Migraine Medicine And My Peptic Ulcer

[Gaccha]

I developed a peptic ulcer from NSAID usage.

I have taken Omeprazole at 40mg for 17 weeks. The literature indicates 95% of ulcers are cured at 8 weeks.

I am guessing it might be owing to Cafergot usage, that I have only just noticed is classed as a 'Severe Potential Hazard' because of "Methylxanthines are known to stimulate peptic acid secretion".

http://www.drugs.com/disease-interactions/caffeine-ergotamine,cafergot.html

I am in a bind since without the migraine medicine I would be in real trouble.

I am looking for a migraine medicine of about the same cost that has no such danger.

(Sheryl,) Any suggestions?

Thank you!

[Gaccha]

I guess I can answer my own question:

Cafergot-PB Suppositories would be a perfect answer. But do they exist in Thailand...?

[Sheryl]

Suppository form not available here and in any case might not help as the mechanism through which ergotamine = caffeine causes ulcers is not local action on the gastric wall but rather a systemic action of the drug.

I am confused that you say the ulcer is due to NSAID usage, were you also taking NSAIDs?

Both NSAIDs and Cafergot can cause gastric ulcers (and the combination of both, even more so).

So unfortunately you should try to avoid both in future, which does seriously limit your options for migraine prevention and relief.

For prevention of migraine (worth it if they are very frequent), beta blockers (propanaolol, metoprolol etc) taken daily often help. Pizotifen and flunazaine are also often used for this purpose, pizotifen especially in Thailand. Some anti-seizure medications are also sometimes used for migraine prevention, e.g. valprooc acid, gabapentin.

All of these drugs have significant potential side effects and I do not recommend going on them without medical supervsiion.

For relief when migraines have started, sumatriptan (Imigran) or eleptriptan (Relpax) is usually effective if taken early enough, but is unfortunately expensive.

The cerebral vasoconstrictor isoemetheptine also works for many people but while its use is approved in Thailand there does not seem to be any brand registered here. Possible that some of the hospitals have it though. These drugs also have some significant side effects altho not AFAIK contraindicated for people with history of ulcer disease.

Suggested Doctors:

Prof. Anan Srikiathachorn BNH Hospital Wednesdays 5-6 PM only. he is an Assoc Professor at Chulalonghorn (leading medical school) and heads up their headache clinic. has published extensively on migraine in international peer reviewed journals.

Assoc. Prof Nijasri Charnnarong Suwanwela Modays & Fridays Bumrungrad 4- 6 PM Same affiliation as Dr Anan above

Assoc. Prof. Dr. Kongkiat Kulkantrakorn Bangkok Hospital Sunday 08:00 - 12:00 (1,2,3rd Sunday of each month), Monday 16:30 - 18:00

Wednesday 16:30 - 18:00 Thursday 16:30 - 18:00 Saturday 08:00 - 14:00

He is a US trained neurologist specializing in pain management. Not as speciifically focused on migraine as the two listed above but has published on it some, and very specialized in pain management.

Lastly, if you are female, make note of when the migraines occur, if it tends to be in the last 10 days of your menstrual cycle then a bioidentical form of the hormone progesterone may help. In Thailand it is available in micronized oral form, brand name Utrogestan.

[pumpum]

Also, try acupuncture to eventually prevent them from happening.

[Gaccha]

Thanks Sheryl for the answer. To answer your confusion: I had to take NSAIDs for an agonizing pain, and the ulcer promptly started after there usage. I only mentioned it in case the medicine differed from the regular ulcer. Thank you for all the helpful information.

[Gaccha]

Thanks Sheryl. I may have a tough 3 months ahead of me.