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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Maggiemae on February 29, 2012, at 10:22:57
I had a toradol injection this morning at pain clinic to try to break a 2 week long migraine cycle. 3 hours later not much relief yet. Took a Vicodin to see if that would help me at least sleep a bit while toradol takes effect. No real relief yet.
What do people with migraines do when they are on maois like EMSAM? Imitrex worked great before but now is a no no.
Wondering what tricks my psyc/neurologist might suggest next when I see him?
Posted by Phillipa on February 29, 2012, at 12:04:32
In reply to Toradol for migraine ? (on EMSAM), posted by Maggiemae on February 29, 2012, at 10:22:57
I don't know. But empathize with the long migraine. Phillipa
Posted by ed_uk2010 on February 29, 2012, at 13:59:29
In reply to Toradol for migraine ? (on EMSAM), posted by Maggiemae on February 29, 2012, at 10:22:57
Traditional neuroleptics such as haloperidol (Haldol) can terminate migraine attacks, but may cause adverse effects.
The manufacturer of sumatriptan (Imitrex) states that it cannot be combined with MAOIs... but I think it's fair to say that they are simply covering their *ss. There are published reports of patients taking sumatriptan + MAOIs without sequelae, but since sumatriptan is metabolised by MAO, it might be sensible to half the dose of sumatriptan.
Posted by Phillipa on February 29, 2012, at 20:35:57
In reply to Re: Toradol for migraine ? (on EMSAM), posted by ed_uk2010 on February 29, 2012, at 13:59:29
Ed also it's listed as not being able to be taken with SSRI's for headaches. PJx
Posted by ed_uk2010 on March 1, 2012, at 1:35:48
In reply to Re: Toradol for migraine ? (on EMSAM) » ed_uk2010, posted by Phillipa on February 29, 2012, at 20:35:57
>Ed also it's listed as not being able to be taken with SSRIs for headaches.
It appears that combining sumatriptan (or other triptans) with SSRIs is normally uneventful, but there have been occasional case reports of symptoms resembling serotonin syndrome. Most patients are apparently not affected.
For those on SSRIs or MAOIs, it makes sense to try other migraine drugs first, and not triptans. Unfortunately, other meds often don't relieve the migraine, so triptans might have to be used, under close supervision of course.
Posted by ed_uk2010 on March 1, 2012, at 1:43:54
In reply to Re: Toradol for migraine ? (on EMSAM) » ed_uk2010, posted by Phillipa on February 29, 2012, at 20:35:57
>Ed also it's listed as not being able to be taken with SSRIs for headaches.
The SSRI/sumatriptan combination has received more study than the MAOI/sumatriptan combination.
There is little evidence of a major interaction between MAOIs and sumatriptan, apart from decreased metabolism of the sumatriptan. The contra-indication is based somewhat on the theoretical possibility of a toxic reaction, but mainly on medico-legal considerations. It's a shame that the interaction hasn't received more study since depression and migraine commonly occur in the same patients.
Posted by SLS on March 1, 2012, at 4:24:39
In reply to Toradol for migraine ? (on EMSAM), posted by Maggiemae on February 29, 2012, at 10:22:57
> I had a toradol injection this morning at pain clinic to try to break a 2 week long migraine cycle. 3 hours later not much relief yet. Took a Vicodin to see if that would help me at least sleep a bit while toradol takes effect. No real relief yet.
>
> What do people with migraines do when they are on maois like EMSAM? Imitrex worked great before but now is a no no.
>
> Wondering what tricks my psyc/neurologist might suggest next when I see him?
Maybe Topamax.
- Scott
Posted by SLS on March 1, 2012, at 4:44:09
In reply to Re: Toradol for migraine ? (on EMSAM), posted by ed_uk2010 on March 1, 2012, at 1:43:54
> There is little evidence of a major interaction between MAOIs and sumatriptan, apart from decreased metabolism of the sumatriptan.
