Not gonna right a real post today because my head is exploding with pain, as I will explain below. But I do kind of want to crowdsource response to this situation.
So, I get migraines. Nausea, sensitivity, and then shockingly painful throbbing headaches. Luckily there is an over the counter medication made by Company A which pretty much solves all my symptoms. Yesterday I started to get a really bad migraine, and I didn’t take pills right away because I can’t walk so I had to ask my parents to bring them to me and I hate asking for things and anyway, that meant that the headache got really REALLY bad and I need a second pill and then to lie on my back with my eyes closed for a while. And then a third pill 4-5 hours later.
Started to feel better by the evening but still not great, so I asked my Mom to leave the pill bottle by my bed when I went to sleep in case I needed more. Couldn’t sleep, ready to take a pill but couldn’t remember how long it had been since my last one and wanted to be sure I didn’t need to wait a few hours. Because, you know, even common over the counter stuff can cause organ damage if you take too much. Read the label and it said “only take 2 within 24 hours”. !!!!!
I had a moment of waiting for the sensation of my liver failing, and then though “wait, I am POSITIVE that I usually take 3 or 4 pills from Company A before the headache cycle is over, meaning well within 24 hours. Something is weird on this label.” Next day, we cleared out our cabinets and checked all the labels on our medicine from Company A. One bottle said “take no more than 8 in 24 hours”. The other said “take no more than 2”. Then we checked other pills from Company B and C and Store Brand with similar ingredients, adding up the risk factors, everything agreed with the “8” limit, not the “2”. So my Mom called Company A.
This is what she was told. The FDA has decided that if a migraine is not cured within 24 hours by two pills, you should call your doctor. Rather than telling you to call your doctor, they have told the pill companies they need to lie (essentially) on the bottles of things labeled “migraine” so that people will think they can only take two pills and therefore be forced to call their doctor. But if you sell the exact same pill in a bottle without the word “migraine” on it, you label it with the true risk factors.
Check this for yourself! Go to your medicine cabinet and see if you have two identical bottles but one is labeled “Migraine” and if the dosage warning is different. And also, if you have spent years wondering “why are there two versions of the same thing just with different labels?” this is why.
Obviously this is a very stupid policy for 3 reasons (at least):
a) Migraines TOTALLY last longer than 24 hours! Or more like, they surge in and out of existence for days at a go.
b) Putting a warning on the label is not going to make me go to a doctor or an emergency room for a freakin’ migraine, instead I am going to do what I did, stop taking pills because the label told me I should and tough it out in a dark room.
c) Literally the exact same pill from the exact same company, but not labeled “migraine” has no such restrictions. Are you saying anything that isn’t migraine pain, people can decide for themselves when to call a doctor and also can handle truthful warnings on the label?
Seeing as migraines are wildly more common in women then men, is this misogyny?
Or is it just lack of sympathy and understanding for how migraines work and general medical stupidity?
Also, does this mean I CAN take another pill now? Because my head is really starting to hurt again.
dontcallitbollywood 
Maybe misogyny! I think. We do get migraines more than men (I have them too.) Now I have to guess that it’s Excedrin that you’re taking about, but it makes sense to label differently as some people don’t know what migraines actually feel like so the FDA is defaulting to ‘if this is the worst headache of your life go to the ER since it might be an aneurysm.’ But as I type I’m not sure that’s directed at women. I think we are way more in touch with our bodies and what to do. I want to recommend that you ask your doc about Imitrex, which has been a blessing for me. I used to get 3-4 migraines a month, now I get 1-2 but either way 100 mg of that will KNOCK. IT. OUT. Like the happy ladies on the migraine ads, I’m back pushing my kid on the swing! Magic! The first time you take it you need to do it with someone there just to make sure you don’t have an adverse reaction but it’s absolutely worth it. I tried preventive medication and it didn’t help me. And for me personally Excedrin doesn’t do anything. My 2 cents. Feel better! I know it sucks. Hard. But prob not misogyny. Maybe.
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You said the brand name, not me! They can’t get mad at me!
Anyway, whatever magical potion Exedrin uses knocks the headache right out of me. I am soooooooooooooooooooo grateful for that. I don’t need preventative medication or prescription strength, I just pop a couple over the counter pills, woo-hoo! Also, of course, coca-cola.
