Triptan the light fantastic
Thursday, August 18th, 2022
I started keeping a headache diary in early 2021. After decades of suffering from migraine headaches, the debilitating attacks had started to get worse and more frequent, and I wanted to work out the patterns so I could maybe do something about it.
The pattern became clear immediately: the headaches almost inevitably arrived a few days before the start of my menstrual cycle, and they were probably getting worse because of hormone fluctuations related to perimenopause. As for what to do about them, that was a trickier question to answer.
Women are more likely to experience migraine than men, so it is supremely unsurprising that, even well into the 20th century, migraine headaches were often dismissed as a psychosomatic problem, and comparatively little effort was put into developing treatments for them. But now, at long last, we know that migraine is a neurological disorder, and headaches are just one possible symptom. There’s no such thing as “a migraine” (though I use this parlance myself). People with migraine will periodically experience attacks (e.g., headaches), but if you have migraine, you have it all the time.
In my quest to get my headaches under control, I’ve become somewhat obsessed with migraine research, and I’ve learned things that have literally made my jaw drop because so much of how I experience the world suddenly makes sense—like why I have to eat regularly (because migraine brains are overly sensitive to blood sugar fluctuations, so I’m like a toddler always needing a snack), why I can’t tolerate bright or flickering lights, why it takes so little for me to feel like everything is suddenly too much:
“The brain of a person with migraine cannot properly process sensory inputs from external stimulation, such as light, sound, smells or touch, even when an attack isn’t happening” (from Managing Your Migraine by Dr. Katy Munro—emphasis mine)
But it’s the attacks that can make the condition unbearable. To avoid delving into the whole history of migraine research (interesting as it is), I’ll just say that the real treatment revolution only started in the 1990s with the approval of drugs known as triptans. My mom was an early user of sumatriptan, the first triptan to be released and the only one available over the counter in the UK. While you don’t need a prescription for it here, you can only get it after consulting with a pharmacist, because it is not entirely without risk.
Triptans are vasoconstrictors, which means they narrow they blood vessels around your brain. (Fun fact: no one knows exactly what this has to do with alleviating migraine pain, because no one knows exactly what’s going on with migraines or why the drugs used to treat them even work in the first place.) The Wikipedia page for sumatriptan succinctly lists some of the potential issues with the drug: “Common side effects include chest pressure, fatigue, vomiting, tingling, and the feeling that the world is spinning. Serious side effects may include serotonin syndrome, heart attacks, strokes, and seizures.”
I bought a box of sumatriptan years ago and never opened it. My migraine headaches were still relatively infrequent and semi-manageable at the time, and while I knew people who sang the praises of sumatriptan, I was too scared of the stuff to try it myself. It had never really worked for my mom, and some people find the side effects worse than the migraine attack itself. My headache pain was bad enough, and I couldn’t bear the thought of trying an unfamiliar drug that might make me feel like I was having a heart attack on top of it. So I’d get a migraine and pointlessly take ibuprofen or paracetamol, and the headache would get worse and I’d think about that box of sumatriptan, and I’d start feeling panicky about the potential side effects and try to convince myself that maybe the headache wasn’t so bad after all, and I’d ride out the pain as always, for hours and hours.
Long after that first box of sumatriptan expired, I went to the pharmacist and bought another one. My headaches had intensified, and I realized that things couldn’t continue the way they were. I couldn’t keep losing entire days to pain and brain fog, and I couldn’t cope with the near-constant anxiety of wondering when I’d get the next headache and how long it would last and how much it would disrupt my life. But I also couldn’t overcome the stupid fear of the triptan, so nothing really changed.
The first entry in my headache diary is from March 13, 2021, when I had an 8-hour migraine with a severity of 7-8 on a scale of 1 to 10 (1 being “this is awful but I can still kind of function”, 10 being “just get me to a guillotine”). The next entry is from May 9, when I had exactly the same kind of headache. After that, there’s an entry for July 19-20, when I had a 12-hour migraine with a severity of 8-9. And just under a month later, I had a whole week of feeling “off” which culminated in a 14-hour migraine with a severity of 8. I noted the usual accompanying effects in the diary: light sensitivity, movement sensitivity, spaciness, hammering pain. Not noted: a feeling of utter despair.
