for 2 hours after the headache pain stops. I take 60mg duloxetine delayed release at night for depression and it also helps me sleep. I also take 1 15mg meloxicam with the Zomig to help reduce the muscle and bone ache side effects. Any suggestions would be appreciated. A day without a migraine would be such a blessing.

  3. Dr. Mauskop says: 10/13/20179:53 am

    For weather-related headaches, I recommend a free app, MigraineX, which sends an alert when barometric pressure drops by 20 millibars or more. It is more effective to take medicine at the time of alert and before headache starts. My patients take their migraine medication, such as Imitrex (sumatriptan) or an over-the-counter pain medicine, such as ibuprofen or naproxen. Sometimes these do not help and I prescribe Diamox (acetazolamide), which is also used for mountain sickness.

  4. michiganmigraine says: 10/13/20178:09 am

    Topirimate was a miracle drug for me, reducing the frequency and duration of my migraines to maybe 1-3 a month at most and making them very short-lived. It had the side benefit of reducing my appetite, so I was able to keep my weight down. Then it stopped working, progressively, and I was weaned off of it while a migraine specialist has been trying other prophylactic meds. None of them have worked, either giving me GI problems or regular headaches. He has helped, however, by prescribing Imitrex and I have the pen and the tablets. The pen works much faster. My migraines, though, are now at over half a dozen a month–and almost always come with rain or thunder storms and changes in barometric pressure. I don’t like the potential side effects of Botox, especially the possible voice change since I am a singer. I’m very glad to read this information about dosage above because BCBS allows for many more tablets than pens. I have to save those for migraines that can put me in bed.

  5. Dr. Mauskop says: 07/03/201711:06 pm

    I would suggest printing out my blog post and a few comments to show your GP.

  6. Rose Whiteley says: 07/03/20173:32 pm

    Hello, I am have difficulties in the UK because my GP is not happy with my triptan use – I use up to a maximum of 12 naratriptans per month. I am 51 and have had frequent migraines, both common and the type with brainstem aura, for 36 years. As far as I am concerned my migraines are stable and well-controlled; the pattern is a few more some months and a few less others, but generally i start 8-12 migraines per month, most of which I can get rid of within an hour or two with the triptans.

    I have tried all the prophylactics (except botox) in the past, with no success; most recently on my GP’s insistence I tried topiramate, which was disastrous and gave me problems with speech, balance, vision and co-ordination. I do not understand why my GP is reluctant to give me triptans. except that she says she’s heard they can cause migraines (overuse) which I am very sceptical about. She wants me to stop triptans altogether to see what happens; I argue I cannot possibly do this as I need to earn a living (I’m a self-employed psychotherapist) and could not do so with two-three one to two day migraines a week; plus, surely the stroke risk is higher with frequent full-blown migraines?

    Any comments would be much appreciated, and thank you for this article.

  7. Dr. Mauskop says: 06/05/201710:29 am

    I would ask your doctor about trying sumatriptan injections, 3, 4 or 6 mg – they work much faster and are particularly useful when nausea accompanies the migraine.

  8. Charlotte B says: 06/05/201712:33 am

    What are the risks of taking more than 200 mg of Sumatriptan in a day? I take 100 mg pills for my migraines but the more severe headaches make me prone to vomiting. When that happens, I can usually take the first dose without problems and attempt to lay still until it kicks in or enough time has passed I can take another pill as needed. On more than one occasion, however, I’ve vomited soon after taking the second dose and am always conflicted about redosing. I’ve never had more than fifteen minutes elapse between when I take the pill and when I vomit and I’m always concerned that not enough time has passed for it to have properly been absorbed in my system. When is it safe to redose, if ever?

  9. Dr. Mauskop says: 02/21/20171:52 pm

    Yes, if you have daily migraines you may want to ask your doctor about trying naratriptan (Amerge), which often lasts longer and could work better than sumatriptan. Frovatriptan (Frova) is the longest lasting, but it is not available in a generic form, so it is very expensive.

  10. Jack Wehr says: 02/19/20171:34 am

    Greetings Doctor.
    So glad to see this thread. I will be calling Monday for a consult. There is no one I trust more. A question, daily imitrex 100mg, 6 a day provides some relief but it seems I am chasing the daily migraines. I literally have to set my alarm as if I sleep more than 3 hrs I’m in big trouble from the pain. I have gained 80 lbs over the past 8 months due to not being able to function. Current weight 280. I realize this is a risk, but could not manage the pain without the imitrex. You referred me to uc headache clinic for botox, but the earliest appointment is June. Would it be beneficial to try one of the longer acting triptans? I know this is a lot of info, I have dementia issues as well and it’s difficult to explain things. Sorry for the long winded post. I am scared and having trouble wheezing. Just trying to get some direction. Thank you for your time. I so wish I could just come there for botox, just not financially possible.