Sounds like you are in the same place as me with the misogyny! If I have the worst headache of my life, would I even have migraine pills? Or would I have regular pills? If I regularly get migraines and therefore have the pills, wouldn’t I be able to tell the difference between a familiar migraine or a strange headache? But on the flip side, if I am buying something just from the labeling because I have a terrible headache, take 2, and am still sick, I really should go get treated. On the third hand, migraines usually don’t happen in isolation. I mean, my sister got the first migraine of her life at age 30 but was able to call half a dozen relatives to confirm that her symptoms were familiar and get advice on how to feel better.
But even if the warning is dumb (or rather, the lack of warning and rather just changing the number of pills recommended without saying you should go to a doctor), is that misogyny? Or is it just because migraines are such a weird medical issue it can’t be pinned down and is unlike anything else?
On Mon, Aug 3, 2020 at 2:47 PM dontcallitbollywood wrote:
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I’m certainly no doctor but if I understand correctly that you’re talking about the exact same medication which you’ve successfully taken in the past–and had more than 2 pills in 24 hours–I can’t imagine there’s any reason not to take it the same way you have before. I might ask your doctor at your next appointment about it, or send an email if your doctor does that.
I suspect, though, that it isn’t misogyny. It’s just stupidity.
And I’m really sorry to hear you’re suffering through this. Get well soon!
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I just switched to taking pills from the bottle labeled “extra strength” instead of “migraine”. Same pills, same ingredients, bought at the same time, but the bottle says 8 in 24 hours instead because the label doesn’t have “migraine” on it. So now I am taking them as directed and don’t have to worry about it!
On Mon, Aug 3, 2020 at 2:47 PM dontcallitbollywood wrote:
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A pill has no capacity to understand a patient’s situation. That is why we consult doctors. Btw, on Company A’s tablets or for that matter even B and C, dont you have that Rx symbol? The scheduled drug one?
Coming to Migraine and misogny, I would rather call a disease misanthrope. When it happens, it does not judge your character. It only goes after the immunity system.
Either way, I wish you get well soon. And yes, please consult a doctor if things go worse.
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Not sure what you mean by Rx symbol. It’s over the counter mild medication that you don’t need to talk to a pharmacist about or anything. It does give a listing of active ingredients, which is how I was able to look and see that the exact same ingredients had different warnings with a different brand name, which seems odd.
I don’t think Migraines can be misogynist, but for sure over history the way migraine sufferers have been treated has involved occasional misogyny. Just like treatment for menstration issues, menopause, and everything else female body-y.
Thank you for hoping I get better!
On Mon, Aug 3, 2020 at 3:02 PM dontcallitbollywood wrote:
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It’s definitely part misogyny, but also the fact that a migraine can be or be a lead-in to a seizure, so I get that they want you to contact the doctor so that it will at least be monitored. But maybe tell people that instead of weirdly manipulating them through pill instructions, or let doctors take them more seriously so they will dare to go to the doctors themselves.
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Yes! If you put something on the label saying “if a migraine lasts longer than 24 hours” or “if a migraine does not respond to this medication” or whatever, “then call your doctor”, I would actually find that helpful! I wanna know if there is anything that would tell me it is a migraine versus a not-migraine.
I like how most doctors have treated my migraines, meaning “not at all”. I tell them “I get migraines, I take care of it” and they ignore me. Which would be bad if my migraines weren’t treated by over the counter stuff or were a symptom of something big. So I guess I like that they don’t treat them seriously? But yeah, they really should at least as some follow up questions probably.
On Mon, Aug 3, 2020 at 3:09 PM dontcallitbollywood wrote:
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Absolutely they should, because it can also be an epilepsy sympton, and like Rachel said, an aneurysm. I mean, if it’s not, then there is very little they can do so I get it, but they are really underachieving in this field.
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Kind of feels like that’s what it is, they don’t want to ask because then they will feel like they have to do something, and there isn’t actually anything they can do, so better not to open that can of worms.
By the way, just in case you were worried, I did get fully checked out by a million specialists back when I was a kid and started getting weird bad migraines. As the doctor told my parents “her brain is PERFECT”. So if a doctor ever did really push, I could answer their questions and we’d land back at the same place of me handling myself. But they never even ask.
