I’m in a Migraine Attack and Can’t Get Into My Rescue Pills

Sometimes I can stop it–that is if I can function well enough to break the glass vile, open the packages of syringe and filter needle, fill the syringe with the DHE, change back the end of the syringe from the filter to the needle, and give myself an injection in my thigh. If I can think clearly enough to remember the anti-nausea medicine, I may be spared an additional agony (O’Shea, 2020).

Pill Packaging

Source: Volodymyr Hryshchenko/Unsplash

Each of us has stories of frustration, fumbling, and fighting with one or more migraine medications’ packaging. Whether it’s like the one mentioned above or trying to push through a blister pack or peel a corner back when clearly you need scissors or a knife (which may well not be near you when in the middle of a migraine attack), the articles, blogs, and frequent comments from migraine sufferers suggest most of us are exasperated with the seeming thoughtlessness on the part manufacturers when it comes to providing us with the very medications we are supposed to be taking while perhaps in the throes of an attack.

Even headache specialists are frustrated when they hear these stories. After several people discussed this problem, Heidi Schwarz, a retired headache specialist from Rochester, NY, currently working at the University of Rochester Medical Center, stated recently, “I didn’t realize some of these problems. You know, particularly when working in Academia, we prescribe these new medications, but we don’t know how they are presented to patients.”

In her 2014 article, “Outsmarting Triptan Packaging,” migraine patient advocate Kerrie Smyres cited Silberstein and Kesslick’s (2014) article “Removing Barriers to Appropriate Migraine Treatment: Formulary Limitations and Triptan Package Size” and offered interesting consumer information:

Wondering why triptans come in annoying blister packs when they don’t need to? It’s an economic thing. Normally, pharmacies stock medications in large quantities and dispense them for individual prescriptions. When triptans first became available, they were considerably more expensive than many other drugs. To make triptans affordable for pharmacies to stock, manufacturers used blister packs to distribute the drugs in smaller quantities.

Hmmm…

Melissa Arnold, an administrator for Migraine.com, commented:

I think the issue of medication packaging is so universal and needs to be addressed. How often do we all hear stories of folks with arthritic hands, motor skill issues, or grip problems who can't get even standard pill bottles open? There's got to be a better solution – for all of us!

One major concern focuses on the difficulty of opening the packaging to gain access to the medication. Multiple participants had difficulty opening both the blister packs and the pouches. One person remarked, regarding the blister pack, “These are really hard to punch out,” while another who uses the pouches mentioned that “for elderly people, it seems to be hard because it’s hard to tear.”

A recent study on medication adherence mentions that” packaging may also play a role in a patient’s subjective feelings toward ongoing medication therapy” (Chou et al., 2022).

What follows are a sampling of responses I received after putting out a question on my migraine Facebook, and Twitter pages asking for personal experiences with migraine medication packaging: Comments on packaging range from those who use Triptans to those using calcitonin gene-related peptides (CGRPs).

• “OMG!! I've always cursed pharmaceutical companies and their sadistic tendencies towards migraine sufferers! They hate us!!
• “I have used nail clippers and scissors.”
• “My husband must open mine for me. It’s impossible for me to do when I am in the middle of one [migraine]! I’m not sure what the drug companies think we’re going through…but they don’t’ get it!!”
• “I gave up trying to peel the blister packs. I now have a small knife near my pills and just cut them open to the side of the pill.”
• “I always struggle with opening the blister packs; my husband has to be there to help me.”

So, what are some innovative ways to combat these problems?

• On a day you are not having an attack, go through the painstaking effort of opening the medications and putting them in a prescription bottle. Since it is airtight and not clear, dissolvable tablets stay dry, as well. Just in case you need to provide documentation to law enforcement or need to have someone help you take the medications, peel the RX label off the box and tape it on the bottle. Schwarz (2022) stated that this is safe for medications “unless they are melts where special packaging is needed.”
• The World Migraine Summit mentioned they are working on more nasal spray rescue medications to help with this. (Note: Trudhesa would be one such recent example.)
• Consider asking your pharmacist to put the pills in a bottle for you before picking them up; some will, and some won’t.

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I know I’m heading right up to slice open some very difficult packaging and find an old pill bottle. I’ll be ready next time!