I've been on imitrex for 30 years (since it first came out in injection only format). It may be a combination effect that they warn you about, but simply using imitrex long term has not been an issue for me. I used ut 50% of the time until 2002 and then daily AC chemo helped migraines but then a single "monthly" Lupron shot brought them back continuous if i didnt use imitrex, so ive been using it at least daily since. 3x a day after 2020 surgery for several months until the body calmed back down to 1x after vestibular migraine eye movement physical therapy.