Posts Tagged ‘Migraine preventive medication’

A Certain Level of Brain Freedom

August 22nd, 2010

I am enjoying a long stretch of freedom from pain in the brain. Hooray! I have had only six Migraines since late June. Less than one a week! A better rate than I’ve achieved in the past three years, at least. I began taking the blood pressure medication Lisinopril in late June, and this seems like a winning combination for me. My current regimen includes:

That’s about 15 pills in the morning and 6 at bedtime. If that’s the price of freedom, I can live with it. As always, an unintentional experiment proved how well this regimen is working for me. A few weeks ago I had a Migraine on a Thursday evening and, as I sometimes do, forgot to take my bedtime pills as I was treating the Migraine and everything else went out of my head. The next day we were leaving just after work for our cousins’ beach house and I got up early in foggy post-drome and packed for the weekend before work. I forgot to pack my pills! So just as Danny was leaving the house to come meet me at my office, I called him and asked him to pack them for me. He did that, but when we met up and transferred the bags from the car he was driving to the other, the bag of pills got left behind. We discovered this at about 10 pm at the beach house. So I went without pills for a second night in a row, and missed my morning doses Saturday morning. Danny was a hero and drove over 6 hours round-trip to go get my pills so I could stay through Monday. Two nights and a morning without had a cumulative effect, though, and I had a pretty severe Migraine Sunday night.  It is now two weeks later, took my pills every day and no Migraines in that two weeks!

My Migraine specialist, Dr. Bill Young of Jefferson Headache Center, had said to me , “Six to seven Migraines a month isn’t good enough. We can do better!” (Love this guy! Compare with the last guy who thought I should be satisfied with reducing from 10 a month to 7.) So when I went to my last appointment in late June with the news that my blood pressure had been running high, for the first time in my life, he was excited! I had to tease him about that, how many physicians would say, “Oh good!” on learning that their patient had developed high blood pressure! But he explained that anti-hypertensives can be excellent Migraine preventives, but can’t be prescribed if the patient’s blood pressure is too low. He was confident that the two medications together, along with all my other supplements, would produce better Migraine prevention results for me. And so far, so good! I try not to really measure a trend until it’s been going on for several months, but early results look promising. I am loving the extra time and energy I have for hanging out with family and friends, and getting some chores and projects done around the house. Now if I could just manage the fibromyalgia…

For any of you who see doctors who only know a limited number of Migraine preventive options, or who aren’t comfortable with combining several medications, or who aren’t knowledgeable about supplements, find another doctor! If you aren’t doing daily relaxation, meditation, yoga or another practice to calm your nervous system, get on it! It can take time, but most of us achieve a significant level of brain freedom.

Hope you’re doing well. Leave me comment and let me know how you’re getting on, okay?

- Megan

Smoo cave waterfall photo courtesy of Subflux.

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Blue Tuesdays

April 20th, 2010

On Tuesdays there are staff meetings at my new office, at 8:30 a.m. That may not be ridiculously early, but it means I have to be up at 7 and racing through my morning to get there on time. The nortriptyline I take as a Migraine preventive makes me good and sleepy, and it’s hard to wake up and move on less than 9 hours of sleep. Today I not only had to be awake but to give a little presentation at the meeting on using Facebook and Twitter for business. I am relearning some things I used to know, like how to get up and go even when I don’t feel up to it. How to push myself through times when my focus isn’t there, or I’m a bit fatigued, or to work with a triptan in my system.

Don’t get me wrong, this new job wouldn’t even be happening if my Migraine prevention regimen weren’t working quite well. My Migraines went down by about 60% in the months before I started the job. The challenges of the work routine have them back up a little again, but it’s still significant progress. If I had tried to take on the challenges of this job a year ago, I doubt I could have done it.

I also work an 8 1/2 hour day on Tuesdays and Thursdays because Monday and Friday are my short days and Wednesdays are a day off. That’s just the way we worked out for me to work a 25 hour week. It makes those long days challenging, though. If I don’t sleep well the night before (like last night) and I still go put in a full day, it can lead to an evening Migraine. Right now I am lying down with the laptop, writing to you all after dinner, with a bit of a headache. Trying to see if I can contain it by resting. That works sometimes.

