Most drugs used to treat pain1 are either antiepileptic drugs (AEDs), or antidepressants that have a positive effect on the neurotransmitter norepinephrine, usually SNRIs like Cymbalta or TCAs like amitriptyline.AEDs are also used to prevent migraines. 

Brand/Trade name  generic name  Approvals  
carbamazepinecarbamazepineTrigeminal Neuralgia, Glossopharyngeal Neuralgia
Cymbaltaduloxetine hydrochlorideFibromyalgia, Diabetic Peripheral Neuropathic Pain, Chronic Musculoskeletal Pain
Depakotedivalproex sodiumMigraine prophylaxis
divalproex sodiumdivalproex sodiumMigraine prophylaxis
duloxetineduloxetine hydrochlorideFibromyalgia, Diabetic Peripheral Neuropathic Pain, Chronic Musculoskeletal Pain
gabapentingabapentinPostherpetic Neuralgia
InderalpropranololMigraine prophylaxis
LyricapregabalinPostherpetic Neuralgia, Diabetic Peripheral Neuropathy, Fibromyalgia
milnacipranmilnacipran hydrochlorideFibromyalgia
NeurontingabapentinPostherpetic Neuralgia
pregabalinpregabalinPostherpetic Neuralgia, Diabetic Peripheral Neuropathy, Fibromyalgia
SavellamilnacipranFibromyalgia
Stavzorvalproic acid delayed releaseMigraine prophylaxis
TegretolcarbamazepineTrigeminal Neuralgia, Glossopharyngeal Neuralgia
TopamaxtopiramateMigraine prophylaxis
topiramatetopiramateMigraine prophylaxis
valproic acid delayed releasevalproic acid delayed releaseMigraine prophylaxis

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2.  Other Meds with FDA Approval to Treat Migraines, Other Headaches, and Neuropathic Pain

2.1  Serotonin Receptor Agonists (Triptans)

  • Zomig (zolmitriptan)
  • Amerge (naratriptan)
  • Frova (frovatriptan)
  • Axert (almotriptan)
  • Relpax (eletriptan)
  • Imitrex (sumatriptan)
  • Maxalt (rizatriptan)

There are conflicting data regarding the safety of mixing triptans with SSRIs or SNRIs.

  • I had a blanket warning about combining the two classes all over this site 2004 – 2009 due to the danger of serotonin syndrome.
  • The FDA caught up with me in 2006 when they issued this alert.
  • Since then it’s been standard practice to make sure no one takes one from column A and one from column B.
    • Except lots of people are probably still taking both.
  • Like I did, the FDA based its warning on a bunch of case reports.
    • As I have a crappy little website, my warning consisted of “talk to your doctor(s) about mixing these two meds that will result in an interaction with a greater than 0 chance of killing you.”
      • Or something like that.
    • When the FDA says essentially the same thing, doctors are the ones who stop prescribing one if you’re already taking the other.
    • Since then I’ve learned that the chance of serotonin syndrome is extremely low no matter what, and the likelihood of it killing you is lower yet.
    • Not only that, we have the best example of contradictory data and dueling studies ever!
  • Like I have, the FDA seems to have changed its mind regarding just how dangerous it is to mix triptans and SSRIsor SNRIs.
    • Have they rescinded their warning? Of course not! The FDA is never wrong. Even though it was updated in August 2013, look at it. Notice anything missing? Where’s Pristiq?
    • The real question is: where the hell is Viibryd? If any med on the planet is going to cause serotonin syndrome when mixed with a triptan it would by Viibryd.

As always talk to your doctor(s). If you have more than one doctor prescribing the medications that could be interacting with each other, try to get them to talk with each other. Good luck with that.

2.2  NSAIDs

  • Bayer Extra Strength Asprin
  • Cambia (diclofenac potassium)

2.3  Other

  • Botox (onabotulinumtoxinA)
  • Migranal (dihydroergotamine)

Crazy Meds Commonly Used Off-Label to Treat Migraines, Other Headaches, and Neuropathic Pain

Brand/Trade name  generic name  Approved Indications  Off-Label Uses  
ElavilamitriptylineDepressionMigraines
PamelornortriptylineDepressionMigraines
TofranilimipramineDepressionMigraines

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4.  Meds not Available in the US Approved to Treat Migraines & Neuropathic Pain

  • flunarizine – a calcium-channel blocker (like verapamil) and antihistamine approved to treat migraines

5.  Devices and other Non-Medication Treatments Proven to be Effective in Treating Migraines & Neuropathic Pain

References

  1. Evans, Randolph W. “The FDA Alert on Serotonin Syndrome With Combined Use of SSRIs or SNRIs and Triptans: An Analysis of the 29 Case Reports.” MedGenMed. 2007; 9(3): 48. Published online Sep 5, 2007.
  2. Kogut, Stephen J. “Do Triptan Antimigraine Medications Interact with SSRI/SNRI Antidepressants? What Does Your Decision Support System Say?” Journal of Managed Care & Specialty Pharmacy. 2011 Sep;17(7):547-51.
  3. Virani, Adil S., K. Bezchlibnyk-Butler, and J. Jeffries Clinical Handbook of Psychotropic Drugs 18th edition Hogrefe & Huber Publishers 2009. ISBN:978–0889373693
  4. Silberstein, Stephen D., Michael J. Marmura Essential Neuropharmacology: The Prescriber’s Guide Cambridge University Press 2010. ISBN:978–0521136723

1 Other than opioids, of course, or medications that treat the source of non-neuropathic pain, like steroids or other anti-inflammatory drugs.

2 Drug study I want to see: Botox vs. Acupuncture vs. placebo instead of Botox vs. sham Acupuncture vs. Acupuncture using Botox. The PI sheet for Botox really stresses the importance of where the injections are placed. I swear it looks like an acupuncture diagram. How much of Botox treatment’s success is due to the paralytic effect of the toxin and how much, if any, is due to it being a form of acupuncture? Of course the injection sites need to be accurate as hell in order to not fuck up something, so the last part of the study may not be ethical.

3 Which is the main reason we don’t discuss medical MJ on the forum. It turns into a holy war time sink. A close second is that smoking, or however you like to ingest your pot is one of the worst things anyone with bipolar disorder or schizophrenia can do. I’m positive all the pot I smoked is one of, if not the main reason I’m now treatment-resistant. I’m all for the full relegalization of cannabis and people who aren’t as crazy as I am getting as high as they want to as often as they want to. I just want a warning label on it regarding bipolar and schizophrenia – even if 1% of pot-smoking nutjobs, at best, would pay attention to it – and more of the tax revenue that goes for mental health treatment programs to go to something other than drug rehab programs.