D.H.E. 45 injection for migraines
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JessicaH777 posted:
Has anyone ever tried the D.H.E. injection for migraines? I went to the neuro today and he prescribed the D.H.E. injection 3 times a day for 3 days. That seemed like alot. Is it safe to take that much of it in that period of time?

The other problem is my insurance does not cover these injections. The pharmacy said it would be $399 and I am not sure how many injections that was for. Not sure if that would be the whole 9 injections of just part of them.

I have tried many other medications and nothing has worked so far. I have had my current headache for 11 months straight.

I would be interested to hear from others that have tried these injections and whether they worked or not.
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sophiespike responded:
Hi Jessica,

I'm sorry to here that you're still in terrible pain. I, personally have never tried DHE, but coincidentally, I read another post today by someone who is currently hospitalized and receiving the DHE by IV drip. So I researched it, to learn about it. You can do the same thing, here on WebMD, click on Drugs & Supplements and type in DHE 45; what I read is that the longer you wait after the headache starts, the less effective it typically is. But I don't want to discourage you if your doctor thinks it may give you relief. It is worth a try.

About your insurance, I used to work in the h3ealth insurance field, and you may be able to get an override and have them pay at least part of the cost. Call the insurance co. tomorrow and ask for the name, address and title of the claims administrator for your company (employer). Have your doctor write a letter stating that he has tried you on all other covered meds and nothing else worked.

This may not work, but if you are adamant enough, you can probably get reimbursed some portion of what you pay.

As far as the dose he gave you, he is the doctor, and it's up to him to determine the amount you require based on his experience. I am certain he would not have prescribed it if it were not safe.

I wish you the best; please let me know how it goes. If you have any ?s regarding the override for the medication, let me know and I'll try to help you.

Take care, Sophie
 
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JessicaH777 responded:
A little bit of an update. I called the dr on Friday. He wasn't working and they couldn't have the on call dr look at the chart notes (they weren't ready yet since my appointment was Thursday). They finally called back Tuesday afternoon and said just to take the chlorpromazine. It does nothing though. I told them this and they said they would have to call me back.

They called back this afternoon and said they checked with the phamacy and my insurance will not cover injectable migraine drugs. They told me there are no more options left for fighting this headache. The only option they gave me was to try another preventative medication and that might work in a week or two. I am already on 2 preventative medicines Topamax and amitriptiline.

I went to the pharmacy to pick up this new preventative medication and found out that this one has to be pre approved by the insurance company. They said that could take a few more days. It seems the insurance doesn't want to pay for anything.

I am getting very frustrated.

Jessica
 
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sophiespike responded:
Jessica,

Oh boy, just hearing what you are going through is making me frustrated and I can feel a migraine starting (no sarcasm!). In my opinion, and please bear in mind that I am not a physician, only another migraine sufferer like you, but when I hear the words 'no more options,' I start to think 'new doctor' or 'another opinion.'

There have been so many people on this board like you and me who have received the same rotten attitude and inferior treatment by both physicians and insurance companies, it's ridiculous. Doctors are supposed to be our advocates when dealing with insurance companies. We pay our premiums, we pay our copayments, and in turn, we have the right to expect the best care that science and technology today will allow. Instead, people like you, who are in enough pain for so long that you want to chop your own head off, are given the run-around, and the doctor says, no more options?

Ok, I am off the soapbox for now. I just get frustrated as well, because I have been through the same merry-go-round at times for this and other disorders. In my last post, I suggested you try an appeal to get the DHE injections paid for at least in part by the insurance; did the doctor write a letter for you? You have tried every other possibility, and if he includes a list of all other meds tried, they may give the benefit that they would pay for a Tier 3 or Tier 4 drug. I would ask him to write and fax a letter on your behalf.

As for another preventive, since you already have the headache, and for such a length of time, I am skeptical, but who knows?

Jessica, have you ever thought of visiting a headache clinic, where they treat headaches exclusively? That may be a really good option for you. If you live near a large hospital or a teaching hospital, try calling them and see if they have one or if they can refer you to one (try the Neurology Dept first). Headache clinics have teams of doctors who have access to the latest medications and tests available, which neurologists who don't limit their practices to headaches exclusively may not have. I would certainly give this option a try. Short of this, I'd get another opinion outside of the group your doctor practices in. Different groups have different practice guidelines, all within acceptable medical practice of course, so I do believe there are always other options. I am just so sorry for you that it is taking so long to find the right option for you.

