Imitrex not working this time, don't want opiates

Patient : Hi - I have migraines that last around three days if they're not aborted. I take Imitrex when I get them, and it usually works great, but today I have taken the maximum dose on my Rx for a 24 hr. period (200 mg) and it's still not gone. I am wondering if I went to the ER, is there something else they could do -- could they give me more Imitrex, or another triptan or something else to try to stop it? I don't want opiates.
Symptoms:  Migraine
Doctor :   Hello. Welcome to Ask The Doctor. We are here to help you. In case of Acute attack of Migraine, the preferred drug is an NSAID like Ibuprofen, Naproxen. Patients who don't respond to oral NSAIDs we prescribe injectable shots. In severe cases, the Intranasal spray of Triptans is very helpful and has been shown to terminate an acute attack within 20-30 minutes. Oral Triptans if they are not helping you then you should visit ER where they would prescribe you intramuscular Diclofenac injection which should terminate the attack. Once the attack is terminated you should see your doctor once again to modify your treatment for Migraine Prophylaxis. I prefer to use Flunarizine and Amitriptyline in such cases. Moreover, you should look for the factors to identify the triggers of your Migraine attack and try to avoid them. Most common triggers being Alcohol, Sleep deprivation, Loud music. You should go to ER. Get a parenteral injection of Pain-killer and go to sleep. Hopefully when you would get up you will feel better. I hope it helps you. If you have any further query, please ask me. Stay Healthy.

Comments / Follow Ups

Patient: Thanks for your help -
Doctor: We are always here for your help.
Wish you good health.

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