I remember this last headache well (I remember all of the really bad ones well). I remember holding the box of sumatriptan and sobbing, feeling so overwhelmed by pain and so unable to just open the damn box and take a pill. I just couldn’t. I had thought I would do anything to make the pain stop, but couldn’t bring myself to leave the known world of the migraine for the unknown world of the drug. It’s hard to explain that anxiety and probably impossible to understand if you haven’t experienced it yourself. I wonder if it’s something like agoraphobia, a sheer terror of crossing a threshold even though remaining on one side of that threshold is making you miserable.
To be fair, in the case of that last bad headache, the sumatriptan probably wouldn’t have helped at that point anyway. You’re supposed to take a triptan as soon as you feel a migraine coming on, and by then I was likely beyond the drug’s reach. So I rode it out, hour upon hour, trying not to cry, trying not to succumb to the paralyzing fear that the headache might never end, trying to just get through it. And I did. The headache eventually passed.
And at some point in the following days, I finally called my doctor and asked for help. I wasn’t expecting much, to be honest. Many “migraineurs” spend years trying to get the help they need, trying to get someone to take them seriously and prescribe treatments that might actually work. My doctor isn’t a headache specialist, he’s a general practitioner, so I wouldn’t expect him to be up to speed on all the latest migraine treatments. I thought, at best, he might tell me to take sumatriptan, which would kind of bring me back to where I started—though I told myself that, if the doctor himself green-lighted it, I would take the plunge and try it.
Instead, he listened carefully, asked smart questions, and gave me a prescription for eletriptan, a newer triptan which is more effective than many of the others (though it apparently can also have more side effects). I picked up the pills from the pharmacy and was determined to absolutely, definitely take one the next time I got a migraine headache.
I didn’t have to wait long: the next attack rolled around like clockwork about a month later. Of course, I still did the typical migraineur thing of trying to tell myself that what was obviously a migraine was not actually a migraine. I denied reality for two hours, (pain severity: 6) before finally, FINALLY opening the box and swallowing a pill. And then I had to do everything possible to distract myself from my rising panic as I wondered what the drug would do to me.
What it did was this: An hour after the first pill, I felt kind of “floaty” and the headache pain had abated to a 4 (bad but tolerable—I could sit and sort of watch TV). I took a second dose two hours after the first. And three hours later, the headache was gone. Just…gone. No side effects, no lingering pain. As if it had never been there in the first place.
Reader, I cried. I cried for myself and all the months and years of unnecessary pain, and I cried with relief because the seemingly impossible had happened: I overcame my fear, took a pill, and my migraine went away.
I’ve had 13 migraine headaches since then, and they’ve all responded well to the eletriptan. I’ve only reached a 7 on the pain scale once since starting the meds, and that was because I waited way too long to take my first pill. Otherwise my attacks have averaged about a 4 and have only lasted a few hours altogether. My headaches are finally manageable, and I no longer live in constant dread of an attack.
That’s not to say I don’t still worry about getting migraine attacks, because aside from the headache, they just make me feel physically and mentally awful for a while. And every single time I take an eletriptan I think “maybe this time it won’t work”—but so far, it continues to work. So it is not an exaggeration to say that eletriptan has changed my life. I realize this makes me very, very lucky. Triptans don’t help everyone, and some people can’t take them at all because of other health issues. Sometimes they do stop working and you have try a different treatment. They’re not a cure-all, and they’re not preventative, and they do have their potential downsides. But this particular triptan has eased a major burden in my life, and it’s given me some sense of control.
I regret that it took me so long to come around to trying it, but I’m also thankful for every hour of pain and misery that it’s spared me. I still have to put up with my migraine brain, but at least I understand it more now. And by extension, I understand myself more now. I am not my migraine, but my migraine is part of me, and I’m finally learning how to live with it.