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One of my friends is a doctor. And it has been kinda weird as due to past poverty my family has learned to never go to the doctors. But she has been on me to get a pap smear for years so finally I did last month. It was actually more comfortable to be in that uncomfortable position with a friend than a stranger. Also she prescribed me an inhaler for my exercise asthma which has gotten worse with my newly developed allergies this year, and she prescribed me flonase for the allergies and that has been fantastic. Modern medicine is pretty sweet. But anyway if you had gone into see her and told her you could handle your migraines she probably would have asked you how often you get them. And if you got them within the realm of what is medically considered reasonable, she would have assumed you had it under control, because you just told her you had it under control. That is my defense of doctors, they aren’t mind or body readers, they have to trust what you tell them.
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This is the doctor I prefer! I want one who asks minimal questions and then lets it go. But I am aware that is personal preference, other people want the doctor who chases down every little symptom and makes sure you are really really healthy.
Honestly, the last few doctors I have gone to didn’t even ask a follow up question, just said “I see you get migraines” “yes”, and that was it. Now I want to go to your friend! I should just move to California for the sake of knowing one decent doctor.
On Tue, Aug 4, 2020 at 8:36 AM dontcallitbollywood wrote:
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If you can work remotely from home and like the outdoors where I live is ideal. If you like museums, shopping, eating out, and listening to live music every week, I live in hell.
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I grew up in the worst possible option, urban enough that there was no beauty and no outdoors activities, but a small city so all the music, museums, etc. were kind of terrible.
Top city is totally my first choice (world class museums, movies, an exciting varied population that gives me energy), but I think I’d still go for your option ahead of “3rd rate city”.
On Tue, Aug 4, 2020 at 9:28 AM dontcallitbollywood wrote:
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I don’t know enough about migraines to say, but I might be able to contribute with a quick story. I had kidney stones some years ago, and before I was operated on to get rid of the one that was causing me the most problems, I was taking ibuprofen constantly and preventatively. My doctor told me that I could take up to three at a time, up to three times a day, which is NOT what it says on the bottle. I think only two. Obviously, my situation is different because I don’t know if there are gender disparities when it comes to kidney stones like there might be with migraines, but do with that what you will. My dad had kidney stones too, when I was a kid, but I think our situations were different so that could explain why they “operated” on him faster than they did me. I don’t know. But I can answer questions if you’re curious.
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Okay, that matches with something we were trying to figure out. My Grandpa’s doctor prescribed him pain pills way way above the recommended dose. But he knows it is temporary (as in, Grandpa’s very old so long term damages don’t really matter), and generally how my Grandpa is. So I guess the bottle recommendations are the cautious generally good list, but your doctor might have a better idea of what you need. I ran into that myself with Vitamin D supplements, the over the counter stuff has warnings about taking more than 2,000 a day I think, and then my doctor checked my labs and prescribed me 30,000 pills.
On Mon, Aug 3, 2020 at 5:03 PM dontcallitbollywood wrote:
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I’ve had a similar experience with ibuprofen. I was prescribed the 600 microgram pills once against a pain in my shoulder. As I remember, the label for those listed a maximum dosage at least half again as high as for the regular over the counter non-prescription 400 microgram pills. With the lower dosage, they don’t even bother calling them “non steroid whatever“.
I assumed that they reasoned along similar lines as your migraine medicine manufacturers probably did: If you’re self-medicating with over-the-counter stuff and the unspecific lower dosage doesn’t work, you should probably get a doctor to check out whether there’s anything more specific wrong with you before you increase the dosage. But I agree that it’s stupid to not just clearly state that in the label.
I have often exceeded the dosage recommendation on the over-the-counter ibuprofen for my menstrual pain, so I guess I just see myself in the category “unless prescribed otherwise”.
And yes, Margaret, get well soon.