One of the difficulties for me is that I can’t seem to go to sleep and get up at the same time every day the way my Migraine brain demands. I need plenty of sleep, and if I went to bed early enough to make the Tuesday wake-up hour my standard, I’d never get to see my teenage kids or night-owl husband. I’d be best off if I could take a nap to even things out, I think, but short of napping in my car that’s not an option right now.

All in all, I am very grateful to have a job, to be doing professional work and helping people, to be getting some respect and recognition, and earning a living. I am grateful that I still have Wednesdays to keep working at my Migraine coaching. I had forgotten, as a self-employed person for many years, how satisfying it is to leave at the end of a work-day, knowing I had filled the day with doing my best, and that I am done for the day. I am enjoying my evenings more, and allowing myself to relax. Except that these Tuesdays are hitting me hard!

- Megan

Sleepy law student image courtesy of umjanedoan.

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Happy New Year!

February 12th, 2010

What? It’s 43 days into 2010!

I know, but I haven’t posted since January 7th; I feel like I need to catch up with you all. Greetings from snow-bound New Jersey!

I just saw that Medical Assistants.Net listed me as “One of the Top 50 Health and Wellness Blogs to Watch in 2010.” If that’s the case, I’d better get writing!

It’s been a busy month and a half for me. I have returned to my professional roots and taken a half-time job as a lawyer. I love working with you all to help you manage your Migraines, but it’s not keeping me busy full-time. I’m lucky to have a good set of skills to return to, and a great firm owner who knows me, likes my work, and is very flexible about my health needs.

I haven’t missed a day for a Migraine yet, though I have to admit I’ve had a few let-down Migraines after busy days at work. I am adjusting to a new schedule. That takes some time for a Migraineur – our systems crave regularity, and tend to freak out when we change things up on them. It took a few weeks to build enough stamina to have energy left for the other things I do. I am very glad that my preventive medication works well for me, and that my years of practice in managing my Migraines have given me the breathing and relaxation skills to get me through.

When I left the practice of law in 2000 I thought I’d never be able to go back to the pace and demands without frequent Migraines. I’m happy to report that my Migraines haven’t increased at all. Even better, I seem to have a reputation around the office as a calm person and a calming influence. That would have shocked those who knew me a few decades ago! Learning to manage Migraines, to keep my system on even keel, has left me knowing not to sweat the small stuff, and yes, most things are small stuff.

I owe all my subscribers a newsletter, and I am backed up with a couple of book reviews I want to give you. I have some stories about medication allergies for you and some great new products to link to. The Migraine Support & Coaching Group is going well, and I’d love to have more of you to talk to in the meetings! I think I’ve got my new rhythm down enough to be back and talk to you more often.

I hope your winter is going well. Let me know how you’re doing!

- Megan

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Medication Basics

November 3rd, 2009

I’ve been getting a lot of medication questions from readers lately. Of course what we are all looking for is something that will help us feel better, without side effects that mess up our lives! I am not a medication expert. I’m not a doctor, and while I am interested in science I haven’t taken a science class since college, many years ago! What I do is help people with Migraine disease manage their lives, inside of the resources that are available, part cheerleader (you Can do it!), part manager (here’s how – here’s when – let’s plan it), part personal trainer (yes, just stretch a little further, let’s keep it going), part teacher (here’s some knowledge and information that will help).

In my view, medication is a partial solution. We have a brain chemistry that causes us to have Migraine attacks – that chemistry can be partially addressed with medication. We can also have a large impact on our nervous systems through regulating our lives – getting regular sleep and relaxation, eating properly and regularly. Learning our triggers and getting attuned to our energy levels, we can reduce our Migraines. With a combination of medication and this kind of self-knowledge, we can reduce Migraines significantly.

That said, here is some basic information about types medication for Migraine.

