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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Migranal Nasal Spray
        
(Message started by: Ray on Feb 14^th, 2008, 9:32am)

Title: Migranal Nasal Spray
Post by Ray on Feb 14^th, 2008, 9:32am

Hello Clustervillians:

As many of you know, I went through IV DHE therapy last October and received a 3 month break from CH with only an occasional CH here and there.

I've been getting 3-4 hits a night lately, and day before yesterday, I had my first Kip 10 in many months. This has been leaving me exhausted. Last night, before going to bed (waiting more than 24 hours since the last Imitrex injection) I used a Migranal Nasal Spray to get a good nights sleep.

I'm bringing this up because it isn't talked about here very often, and I feel that it's another good tool for those who respond to triptans and other 5HT receptor effecting medications.

It's fairly simple, you assemble the nasal sprayer, prime the sprayer with a couple of pumps, and spray once in each nostril. 15 minutes later, repeat the spray in each nostril.

Each time I've used this medication, I've had a 24 hour break from CH (remains to be seen this time). I tolerate it well, as I do Imitrex, and the cautions are similar. The only bad side effect that I have is rather severe congestion for several hours after use.

These sprays come 8 to a box. I find it useful to take a short vacation when the hits have me exhausted, and feel that there may be others out there who could use it too.

Here's a link to the maker's page on Migranal NS:

http://prescriptionmigrainerelief.com/HTML-INF/index.shtml

Here's a link to the drug circular in Adobe PDF format:

http://prescriptionmigrainerelief.com/HTML-INF/6_0_Prescribing_Info/migranal_PI.pdf

I hope that this is helpful information to you all.

Wishing you well,

Ray

PS WARNING:

Migranal® (dihydroergotamine mesylate, USP) Nasal Spray should only be used where a clear diagnosis
of migraine headache has been established.
CYP 3A4 Inhibitors (e.g. Macrolide Antibiotics and Protease Inhibitors)
There have been rare reports of serious adverse events in connection with the coadministration of
dihydroergotamine and potent CYP 3A4 inhibitors, such as protease inhibitors and macrolide
antibiotics, resulting in vasospasm that led to cerebral ischemia and/or and ischemia of the
extremities. The use of potent CYP 3A4 inhibitors with dihydroergotamine should therefore be avoided
(See CONTRAINDICATIONS). Examples of some of the more potent CYP 3A4 inhibitors include: antifungals
ketoconazole and itraconazole, the protease inhibitors ritonavir, nelfinavir, and indinavir, and
macrolide antibiotics erythromycin, clarithromycin, and troleandomycin. Other less potent CYP 3A4
inhibitors should be administered with caution. Less potent inhibitors include saquinavir, nefazodone,
fluconazole, grapefruit juice, fluoxetine, fluvoxamine, zileuton, and clotrimazole. These lists are not
exhaustive, and the prescriber should consider the effects on CYP3A4 of other agents being considered
for concomitant use with dihydroergotamine.

Edited to add the warning at the end.

Title: Re: Migranal Nasal Spray
Post by brewcrew on Feb 14^th, 2008, 10:06am

Do you still have to break the vial and then snap it into the applicator? Always seemed to be a pain in the ass.

It worked pretty well for me, but the second application (the one 15 min. after the first) was hit and miss as my nasal passages would get stuffed up from the first one.

I respond even better to the DHE-IV, but who wants to go through all that if it's not necessary. I only do it when I become intractable.

As long as the O2 is still working, as a rule I stay away from all that stuff.

Title: Re: Migranal Nasal Spray
Post by E-Double on Feb 14^th, 2008, 10:08am

I never found it to be a good abortive yet it did "seem" to have preventative qualities for me briefly before going into the hospital.

Yes you still have to break the bottle....bites

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 14^th, 2008, 10:18am

You do have to snap a plastic cap off of the vial and tear off the ring around the rubber plug that seals the vial. Then pull the plastic dust cap off of the straw of the sprayer then screw them together and prime the sprayer 4x according to the instructions.

I didn't use this as an abortive, rather as a short term preventative. That clearly is not it's labeled indication.

Wishing you well,

Ray

Title: Re: Migranal Nasal Spray
Post by brewcrew on Feb 14^th, 2008, 10:24am

That's different than it used to be (late 90's, early 00's). It came in a 100% glass vial, and you positioned it in the plastic case so that slowly closing the lid broke the top of the vial off.

I always worried about snorting glass shards when I sprayed. :o

Title: Re: Migranal Nasal Spray
Post by jace77 on Feb 14^th, 2008, 1:22pm

sorry to hear this Ray, as you know, we have the IM DHE, have had 2 attacks since stopping the s/c therapy yesterday, what about a pred taper?

wishing you painfree days soon!

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 14^th, 2008, 1:40pm

Dear Jace77:

I'm really doing okay, just needed a good night's sleep. My mood is much improved today. I won't use a steroid taper unless I'm building up a new preventative medication in my system.

In my case, I've tried virtually all the preventatives, alone and in combination, without success. For the time being, I'm singing the praises of O2, sometimes Imitrex, and I need an occasional short break, Migranal NS.

Thanks for the pain free wishes,

Ray

Title: Re: Migranal Nasal Spray
Post by superhawk2300 on Feb 14^th, 2008, 8:05pm

Migrinal worked well for me as an abortive the last cycle I had. Seemed to keep attacks off me for about an entire day as well. They were a bit of a pain with assembly and whatnot and I am not a fan of stuff up my nose, but they worked pretty fast for me.

Title: Re: Migranal Nasal Spray
Post by DennisM1045 on Feb 15^th, 2008, 1:00pm

Hi Ray,

Sorry to hear you're getting creamed again. The breaks are never long enough are they :-/ Stay strong my friend.