  11. Alison Inchausti says: 02/17/20171:52 pm

    I have suffered migraines since the age of 18. Before that i had stomach migraines all through my childhood. I have cealiac disease and have some problems with all grains which is why I follow The gaps diet. However the gaps diet doesn’t seem to help with the migraines. But it improves my general health, which is why i persist.
    I am now 49 years old and am post menapausal. All through my fertile years my triggers were mainly hormonal and could be timed accurately with mestration and ovulation. I had stress related ones too sometimes. During menopause i had a period of time ( 5 months) when i completely stopped menstruating and completely stopped having migraines… It was sheer joy! I hoped that menapause would mean the end of migraines. A few years on and they still come very much on a cyclical basis. I have been on preventatives for ten years but none of them seem to help me much and so recently i am just taking injections early on in an attack which nearly always aborts it. Sometimes i have to take two. I am getting them and aborting them up to 8 times a month.
    I am slowing reducing preventative medications in favour of just taking sumatriptan injection to abort attacks. I like Petra L sometimes get a block of attacks close together and then i end up deciding to go through the 3 days agony of a full blown migraine, in the hope that i won’t get rebound headaches from taking too many. I feel as if my body has to have the attack to stop the increasing cycle. Then i will normally go for 4 weeks completely migraine free! It is very odd. It is almost like my body has to do it…. Like a person having an epeleptic fit or something.

    In my mind, surely it is better to take an efficient 6 mg injection, thus avoiding my very sensitive stomach, than taking a 50mg tablet. Plus if the preventatives (anti depressant, anti convulsant and beta blocker) aren’t really working anymore, isn’t it better to stop taking a cocktail of drugs when sumaptiptans work 95% of the time.
    I am spending about £80-100 pounds on sumaptriptan injections which luckily are available over the counter to buy in Brazil where i live.
    I sometimes worry i am taking too many but without them my life, quite frankly, isn’t worth living.
    Since resorting to just taking the injections i no longer take any pain killers of any sort.
    For me this is huge progress. I have been aborting them for 5 months now but feel i may be due that 5% of the time that they don’t work.
    This is the first time i have ever written about my migraines but i find myself increasingly educated by reading other peoples stories. Maybe mine can help someone too. 🙂
    Thanks guys !

  12. Dr. Mauskop says: 12/21/20169:24 am

    You should ask your doctor about trying a different triptan, such as eletriptan (Relpax), zolmitriptan (Zomig), or naratriptan (Amerge), but the most effective one would be sumatriptan (Imitrex) injection. Otherwise, a single dose of steroid, such as 8 mg of dexamethasone sometimes helps. If you are young and healthy, there no danger in taking the fourth dose of rizatriptan within 24 hours, but it is not likely to help if the first three did nothing.

  13. Dawn Carter says: 12/21/201612:30 am

    Hello. I am having difficulty locating the information online that I am looking for. I’m wondering about Cambia. I have taken it on occasion with good results. Today I had a migraine and took 10-mg rizatriptan. Four hours later it had not subsided, so took another 10-mg dose. Approximately 4 hours after that still had no relief, and took another 10-mg dose. No relief. Four hours later I took Cambia, with no relief. Is there anything left I can take? I have Midrin, which typically seems to not do anything. I am desperate. What happens if I took a 4th dose of the rizatriptan? within the 24-hr period? Started with first dose at 5:00AM, and now its 9:30PM, so not quite been 24 hours.

  14. Dr. Mauskop says: 11/28/20162:53 pm

    Although even this much sumatriptan is not likely to cause heart disease, it doesn’t seem to be working well. Ideally, she should be getting a preventive treatment such as Botox, supplements or medications.

  15. Nick says: 11/28/20163:21 am

    Dr. Mauskop,
    My girlfriend is taking between 3-5 100mg sumatriptan pills per day. I know this is horrible for her heart and causing rebound headaches, what else is it damaging? She tells me I don’t understand how migraines fell which I don’t, but I am very worried. She sleeps all day and has mood swings. Please let me know.