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No, it is not misogyny. Well, it could be but not in the way you are reasoning. Also, my apologies in advance for the length of the comment. I actually edited it to make it shorter than it originally was, if you can believe it. 🙂
Excedrin for migraine was approved by FDA in 1998, over 30 years since the original product had been on the market. For the product to receive approval, the manufacturer had to conduct separate efficacy and safety trials specifically on migraine patients. Based on those trials, the manufacturer proposed the labeling of “take 2 tablets with a full glass of water; if symptoms persist or worsen, ask your doctor” and not the earlier version. The clinical trial demographic was approximately 80% women. That is a good thing because as you noted, significantly more women than men have migraines, and at the time most clinical trials consisted mainly of men even for those conditions that disproportionately affected women. This was bad. For example, a retrospective analysis showed that 80% of prescription drugs withdrawn from the market from 1997 to 2001 posed greater health risks for women than for men. When it comes to metabolizing medications, men and women are NOT equal. There are so many factors that affect the way a woman metabolizes a medication that is different from to man, including fat storage, gastric acid, hormones etc. For example, estrogen inhibits the way a woman’s liver breaks down medication. So, if the woman’s the liver does not filter a medication similar to a man’s liver, then the concentration of drug in the blood may be higher than expected even when taking a normal dose.
Therefore, while I don’t think the manufacturer nor FDA necessarily composed of this particular clinical trial based on gender, thankfully, circumstances were such that drug was actually studied predominantly in the population that the condition affected. Other medications, unfortunately, had severe detrimental impact on women because of inadequate clinical trials, and it took years before the labeling would be changed to account for gender differences. For example, FDA’s first gender-specific dosage label was for Ambien in 2013, 20 years after the medication had been on the market and years after women kept being arrested in the morning for a DWI while taking the recommended dose because gender differences were never studied.
Now, why did FDA not study and adjust the dosing of all the other non-migraine pain medications? Probably because it wasn’t a high enough safety concern and they balanced that with the fact that asking manufacturers to conduct this type of study and relabel the products would result in the prices of these medications rising exponentially.
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Also, I have a feeling the actual scientific reason for the 2 and not 8 over 24 hours may be to prevent migraine overuse headache or rebound headache. However, I am not sure how extensively it was studied by the manufacturer in 1998.
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For me, that purpose TOTALLY FAILS. You are supposed to take them at the first sign of headache to be most effective, I know that I can only take a limited number, so I wait until I am in excruciating pain and really really need the pill before I take it. And then it doesn’t quite work as well and I just feel sick for a long time.
Also, right now the frakkin frukin weather is making me sick and until God changes it, I’m gonna just keep having that headache and needing to take a pill at least once a day. It’s not fair! Usually when I get a migraine it is punishment for my own bad behavior (had MSG, ate too much chocolate, didn’t get enough sleep last night, etc.). But this is just an out of my control weather headache. BOO!
On Mon, Aug 3, 2020 at 5:23 PM dontcallitbollywood wrote:
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Ugh! I am sorry you are going through this right now. I hope you feel better soon!
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Just woke up, it’s STILL OVERCAST! 3 days of foggy rainy weather and the temperature dropping suddenly. The Weather God hates me.
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I’ll trade you some bright hot sun for some of the that fog. Every week for the past month we’ve had days that are over 100 degrees. It like 105 is becoming normal. Usually we spend the hot months camping in the mountains, but our mountains are overrun with tourists (I don’t blame them for coming but I don’t want to hang out with them). On the one hand the heat isn’t killing me, and my family is spending a lot of time outside (mostly at swimming holes and ponds) but on the other hand I’m sick of sun.
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You know what’s crazy? I haven’t been outside in a week (because my parents live in a walk up apartment and I can’t go up and down stairs), and yet the weather still affects me! you would think in my little air-conditioned locked up room I wouldn’t even know what it was like outside, and yet when it is overcast I feel down, and when it is foggy I get a headache, and when our heat wave finally broke a week ago, I felt better.
On Tue, Aug 4, 2020 at 9:14 AM dontcallitbollywood wrote:
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You are so good at research! I would hire you for these things if I could afford you. Oh! I could just keep putting up random posts about things I wonder about and trick you! Watch out tomorrow for a post on “Gee, I wonder if it is illegal to sign for a package under my parents’ name?” and “Does chiropractic medicine actually work, what does the law say?” and “Wouldn’t it be fun to find out who holds the patent for the sewing machine? I think so!”