I see that sumatriptan is a specific agonist of 5-HT1d receptors. No other serotonin receptors are affected. Do you know of any 5-HT agonists that are dangerous to combine with MAOIs? I take Abilify, which is a partial agonist at 5-HT1a receptors. I don't react badly when I combine it with Nardil or Parnate. Also, what is the function of 5-HT1d receptors other than modulating blood vascular tone? I understand that clinical observation takes precedence over feeble theories, but I am curious.
- Scott
Posted by Maggiemae on March 1, 2012, at 20:55:11
In reply to Re: Toradol for migraine ? (on EMSAM), posted by ed_uk2010 on March 1, 2012, at 1:43:54
Thank you. Interesting about imitrex and MAOI. But it would be scary to try it I think.
But I was afraid to have my first beer, and I was fine! Ha! I suspect I am taking the diet restrictions too seriously.
Posted by SLS on March 1, 2012, at 23:41:47
In reply to Re: Toradol for migraine ? (on EMSAM), posted by Maggiemae on March 1, 2012, at 20:55:11
> Thank you. Interesting about imitrex and MAOI. But it would be scary to try it I think.
>
> But I was afraid to have my first beer, and I was fine! Ha! I suspect I am taking the diet restrictions too seriously.Take the diet seriously.
The requirement to adhere to a special diet is important. I experienced a tyramine pressor reaction to a few slices of pepperoni on a pizza. My head almost blew off with the sudden onset of a pounding headache at the base of my skull. The mozzarella on the pizza was okay to eat. I eat pizza all of the time. It is not okay to eat parmesan. Ricotta is okay. Provolone is not okay. Blue cheese is the worst. Any protein food that is aged or fermented should be avoided. Bottled beer from major manufacturers is okay. Micro-brewery and draft beers are suspect. I have a few glasses of white wine every now and then. I am reluctant to drink red wines, but this might be an old idea.
Here is the old list of foods to avoid:
http://www.livestrong.com/article/301453-list-of-foods-high-in-tyramine/
There are quite a few foods on the list that should not be. It has been quite awhile since we had a thread on the MAOI diet. Perhaps it is time for another one.
Here is a good paper that scrutinizes the old list:
http://psychotropical.com/pdfs/maois_diet_full.pdf
When in doubt, follow the old list.
If you find a concise updated list, please post it.
Warning signs of a tyramine reaction:
Headache
Nausea
Vomiting
Sweating
Fast heartbeat
Dilated pupils
Brain hemorrhage (infrequent)
Death (rare)You can sometimes get lucky and accidentally eat a restricted food without experiencing a reaction. However, this does not guarantee that you will not react to the same food in the future.
- Scott
Posted by phidippus on March 3, 2012, at 17:12:26
In reply to Toradol for migraine ? (on EMSAM), posted by Maggiemae on February 29, 2012, at 10:22:57
Fiorcet
Eric
Posted by Maggiemae on March 3, 2012, at 22:53:13
In reply to Re: Toradol for migraine ? (on EMSAM) » Maggiemae, posted by phidippus on March 3, 2012, at 17:12:26
Thank you everyone. I don't think fioricet is much better than exederin migraine (and the barbituate not much better than xanax i suspect), but I can ask if it is an option for me with EMSAM. I had a rx many years ago but don't recall it working as well as imitrex once I switched to that. Fioricet might work better for tension headaches?
The toradol lifted my headache only briefly- today it came back. Sigh. We shall see. Does anyone have experience with EMSAM at higher than 6mg dose - our plan is to try that first before moving on to something else (parnate?) for migraine prevention. (have already been on the ssri snri merry go round )
The info about tyramine reaction is helpful - I hope I never get to experience it! I have had food allergies all my life so I am used to being careful about what I eat. It can be challenging, but eating fresh foods is actually quite healthy once you get into the habit. I have missed my four cheese pepperoni pizza however, and blue cheese bacon burgers...
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