Please let me know again how you're doing in a few days. I appreciate the update, and I'll say a prayer for you.

Best wishes, Sophie
 
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kathsteve responded:
Jessica Yes I have used it on occasion when I had to go to the emergency room from being in so much pain and could not stop vomiting. It is my choice of meds over demoral or anything else they try. I just heard on Dr. Oz show that they are coming out with an injection or pill and can't wait to try it. It is fast working. In the meantime I am currently using the new Treximet by the makers of imitrex. Relieves the pain usually within 15-30 minutes and then after about 4 hours I feel great and can go on with life. It can be pricey if your insurance does not cover it. Don't go by what they tell you on the phone. I was told it would cost me $300.00 but when I went to pick it up, it cost me 15.00 and actually got it free because I had a $25.00 coupon which you can find on their website. I am right there with you, I have tried everything from chiropractors, acupunture to hypnotists. The acupuncture did help and waiting to try to get it covered by my insurance because it is not cheap. Nothing with this curse is. I am currently trying the bioidentical hormones (pellets) and a progestrone cream. the cream seems to help the most which is odd since I cannot take any form of estrogen since my hysterectomy. It causes headaches. Hopefully some day, someone will find a miracle to help us all. It does debilitate us from life. I would definitely try the new DHE. I know the shots work in the hospital..my big thing is giving myself a shot. Hate needles unless I am in pain.
 
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sophiespike responded:
Hi Kath,

Do you mean that they are coming out with DHE in a pill form? That's interesting. I've not had to use DHE yet, but I've been suffering lately since entering perimenopause and my hormones have been going all over the place. Since I also have hot flashes and several other symptoms, my gyn had me try fem-hrt, which is a progesterone-estrogen combination pill, but about a week after being on it, I got the worst migraine I've ever had, so I stopped it on my own. I also got a heavy period, which I shouldn'y have, since I'd had an endometrial ablation in March of this year.

What type of cream are you using? maybe that would help me if I go ahead and have the hysterectomy, which I may have to do. I use Topamax and Maxalt now for the migraines, but since I can only treat two attacks a week, I'm starting to be in pain more often than not. I can give myself shots with no problem, so that might be another option for me, I might explore.

Thanks, Sophie
 
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JessicaH777 responded:
Part of the frustrating part of the drs office is of course you can't talk to the dr directly. I have to talk to the receptionist/ or assistant and then they go talk to him. I read the post above that the dr could send a letter to the insurance company to see if they would cover the DHE injections. I haven't talked to the dr yet about this option. The person I talked to at the neuro office just said they weren't covered and I would have to try something else.

I am still waiting to see if I can the new preventative drug. Still waiting for the preauthorization from the insurance company.

I did go the pharmacy too and check the price of the injections it was $399.

I am checking into other neuro drs about 135 miles round trip from here. It looks like there are a couple offices besides the one I am going to. I don't think there are headache clinics around here. I think the nearest teaching hospital would probably be about 4 hours one way from here. But I am checking to see if I can find anything out.

I too have had a hysterectomy but I do not take any hormones for it. I had the ovaries and everything out. That was a little over 4 years ago. I don't feel that it has anything to do with this headache though since it was that long ago.

I feel that my headache is coming from the pain in my neck and shoulders. The neck and shoulder pain is from a car accident almost 2 years ago. I had neck surgery in May 2008 but my pain never got better even after the surgery. I have had an MRI of my left shoulder but it didn't show what is causing the pain.

My PCP left, then I got another PCP but he was only here for the summer. Now I have no PCP. I am seeing the on call dr tomorrow to see if anything else could be done for the neck/shoulder pain. I wonder if I find something to help the pain in the neck/shoulder if the headache will go away.

Jessica
 
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sophiespike responded:
Jessica,

There's a good chance you're right about your neck being the cause of your headache. I apologize, but I can't recall if you did see a chiropractor or tried acupuncture for your pain? That might be helpful. Again, you might not have insurance coverage for these services, but they are becoming more and more mainstream, so you might be lucky. In any case, afresh pair of eyes, your pcp on-call, may be able to catch something or know where to refer you that everyone else missed.

