"I managed them with Migranal. Triptans didn't help."

Similarly, I found that triptans (sumatriptan) wasn't as good or as effective as ergotamine-based formulations.

Whilst sumatriptan worked it didn't suppress migraine pain as effectively as did ergotamine, nor was its effective duration anywhere near as long. A single 1mg dose of ergotamine would last 24 hours whereas 100mg (the stronger dose, 50mg being the other) of sumatriptan would last only 6 or so hours and its action not as effective.

The other problem is that until recently sumatriptan† was much more expensive than ergotamine. I say 'recently' because where I am in Australia the price of ergotamine has gone up eightfold in recent months. Now, it seems the only drugs availabe are the triptans—and that's not the only problem, here triptans are only available in packs of two (or four on script for half strength tablets), which is a ridiculously small quantity—one runs out of the drug when it's most needed. (Clearly, the bastards who set the regulations don't get migraines.)

On the other hand I could get 100 capsules of ergotamine on a single script. As far as I'm concerned, I'm back in the dark ages before my migraines were diagnosed.

No doubt, medicos and pharmacologists who read this will say that triptans are better drugs in that they are more selective, that is their vasoconstrictive effecs are more specific and thus less harmful than ergotamine and no doubt there's some truth to that.

That said, what they and drug manufacturers don't emphasize is that the triptans also have bad side effects such as serotonin syndrome which can be brought on by interactions with other drugs such as the TCAs/tricyclics, MAOIs/monoamine oxidase inhibitors just to mention a few (of the side effects). Also, they quickly become ineffective upon repeated dosing — hence the restricted quantities per script. Yes, ergotamine also has some nasty side effects but not those I've mentioned for the triptans. One of the greatest benefits of ergotamine is that it's just as effective after taking it for decades as when one first starts (I know from experience).

It seems to me the benefits of the triptans have been oversold and that medicos et al actually believe the mantra. It's great for Big Pharma to have everyone believe that given that ergotamine is a readily-available natural product (from ergot fungi), and that any competent lab could refine it for medical use. It's great for Pharma to have everyone believe ergotamine is obsolete.

In the meantime the switch from ergotamine to triptans has caused me nothing but trouble.

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† Before the recent huge price hike a capsule of ergotamine was about $1 versus $8 for the half strength 50mg sumatriptan tablet (where I am in Australia sumatriptan is available OTC in packs of two for ~$16, the full strength 100mg being script only and even then only in packs of two).

Now do the sums: in my case full-strength (100mg) sumatriptan only lasts 6 hours versus 24 for the 1mg ergotamine. Thus the 24-hour cost for ergotamine is [was] $1 whereas sumatriptan is 24/6 x $8 which makes it 32 times as expensive as the ergotamine!

Moreover, in my case, I break open a capsule of ergotamine and take only half (0.5mg) as that's usually all I'll need. So that makes sumatriptan 64 times more expensive. Right, Big Pharma has ripped us off yet again, big-time!

It's damned time governments did something about this.