  1. anticonvulsants, the same kind of medications that are prescribed to treat epilepsy, such as Topamax or Depakote;
  2. antidepressants, several different classes of these drugs can help prevent Migraines, generally prescribed at a much lower dose than used to treat depression; and
  3. antihypertensives, again, several different classes of these drugs are effective for some people.

No preventive medicine will prevent every single Migraine, and different ones work, alone or in     combination, for different people. A very complete list of these medications is available at My Migraine Connection: Migraine Preventive Medications – Too Many Options To Give Up!

Over the counter pain medications, even if they have “migraine” in the name, do nothing but cover up the pain for a short time, and are not truly Migraine medications. They may be the only alternative for you at a particular time, if you don’t have prescription medications or you can’t take them. But several cautions:

If you have 3 or more Migraines per month, Migraine specialists will consider you a candidate for preventive medication. Most Migraine specialists will prescribe a preventive, abortive and rescue medication for you, so that you can prevent as many Migraines as possible and treat the ones that happen anyway. If your doctor has run out of options, or you are working with a doctor who is not a Migraine specialist, you can get great information about treatment options at My Migraine Connection: Preventive, Abortive, and Rescue Medications – What’s the Difference?

- Megan

Magic pill image courtesy of [O*] ‘BharaT.

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Time for a Change in Medication

May 23rd, 2009

I am stubborn and it takes a while to convince me. At this point I have to finally admit that Topamax is not helping me very much. I diary very carefully and keep statistics on my Migraines, and I can say that since I have been on the Topamax I’ve had about a 20% reduction in my Migraines and overall head pain. Better than nothing, but not much to write home about.  I started on 25 mg in the evening, tried that for a few months, and the first two months saw my Migraines go from 8 – 10 per month to 5 – 6, but I think that was a fluke, because every month since then has been back up in the 6 – 8 range, which is average for me.

My doctor suggested I take the dosage all at night, so that any sleepiness and cognitive side effects would be mostly worn off by morning. This was okay as far as it went, but I discovered after a while that I was having an awful lot of evening Migraines. I also learned that Topamax is pretty well out of your system after around 22 – 23 hours. So the level in my bloodstream must have been getting pretty low by evening, and Migraines were breaking through at that point. When I pointed that out to my doctor, he said that he wasn’t too concerned about it “just for headaches,” he’d be more concerned if I were on the medication for seizures. I have to say I’m getting a bit concerned with a headache specialist who uses the phrase “just for headaches.”

I decided to split the dose evenly between morning and evening and the Migraine preventive effect definitely increased somewhat, but the cognitive side effects became much more noticeable. So much so that after a month on 75 mg I decided it was intolerable; I was getting next to nothing done in the course of a day. So my doctor was certainly right that taking it all in the evening lessened the side effects, it just lessened the main effects as well! I went back down to 50 mg two weeks ago.

But even on 50 mg, I’ve been so slow I am hardly getting anything done and I have almost no days where I am full of energy. I just don’t feel like me, at all. I cut down the Topa to 25 yesterday, as per schedule with my doc. Well I took this morning’s half pill (12.5 mg) and felt all my energy and alertness just drain out of me within about 15 minutes – okay, now I’m eager to be done with the stuff!

The problem is where to go next. My doctor is recommending amitryptaline, an old tri-cyclic anti-depressant. Some people experience sleepiness, fatigue, and weight gain on it. I read on line that some of the top Migraine specialists don’t prescribe it because it is “primitive.” It’s actually off the market as an anti-depressant, but for Migraine prevention is prescribed at a much lower dose than for depression. On the other hand, some people experience no side effects.

I’d like to propose some alternatives to my doctor, but I’m feeling a little overwhelmed by the research involved. I look at side effects lists and I don’t like any of them. I read others’ experience but I know that what was true for them won’t necessarily be true for me. I just know that 6 – 8 Migraines a month is too many. I’ve had worse, and many of you out there live with worse. But I am sure I can do better!

- Megan

Still looking for that magic pill!

