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  • Josh Regel

A compounding pharmacist’s guide to Migraines

Have you tried everything for migraines?

Many of our patients that suffer from migraines tell me that they are glad that they asked “What can you formulate for my migraines?”  Many of these patients are desperate for something that really works.  If you or someone you know struggle with migraines I may have a couple new ideas to consider.

It has been estimated that migraines cost ~ $20 Billion a year in medical expenses and loss of productivity.  Affecting 36 million Americans.  Migraines can last from hours to days.  With several reasons that can cause a migraine, it is a difficult problem for patients as well as for physicians to deal with.

What are the current treatment options?

When you are diagnosed with migraines most likely your physician will prescribe a medication that is in the family we call triptans.  Examples of this family are:

  • Imitrex (Sumatriptan)

  • Zomig (Zolmitriptan)

  • Maxalt (Rizatriptan)

  • Relpax (Eletriptan)

  • Treximet (Sumatriptan and Naproxen Sodium Tablets)

  • Amerge (Naratriptan)

  • Frova (Frovatriptan)

  • Axert (Almotriptan)

  • Sumavel DosePro (sumatriptan)

  • Zecuity(sumatriptan iontophoretic transdermal system)

These medications do have side-effects and many cannot take them.  They are also very expensive and can be out of the price range for many patients.  These medications are not recommended for patients that have cardiovascular disease, history of a stroke, and uncontrolled blood pressure.

Another option for patients that have 15 migraines or more a month is Botox.  These injections can cost $6000.00 up to $10,000.00 a year.  And this option requires a monthly office visit for each shot.

Migranal is a nasal spray that can cost $1500.00 up to $2500.00.

With these options many report poor success relieving migraines.  A study has shown that 56% of patients report inadequate relief 2 hours after their treatment.  Since there is not a current cure for migraines and there are many causes, a product that has multiple benefits may be more effective than using just one medication.

What can a compounding pharmacist do for migraines?

A compounding pharmacist can provide medications in different dosage forms

Combining several medications into:

  • capsules

  • sublingual tabs

  • transdermal gels

  • Nasal Sprays

Using TRNA therapy

Taking a medication like sumatriptan in a transdermal gel and administering it at the base of the head/neck area.

Ketamine can help with the prolonged aura that meany patients suffer with as well as increasing blood flow.

Gabapentin reduces the release of inflammatory neuropeptides that are consistent with headache pains, such as calcitonin gene-related peptide and substance-p.

Tizanidine inhibits the release of norepinephrine and acts as a muscle relaxant.

Magnesium reduces inflammation, relaxes muscles and blood vessels, and modulates calcium ion channels within our cells.  This can trigger the release of neurotransmitters.  Magnesium also decreases the release of substance P and may be more effective in migraines with auras.  For more information on Magnesium click here.

Lavender oil is known for its soothing and calming effect.  71% of patients inhaling the fragrance of lavender oil for 15 minutes fully or partially improved their headache.

Lidocaine is a local anesthetic that can help by its membrane-stabilizing effect, which inhibits the release of vasoactive substances from platelets.  This inhibits the inflammatory response.

Caffeine can inhibit neuronal activity.  Activating adenosine receptors leads to antinociception in neuropathic pain and inflammatory models.

Hormones can effect migraines when there is a sudden drastic drop in estrogen usually at the start of a menstrual cycle.  Progesterone can play a huge part at balancing the effects from the estrogen dropping.  Progesterone also calms the stimulatory effect of estrogen.  Read more about Hormones and Migraines click here.

As you can see, a compounding pharmacist can provide quite a few more options than the standard of care.  If you would like me to help you talk with your physician about your migraines give me a call.  What we will do is set up an appointment for you to meet with myself or Anita Hester, RN.  We will work out a plan and send a recommendation for your physician to consider.  Our best results for patients usually happen when we team up with you and your physician.

What is your trick to prevent migraines?  Post in comments below.


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