Good luck, and please let us know how it goes.

Sophie
 
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JessicaH777 responded:
I have been to the chiropractor. It makes me really nervous when he pops my neck since I have a metal plate and fusion in there. It didn't help with the pain unfortunately.

I have thought of acupuncture but haven't tried it yet. I haven't found a place yet to have it done. My insurance I think covers part of the cost but you have to go to the drs in the "plan". And of course there are none here. Bummer.

One of the posters above mentioned Treximet. I have tried that one but it didn't do anything for the headache. I have tried alot of different migraine medicines but nothing seems to help.

I wonder if I have a pinched nerve in my neck or shoulder. Certain fingers go tingly. I would wonder if a pinched nerve could cause a never ending headache?

We will see what the dr says tomorrow. Hoping that she prescribes something to help with the neck/shoulder pain.
 
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sophiespike responded:
You are correct to be wary about the chiropractor if you have a metal plate, then, I think. It might be worth your while to drive to an acupuncturist. Personally, if it were me, I would do so. It's minimally invasive, and you can read many scientific reports about it being used successfully to treat migraines. It's certainly more gentle than chiropractic. And, it's very relaxing, which on it's own would help you.

The thing that keeps coming to my mind is, if you've tried so many medications and nothing has touched the pain, no matter what the on-call pcp comes up with, if it's a pain medication, chances are very, very slim that you're going to see relief.

I don't say this to dissuade you, please believe me. And I worry about you putting yet another medication into your system, although that's certainly not my decision. You and the doctor are of course going to make that call. But if you were my sister, Jessica, I would likely try to persuade you to try the acupuncture. But bear in mind that it may take a couple of treatments to get significant relief, although you may feel some reduction in pain after the first time.

I really do wish you the best in finding relief from this monster. Please let me know how it goes tomorrow and what youor doctor has to say. Have a good night.

Sophie
 
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JessicaH777 responded:
Well I saw the on call dr today. The appointment was only 5-10 mins long. She told me there was no way she could figure out today what is the root problem for the pain. She gave me a prescription for 30 vicodin that have to last at least 30 days then there are 3 refills (each 30 days apart). That was it. She didn't even look at my shoulder at all. I felt like she was saying she couldn't help me and wasn't going to try to find the cause of the pain.

I am still looking into acupuncture. It will probably be the next step.

Jessica
 
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JessicaH777 responded:
Well I saw the on call dr today. The appointment was only 5-10 mins long. She told me there was no way she could figure out today what is the root problem for the pain. She gave me a prescription for 30 vicodin that have to last at least 30 days then there are 3 refills (each 30 days apart). That was it. She didn't even look at my shoulder at all. I felt like she was saying she couldn't help me and wasn't going to try to find the cause of the pain.

I am still looking into acupuncture. It will probably be the next step.

Jessica
 
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sophiespike responded:
I'm sorry that the appt went so badly. I agree about the acupuncture as the next step.

If your insurance company has a provider website, see if there is a provider rating available. Or, maybe you can request it over the phone, if such a thing exists. I know the state of Florida makes available lists of doctors, and other medical practitioners, and any ratings submitted by patients, voluntarily, whether good or bad. Or word of mouth also works. Maybe you can find an acupuncture specialist that someone else has seen and would recommend.

Good luck and once again, keep me posted.

Try and relax over the weekend at least.

Take care, Sophie
 
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susiemargaret responded:
hello, jessica --

that doesn't sound like a very satisfying dr's appt; i am so sorry.

both my shiatsu (japanese massage) lady, who is familiar with eastern forms of massage, and my pedicure lady, who is of asian descent, have recommended acupuncture practitioners to me, and i would trust their recommendations (altho i have never gone to any of the people they recommended, but solely b/c i've never decided to try acupuncture). if you have access to anyone who might have familiarity with eastern curative practices, they could be a good source of recommendations for you.

-- susie margaret
 
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dhe45 responded:
just came back from Michigan Head Pain and Neurological Institute .Had a 24/7 headache .They did in two weeks what would take on an out patient basis w/ a neurologist years .DHE took my pain away but couldn't take it daily as an injection,substituted a drug called Methergine,works great. Have inject able DHE for abortive. DHE may be out as an inhalent .it is in phase three clinical trial by Mapp Pharma. Jim Maguire