Block head image courtesy of Stefan; magic pill image courtesy of [O*] ‘BharaT.

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Pills, Nasal Sprays, Injections, and Now a Patch?

February 27th, 2009

A clinical trial was begun this past fall, of sumatriptan delivered by transdermal patch.  Sumatriptan, the first to be developed of the triptan drugs, is a Migraine abortive, which acts directly on the trigeminal nerve to abort a Migraine attack in progress.  It was available only as the brand-name, Imitrex, until the past couple of months when the pills and the injectable form came off patent and were approved as generics.  Triptans can be taken by about three quarters of Migraineurs and are effective in aborting a Migraine, if taken early enough, roughly three-quarters of the time.

Regarding the patch, I think it’s a good idea. The injections work better than the pills for most people, me included. Bypassing the digestive system seems to limit side-effects, especially nausea, and personally I’d love to have the faster absorption like the injections without the major ouch of giving myself a shot! That said, I imagine the manufacturer is happy to have something they can patent and charge top dollar for, now that the pills and injections are out in generic. Call me cynical… but only partly!

I have to applaud every advance in Migraine treatment, small though it may be. And though you may call me a broken record, I am still your fired up advocate here and want to point out that we have had no new medications developed for Migraine, other than the triptans, in the past 15 years. So a little yay for another way to deliver triptans.

A way bigger yahoo! would be for more effective abortives, that could be taken by people with heart conditions, AND for effective preventives without hideous side effects that are actually developed for Migraine disease, not hand-me-downs from other diseases. Call me crazy? Well, a girl can dream!

- Megan

Patchwork quilt image courtesy of LePetitPoulailler.

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Migraine Prevention – Early Success

November 12th, 2008

Shhh… I’m whispering so the Migraine monsters don’t hear me and punish me… Oh yeah, that’s kind
of like believing in ghosts. But I seem to be having some success with the topamax I’m on for Migraine prevention. I have a Migraine this evening, but I’ve been running six to eight days between Migraines, for the last three or four weeks. For a year and more before that I had been getting several Migraines a week. So the frequency is cut in half, which makes a big difference. These are early results – I’ve had good 3 or 4 week stretches before, so I can’t predict whether this will continue. But I am hopeful!

I’m still on the minimum topamax dosage. I would have increased it several weeks ago but for a switch in insurance carriers making it necessary to delay the glaucoma test Dr. Gerhardstein wants me to have before increasing the dosage. Now I am happy we have taken it so slowly. Clearly my body has had a chance to acclimate itself to the medication. I am not experiencing any of the side effects I had in the first couple of weeks, either.

The biggest surprise to me is that I have more energy generally. I am not exhausted in the afternoon and evening; I feel motivated and I am getting more done. The constant low level of head pain I lived with most of the time is just gone – it seems to me that pain may have been responsible for a lot of my fatigue in the last year. The last two weekends I have done yardwork and projects around the house that I have wanted to do for ages.

There is a downside, though. It’s very easy to start feeling like Wonder Woman in contrast with how I felt before. So once again I need to practice what I preach! Along with my clients, and you dear readers, I need to find that middle ground! For over five years now I have known that to have balance and well-being, to keep my energy up and my Migraines minimized, I need to pace myself. I need frequent breaks, and shifts in focus. I need time off in the middle of the day where I truly rest. I need to pay attention when I feel myself getting wired, when my blood pressure goes up, when I start moving and talking fast, when I feel the muscles in my forehead and scalp begin to contract. These are danger signs for me. Not least because I enjoy them – I like that edgy feeling of moving fast and powering through. But that energy is inevitably followed by a Migraine crash.

A few energy management tips:

  1. Take a break or shift your focus every 45 – 90 minutes. If you are at a computer get up, stretch and do something else for a few minutes.
  2. Take “green breaks” where you go outdoors, look outdoors through a window, look at a green plant, or at the very least look at a picture of a green plant. 2 – 5 minutes can make a huge difference.
  3. Take deep breaths to slow yourself down if you feel your energy or stress level mounting.
  4. Be sure to take a real break in the middle of the day – don’t work through lunch.