  16. Dr. Mauskop says: 09/06/20169:55 pm

    I cannot give specific advice to anyone whom I haven’t seen, but as mentioned in my post on daily use of triptans and in many comments from readers, there is a small group of patients for whom daily use of triptans is the only solution which allows them to lead a normal life. There is no evidence of any long-term dangers of drugs like sumatriptan or rizatriptan, but having a daily severe migraine can be severely debilitating. While rebound, or medication overuse headache is uncommon with triptans, it is fairly common with opioid pain killers, such as hydrocodone. The ideal prophylactic treatment, which you haven’t listed, is Botox injections, although they are expensive if insurance does not pay for it.
    As far as fighting the insurance for a larger quantity of Maxalt per month, the doctor can appeal the denial and speak to a doctor at the insurance company. However, doctors don’t get paid for sitting on the phone with the insurers, so many are reluctant to do it. You may want to go to to get a coupon for a local pharmacy. I just checked – you can get 12 tablets for $26 and then you do not have to deal with the insurance. You do need an extra prescription from the doctor.

  17. Juliette says: 09/06/20165:26 pm

    I am 70 yrs. old. I have had documented migraines since my mid-thirties. As I have gotten older I now get nearly daily migraines. I get them in early morning hours, i.e. 3:30 AM. I believe this is caused mainly by severe arthritis in my neck, which can trigger a migraine. Over the years I have tried beta-blockers, Topamax (for over 14 years) and all the triptans known to man. The one that works the best for me is the 10mg Maxalt. I have always been able to get my rx for 12 tablets in a month filled more than 1x in a month. Now, in the middle of 2016 I am fighting with my insurance (not Medicare D) for more than 1 refill in a month. The prior authorization submitted by my pain management doctor was denied today. The reason “a quantity of 30 tablets exceeds Citizens RX qualtty level limit of 12 tablets per 30 days. Chart notes indicate you are not on prophylatic therapy (e.g. propranolol, topiramate, valproic acid) to prevent migraines. You also take hydrocodone 7.5 mg every 12 hours for pain and function”
    This is a new PBM insurance vendor, since Jan. 2016. Obviously they see none of my prior history of years and years of topiramate @ 100MG 2 x day. And of course they had no conversation with my physician, in fact, he was not aware I had been denied. I must now file an appeal…

    My question to you Dr. Mauskop is this:
    1. How bad is it to take 24-28 Maxalts in a month? I actually have been doing this for about 3 years (with no issue from refill requests within a month) I do not have heart problems, kidney issues and such. Just migraines and severe neck pain. I have had an epidural injection a couple of months ago and a nasal SPG done about a month ago. Epidural helped with neck pain, but now it’s back.
    2. Do you have a suggestion as to how I am to fight this? My neurologist of 15 years retired in June. She was one who prescribed the maxalt, hydrocodone, and topiramate plus other drugs over the years. I go to a pain management doctor who is one trying to help me with this. His office is very aggravated about this.
    3. Is it your assumption that a PBM insurance co. must have an actual physician that reviews the prior authorization requests and contacts the prescribing physician?
    Thank you so much for your time in responding.

  18. Dr. Mauskop says: 09/01/20165:33 pm

    Yes, it is not unusual for a generic drug, such as sumatriptan (Imitrex) or rizatriptan (Maxalt) to be less effective than the brand or a different generic. You may want to try a generic sumatriptan made by a different company. By law, the manufacturer of the drug has to be listed on the label you get from the pharmacy. You may need to go to a different chain (CVS instead of Walgreens or Walmart) or buy it online. is a good place to get a discount coupon for a local pharmacy for most drugs.

  19. Jen Sims says: 09/01/20163:58 pm

    My 17 year old daughter is suffering terribly with chronic migraines – she has done every preventative drug that they can think of including botox injections – she takes the 100mg sumatriptan and never gets feeling any better than a 4/10 for pain and lately it isn’t even doing that well. Could the generic not be working as well? Should I ask for Imitrex instead?

  20. Dr. Mauskop says: 06/17/20161:22 pm

    Please call 212-794-3550

  21. Saadia says: 06/17/201612:15 pm

    Dr. Mauskop, how do I make an appointment with you? I’m in NYC.

  22. Dr. Mauskop says: 06/08/20169:22 pm

    1. The only way to find out if you have MOH is to stop taking Imitrex for a couple of weeks, with or without steroids.
    2. Yes, anxiety could result from Imitrex.
    3. Yes, BOTOX and Topamax can help even MOH, so there is no need to get off Imitrex first, but there is no point taking Topamax again if it cause side effects in the past.
    I am happy do a written consultation through if you have more questions.