It's just a though but have you tried any of the longer acting triptans? Frovatriptan or Naratriptan? There is at least one study that showed some promise in this area. This way you wouldn't have to fly nakid for 24 hours before taking the Migranal as a preventative. Here is the content from the OUCH-US site.
I couldn't find a link online.

----------------------------------------------------------------

Sequential Use of Triptans
Even though it is not recommended by the manufacturers, in clinical practice, one may combine a rapid acting triptan preparation such as sumatriptan injection or nasal spray followed by a longer acting oral tablet such as naratriptan. These kind of combinations have reduced the length of headache, reduced recurrence and also helped to cut down the total number of triptan doses taken by the patients.47

Mathew NT, Kailasam J, Meadors L, Gentry P, Chernyshev O. Sequential use of rapidly acting sumatriptan preparations and naratriptan in rapid onset, habitually prolonged migraine. Headache 1999; 39:367-368.

Title: Re: Migranal Nasal Spray
Post by Superdave on Feb 15^th, 2008, 2:06pm

I use Migrainal NS as an abortive. It works about 75% of the time. I also get massive conjestion from its use.
I'm paying about 120.00 for 9 of them out of Canada but delivery is 3-4 weeks. A local pharmacy quoted me 350.00 for a box of 9

Superdave

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 15^th, 2008, 7:58pm

Dennis:

Thank you for the suggestion. I haven't tried those longer acting triptans in conjunction with Imitrex. At one time or another, I'm sure that I've tried them all, by samples from the doctor.

I'm almost to 48 hours PF, [yeah!] with the Migranal and consider myself ahead of the game. I hope that I don't jinx it now.

Wishing you well,

Ray

Title: Re: Migranal Nasal Spray
Post by coach_bill on Feb 15^th, 2008, 8:08pm

i hope you feel better soon Ray. coach bill

Title: Re: Migranal Nasal Spray
Post by brewcrew on Feb 15^th, 2008, 9:32pm

On at least 2 different occasions I've used naratriptan (Amerge) as a preventative. One every 12 hours for about a month.

Title: Re: Migranal Nasal Spray
Post by DennisM1045 on Feb 16^th, 2008, 7:17am

on 02/15/08 at 19:58:43, Ray wrote:

I'm almost to 48 hours PF, [yeah!] with the Migranal and consider myself ahead of the game. I hope that I don't jinx it now.

Like someone said in another thread: "The beast can't read". There's no such thing as jinxing where the beast is concerned. I'm glad you are getting some relief.

-Dennis-

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 16^th, 2008, 6:34pm

Almost to 72 hours, but my hits never seem to follow a schedule. I'm taking on the world, one moment at a time.

Thanks for the encouragement!

Ray

Title: Re: Migranal Nasal Spray
Post by superhawk2300 on Feb 16^th, 2008, 7:07pm

Hang in there Ray and really enjoy your PF times!

I too am in a weird cycle where the timing of the hits does not make sense. I just went 24 hr PF!!! Wooooo!!

I wish I knew why or how.....

Title: Re: Migranal Nasal Spray
Post by Lizzie2 on Feb 16^th, 2008, 10:00pm

Ray - Really glad to hear that you've had a bit of a break since the last Migranal! Unfortunately, Migranal does nothing for me, but I think that's because I've had so many nasal surgeries that I absorb nothing through that route any longer. I use naratriptan (Amerge) and frovatriptan (Frova) as preventives, periodically. Used to be every time I worked, I took one of those - which totaled 4 days a week, and I had that amount approved by my neurologist. (This because they usually say not to use triptans more than 2 days a week.)

I know people use triptans a lot more than twice a week, but I would caution against using Migranal that liberally. It must a much more powerful vasoconstrictor than the triptans, and I know someone who once lost the ability to walk temporarily after doing DHE 5 days a week and had all the vessels in her legs constricted.

One another note for the benefit of people who haven't had success when they've tried Migranal. It must be absorbed in the lining of the nose. You can't sniff it down or swallow it. DHE cannot be absorbed anywhere but intramuscular, intravenous, or intranasal. Sometimes migranal fails for people because they sniff it instead of just letting it sit in the nose and absorbing it there.

I really hope that your break lasts, Ray!!

Hugz,
Carrie :)

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 17^th, 2008, 11:52am

Thank you Carrie:

My break is over, had a couple of CH last nite/early this AM. It was nice while it lasted. Those few days were glorious!

Wishing you well,

Ray

Title: Re: Migranal Nasal Spray
Post by DennisM1045 on Feb 18^th, 2008, 6:28am

[smiley=hug.gif]

-Dennis-

Title: Re: Migranal Nasal Spray
Post by brewcrew on Feb 18^th, 2008, 7:24am

Sux, Ray. Just plain sux.

Title: Re: Migranal Nasal Spray
Post by superhawk2300 on Feb 18^th, 2008, 4:39pm

Sorry to hear that Ray. PF vibes for you........

Title: Re: Migranal Nasal Spray
Post by Lizzie2 on Feb 19^th, 2008, 5:01pm

Ray,

I'm sorry that the beast is back... :(

I don't know if you feel as I do, but when I have a few days without them, it recharges me. Even though it sucks when they come back, I don't feel as desperate or as worn down as I did before. Sure, I miss those days without CH, but I still feel relieved that I had any break from them at all.

Does that make sense? I am glad that your break happened for a few days at least!!

Hang in there!!
Hugz,
Carrie :)

Title: Re: Migranal Nasal Spray
Post by Ray on Feb 19^th, 2008, 5:40pm

Dear Carrie:

I think you described it well. I got some nights where the sleep wasn't interrupted and feel recharged. I'm traveling around with my O2 and Imitrex, ready to deal with the beast if I need to.

Wishing you well,

Ray