Anyway, this all makes sense. So what I am getting is, really all medication should say “for men, take no more than — in 24 hours, for women take no more than — in 24 hours”. But instead, they just relabeled the one medicine that happened to have been tested predominantly on women and is expected to be used predominantly by women. Now I am really curious to check my Midol packages! I bet it is the same, I bet they are more cautious with the same dose that is in other non-female brand medicines.
Also, I won’t die because I took 3 in 24 hours instead of 2 (my foremost concern). It’s not like I’m usually popping them like candy, most of the time I only need one, never more than 4 in 24 hours.
On Mon, Aug 3, 2020 at 5:11 PM dontcallitbollywood wrote:
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You are too kind. I did look up the clinical trials for Exedrine and I do love research but the rest is actually everything I knew because of my day job. Gender differences as it relates to diagnosis and treatment, especially as it relates to FDA is a topic I have heavily researched and spoken about.
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Wish you feel better! I have nothing relevant to add as I can’t fully appreciate the logic behind different labeling. Having never needed headache pills or other gender specific medication, I wasn’t aware of things others have explained, so I’m thankful to know for future reference.
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It is irresponsible behaviour on the part of companies.In India,the problem is even worse,where even kids’ medicine instructions are not regulated.But I would suggest consulting a trusted doctor.Under no circumstances would I take 8 pills of the same medicine without consulting a doctor.
I won’t call it misogyny,but fishy packaging by companies.If you try to get the details of the companies,you might find that they were manufactured on tender without a centralised monitoring,and that adds to the problem.Migraine is more common in women,but even worse with people beyond a certain age so it is questionable for the company to toy with their health.
Another unsolicited advice,avoid taking migraine medication unless after consulting the doctor in person(even though consulting doctors at this time in human history is not advisable).Many of these medicines make you dependent on them even if they were made ethically with proper guidelines.They should be taken as a last resort,even though I admit I have no idea how painful migraines can be.
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Luckily, I don’t have to worry about dependence or bad reactions with these pills. I’ve been taking them almost twenty years. Never a bad reaction, never a dependency. One bottle lasts me two years, I usually have to throw it away when it expires. They have only three active ingredients, it’s not really that powerful, just the combination is somehow more effective than taking a larger does of any individual ingredient in another medicine.
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The way that health conditions and their treatments come into prominence as filmkudhi pointed out depend on the population involved in trials. A study published in 2018 went beyond and showed that depending upon the gender of the investigator the response of those in experiments varies. The article talks about pain senstivity and how when female investigators arw involved male participants are likely to report more pain tolerance. Another factor is the gender of physicians in a speciality. In neurology, for example, only 30 percent of the physicians are female so that in a way impacts how female migraine patients receive treatment.
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That’s really interesting! I saw that myself, I worked at a medical office for a while as a receptionist, and when the regular doctor was on vacation a female doctor would come in to replace him. Male patient would come in say everything was fine, no complaints, to the female doctor. Then the first day the male doctor was back, would insist on an appointment and light into him because everything was terrible.
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The “extra” ingredient in Excedrin that helps with migraines is caffeine, which is a vasoconstrictor. Shrink the vessels, lessen the migraine. Combining aspirin and ibuprofen – both NSAIDs – with caffeine seems to reduce the inflation causing the migraine. However, NASAIDs can cause kidney damage if taken “in excess”. How much is too much? Well, that depends on how much your kidneys think is too much. I avoid NSAIDs as much as possible because if I took them every day for pain, I’d have a whole other issue to deal with. You *can* take more, for a short period of time. Alternating ibuprofen and acetaminophen every 4 to 6 hours has been proven to be at least, if not more, effective than opiates for managing pain. I try to stick to alcohol for pain, as the liver is regenerative and the kidneys are not. Perhaps a Kalua coffee might be in your bets interest??
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Not even gonna risk alcohol! Not for everyone, but for some people, it can be a migraine trigger, Or sometimes some kinds of alcohol (most commonly red wine) can be a trigger. I’d hate to take something to feel better and it makes me worse.
But oh man does caffeine work! Coke is truly almost as good as a pill, it’s just amazing. And no other caffeinated soft drink is as effective. Marees up above mentioned fennel as a cure, maybe Coke has fennel in it along with the caffeine?
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Truth on the alcohol. I cannot drink anything other than very pure vodka; apparently I’m allergic to the molds from the fruit in wines and the grains in distilled spirits.