  23. nan says: 06/06/20162:18 pm

    Thank you for your response, Doctor. I wish I could come to your clinic in NY, but I’m in San Diego. Do you ever work with patients on a long-distance basis? I am very nervous about taking the steroids to treat the Imitrex MOH syndrome, especially a 3-week program. I am concerned that after the steroid treatment, my headaches will continue and I’ll be right back where I was with the Imitrex. For several months, I’ve taken 50mg of Imitrex at bedtime, even if I don’t have a headache. When I do that, I don’t wake up with a headache during the night or in the morning. I am usually headache free all day. If I don’t take it at bedtime, I always wake up at about 3-4am with a bad headache; and even if I take Imitrex then, the headache subsides but not completely. I know you’re not supposed to take Imitrex if you don’t have a headache, but this has been working for me. Questions:
    (1) Does this sound like MOH syndrome to you?;
    (2) Could taking Imitrex when I don’t have a headache at bedtime cause me to wake up with anxiety or other issues?
    (3) Does Botox or Topamax help if I am taking Imitrex everyday or do I need to be off the Imitrex before trying the Botox? (I took Topamax for years in the past but I’m not sure it reduced my headaches and the side effects were too much for me.)
    Thanks in advance for your response to my lengthy comments. I would happily pay for a telephone consult, if that’s a possibility. Kind regards, Nan

  24. Dr. Mauskop says: 06/06/20169:41 am

    I’ve had patients on Imitrex complain of anxiety, but it’s been usually related to the worries about the risks of taking Imitrex or about having a migraine rather than due to the drug itself. Yes, a short course of prednisone can occasionally provide relief, but I never give it for more than 10 days.

  25. nan says: 06/05/20168:08 pm

    Dr. Mauskop, Thank you for all the great information. I have been using Imitrex since the early 1990s, lately almost daily. If I take a 50mg pill before bed, I seem to be able to avoid having headaches. But, I’m wondering about some other side effects like anxiety. I have two questions: (1) Have you ever had any patients who complained about anxiety with daily use of Imitrex? (2) My doctor is recommending that I use a 3-week prednisone program (from higher doses to lower doses) to get off the daily Imitrex. Have you heard of this being successful in reducing the number of headaches (and Imitrex doses) each month? Thanks!

  26. Anonymous says: 05/29/20163:16 am

    Good to hear you can take Sumatriptan frequently. I’ve had 30 years of chronic migraines 4-5 days a week and it changed my life when I finally got prescribed Sumatriptan 5 years ago. I take it most days and top up my prescription with ones I buy in India

  27. Geena says: 05/25/20168:38 pm

    I have had migraines for years and only in the past year have started taking sumatriptan. I get any where between 12-20 migraine days a month. I am often worried about the damage taking the sumatriptan on such a regular basis could be causing.

  28. DK says: 11/25/20155:17 pm

    I’ve suffered for 50 yrs+ with Migraines (currently 58) and wasn’t diagnosed until 22 yrs ago. I’ve been on most meds and triptans were miracle drug for me. I am currently on 10 mg rizatriptan for acute migraine. I experience about 8-9/mo. Mostly triggered by barometric pressure changes which I can’t control. 1 tab relieves headache and lasts 24 hrs. If not for the triptan — I would not be able to work; so this therapy is a lifesaver. I find drinking caffeine with triptan helps my migraine. I drink caffeinated tea daily and have not been able to wean myself from caffeine. I was recently cut from 8 tabs to 4 tabs by my neurologist though I have no health risk other than age. I am very concerned what my options would be if triptans are taken away. I have had episodes where I’ve had to have 20-30 injections in my scalp/neck/sinus at one time to relieve headache episode (analgesic, steroid) – these worked well to arrest the episode and provide relief for 2 week period. I am glad to read that there is no evidence of risk for those who even take daily triptan. If I didn’t take the med, I would be nauseated and have to go to bed suffering for 2 days before the headache likely subsided. I did that for years and don’t want to go backwards.

  29. Dr. Mauskop says: 10/27/20151:18 pm

    It is not unusual to have increased urination after taking a triptan, but kidney damage from frequent use of triptans has never been reported. There is a report of two patients having kidney damage from triptans. These two patients were not taking triptans long-term and their kidney damage from an infarction (loss of blood flow) to a section of the kidney. Infarction of the heart, brain, and intestines has also been reported in patients who take triptans. Similarly, in these cases patients were not taking triptans long-term on a frequent basis, but only occasionally. These ischemic complications are rare and many triptans have been available over the counter in many European countries. Kidney damage is much more common in headache patients due to overuse of NSAIDs, such as ibuprofen, naproxen, and aspirin.

  30. Jen says: 10/27/20151:03 pm

    Dr. Mauskop, do you ever find problems with kidneys in patients taking daily triptans? I find they dehydrate me and have noticed my BUN is going up. (It’s still in normal range but the BUN/creatinine is now out of range.) I haven’t found any other cause for it. I’ve been taking 50 mg of Imitrex almost daily lately.

  31. Dr. Mauskop says: 10/17/20155:06 pm

    You may want to ask your doctor for a longer-acting triptan, such as naratriptan. Another option to try is to take Advil, Aleve or Migralex along with Maxalt. This could make it more effective and make the effect last longer.

  32. Petra L. says: 10/14/20157:38 pm

    I have episodic migraines, and take between the 8 and 14 Maxalts a month. They are effective. Sometimes the migraines keep coming back day after day. In that case I stop taking maxalts and suffer 48 hours through a bad migraine. After that I am free of migraines for 1 to 3 weeks. To me this is a very weird phenomenon. Should I just keep on taking Maxalts in case a migraine comes back every day and do not stop taking them?

  33. Dr. Mauskop says: 10/05/20153:35 pm

    Unfortunately, there have been no studies at all of daily intake of triptans, except for short courses for the prevention of menstrual migraines. I usually recommend a magnesium supplement (or even better, an IV infusion) since we’ve shown that 40% of cluster headache sufferers (and 50% of those with migraines) are deficient in magnesium. Magnesium is a natural calcium channel blocker, which is how verapamil produces its effect.

  34. Judy says: 10/05/20153:11 pm

    I have found that taking as little as 25mg of sumatriptan (tablet) nightly before bed prevents nightly cluster attacks, which otherwise occur about 25-28 days per month. This is after 3 GON blocks failed to affect them. I am also still taking 600mg (200mg 3x daily) of Verapamil but am prevented from increasing dosage due to extreme low BP. My doctor wants to send me for inpatient IV DHE but I am reluctant based on comments I have seen online. Wondering if there have been any updated research or studies since this article? Am being treated at UCSF.

  35. Bob McCallum says: 10/01/20145:20 pm

    I use triptans 2 50 mg each day, also use co/codamol 500 paracetamol 30 mg codeine with no side effects. I have just tried latest tms system – it did not work on me. 7 years i have suffered

  36. Dr. Mauskop says: 08/03/20132:21 pm

    Thank you for your comment and the link. It is good to see that the Danish Migraine Association is using common sense rather than just repeating what the FDA and the headache experts are saying. And indeed, what they are saying has no scientific evidence. In the US, both the professional and the lay organizations promote this damaging view that the triptans are a common cause of medication overuse headaches. We do have proof that caffeine causes medication overuse headaches. It is likely (but also not proven) that opioids (narcotics) cause medication overuse headaches, but NSAIDs, such as ibuprofen and naproxen and triptans are not likely to do that. Aspirin, in fact, may prevent worsening of headaches, but it is also lumped together with other abortive drugs. Yes, I’ve seen medication overuse headaches in a small number of patients triptans, but I also have seen many patients taking triptan very frequently and sometimes daily without having medication overuse headaches. For these patients frequent triptan use is a life saver. Many of my colleagues who strongly believe in medication overuse headaches from triptans admit that they also have patients who have failed preventive drugs, Botox, and other therapies and have no better alternative than to take triptans daily.

  37. Anne Bülow-Olsen says: 08/03/20131:00 am

    It is good to read that large amounts of triptans can be used with no particular side effects.

    In Denmark (where I live) most doctors are strict in limiting the triptans to 9 per month. This leads to a large and undocumentet usage of painkillers, including codeine, which is not on prescription here. And subsequent medicine induced headache.

    The established wisdom among the leading doctors in Denmark is that a detoxification takes 8 weeks with absolutely no medication (triptan, painkillers or preventive medicine).

    We do not know how many loose their job because of medicine induced headache, but I hear from a large number via Facebook and the phone. And it is really difficult to find another job if you have to explain that you have been detoxed…

    The Danish Migraine Association has stated its opinion (in English) here:

    I sincerely hope that doctors throughout the world will reevaluate the limitations in triptan usage.

  38. caroline p.lane says: 02/10/20125:59 pm

    as many as 12 a month, but now they are only occasionaly, but at times I do have residuals.

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