Any idea what triggered your headache ? My best friend had very debilitating migraines for a long time. Her neurologist suggested trying a low carb diet, and it worked. She also dropped 40 pounds as a side bonus. (I’m beginning to think a lot of people are sensitive to things in foods …)
In any case. headaches are just a weird mystery.
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Oh yeah, I am obsessively on top of my migraines. It’s not even conscious most of the time now, I just ask my body “do you want this food?” and if my body says “NO!” I don’t eat it. Flipside, if my body is saying “you absolutely really really need to give me something salty this second”, I listen to that too. The only thing I can’t control are my hormones and the weather. Even hormones I can navigate, just know that once a month I will be at higher risk and should be more careful. But nothing I can do about the weather. I very much resent that.
I did go to a neurologist specialist once, and he was fabulous and basically just gave me permission to believe my body and not ignore what it was telling me. He also gave me their master list of “Migraine Foods” which was clearly just stuff that had been reported by 2 or more patients. It was hilarious! Everything from “red wine” (pretty standard and simple) to “canned figs”. Who eats canned figs often enough to know they are a migraine trigger?????
On Tue, Aug 4, 2020 at 8:45 AM dontcallitbollywood wrote:
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Canned figs???
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Yes! I’ve never even seen them in the wild, but apparently for someone somewhere they were migraine trigger.
On Tue, Aug 4, 2020 at 11:45 AM dontcallitbollywood wrote:
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Caffeine also works for asthma. A wonder drug.
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I hope you are feeling better now.
I don’t think this example is a misogyny.
What I would consider misogyny is, if there is no effective treatment for migraines, since it is known to affect women a lot.
I too have migraines, used to take 1 tab of brufen(ibuprofen) & go to sleep. That used to work.
I have stopped taking brufen now because of concerns of effect on stomach when taking on empty stomach
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Sharing a few tips on migraine from my experience:
Trigger foods:
Junk food/fried food
Cocoa / dark chocolate
Coffee
Salt/noodles masala etc
Foods that can alleviate symptoms:
Dairy, cheese, for ex: pizza
Fennel
I am a diabetic & I have observed that when blood sugar levels are not in control, it can exacerbate the pain
It seems to me that the pain intensity is directly correlated to the drop in blood sugar levels after it has spike up.
So the way to minimise this would be to avoid high glycemic foods/sweets & include more fibre which will have a dampening effect on sugar levels.
I usually get it on one side of the face, over one eye. This is the same side where my breathing is blocked due to deviated septum. I have not considered surgery to correct it so far, because I am not sure if it will recur & the septum deviate again
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I had not heard of fennel as a treatment before! I have to try that next time.
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Good point, at least there is a medicine.
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I’ve gotten a true migraine only once, when I was pregnant. I was clued in by the fact that I was having trouble seeing. Fortunately my boss at the time got migraines so getting the day off was easy.
I’m somewhat disturbed by the fact that you felt you had to get another bottle so you could follow the instructions on it rather than simply continue to take the medicine you had already taken for years. I’m disturbed because my oldest is also a rule follower to the point that it makes it hard to live life sometimes. I was hoping he would grow out of it… Hope you are feeling better today.
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Life is so hard for the rule followers! My Dad is even worse than me. Most recently, he is feeling mildly guilty because he gained a few pounds and the weight on his drivers license is no longer his true weight meaning it is a LIE on a LEGAL DOCUMENT. Also, during quarantine I have played more board games with him than ever before, and playing board games with a rule follower is Not Great. You must never let your son see the rule book for any game.
On the other hand, my father had a fairly successful and satisfying 40 year career as a lawyer, so loving rules and practices and stuff can be a good thing.
On Tue, Aug 4, 2020 at 9:23 AM dontcallitbollywood wrote:
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He wants to be an aquatic biologist. He has been obsessed with fish for the last 7 years.
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Do fish follow rules? If so, this sounds perfect!
Also, I have a movie for you! Hey Jude is about a young man who loves learning about fish and stuff. He’s autistic, which your son is not, but the same obsessed by fish since he was a little boy thing.
On Tue, Aug 4, 2020 at 9:34 AM dontcallitbollywood wrote:
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