I failed at finding the middle ground today. I got a lot done, but there’s a price and I’m paying it. And so I learn my lesson again. I’m grateful to have more energy and less pain, and I’m committed to maintaining my energy by using it wisely! Let me know how you’re doing with your energy today!

- Megan

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Migraine Preventive Medication: Move it on up Slowly

October 24th, 2008

Most medications in use for Migraine prevention have a number of side effects, and many, if not most, migraineurs are sensitive to medications and their side effects.  Topamax, which I am currently using, is used successfully by many and considered to have intolerable side effects by others.  Some months ago I read Teri Robert’s report on Dr. Stephen Silberstein’s (of the Jefferson Headache Center) recommendations for a gradual increase (titration) schedule on My Migraine Connection.  You can read Dr. Silberstein’s Topamax Recommendations
here, regarding how to slowly increase the dosage.  He observed that “proper dosage and titration (tapering up the dosage) is essential for successful use of Topamax.”

Being naturally rather suspicious of medications, I went into my headache specialist with this information, and asked that we titrate slowly.  I was pleased to discover that Dr. Gerhardstein takes an even more cautious approach than I do.  At this point I have been on the minimum dosage for about a
month. I saw Dr. G in New Brunswick again this week and he
wants me to have an eye exam to rule out glaucoma before increasing the
dosage. I have that scheduled for next week. Assuming that exam result
is okay (no reason to think it won’t be), I will go to 50 mg daily after

I asked Dr. G about instituting an increase schedule after that point and he told me
he doesn’t want to go on a regular weekly or bi-weekly increase
schedule because it is easy to “blow right past” the minimum effective
dose that way. He said he thinks many incidents of intolerable side effects
may be from being on too high a dosage. The plan is for me to try each
increased dosage for about 3-4 weeks and then call him to discuss. He
wants me to keep a detailed diary and stay very aware of my body’s

I really like this approach. I know we are all
impatient for results, no one wants to stay in pain and with the
disruptions of frequent Migraines. But I think this way I can minimize
side effects and have the most control and awareness over what is
happening in my body.  If more side effects are experienced on higher dosages, and we could end
up on a higher dosage than we need by not giving each level a  long
enough try, maybe a very slow titration increases our chance of finding the
level that is optimum for each of us, with the best balance of Migraine
prevention to side effects.  In the meantime, we can be listening carefully to our bodies and observing their reactions.

- Megan Oltman

Ocean daybreak image courtesy of Hideyuki Kamon.

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Topamax Trials

October 8th, 2008

Just a quick update on my trials of/on Topamax.  No tribulations so far, knock wood (picture me
knocking on my head.)  I’ve just finished my third week on the minimum dosage.  This is too soon to tell whether it is working as a preventive.  I have had 5 Migraines in those 3 weeks – which is on the low side of average for me, but three weeks is not a good sample – any given three week period could be better or worse.  More to the point I may need a higher dosage for full effectiveness, and the medication takes some time to build up in the system.

Topamax is an anti-seizure medication, originally developed for the treatment of epilepsy.  Its Migraine preventive effect was discovered in some epileptic patients who were also Migraineurs.  It is currently one of very few medications actually approved by the FDA for Migraine prevention, all of them originally developed for other purposes.  There are 100 other medications that have been effectively used to prevent Migraines; Topamax is not the only game in town.  It may be the first some doctors try, since it is fairly well known, but unfortunately also has a high side-effect profile.  For people who are sensitive to medications, as are many Migraineurs, this is a dilemma.

Typically people feel tingling in their fingers and toes, less often in the lips and other places.  I emailed my doctor after about a week on the stuff when I was having intense itchy tingling in my lips and nose, tongue and TEETH (who ever heard of itching teeth?),
top of my scalp, behind my ears, my kneecaps, elbows, ankles, tops of
my fingers, outsides of my thighs, shoulder blades, upper eyelids. It
kept waking me up one night.  I was worried that this might be an allergic reaction.  Dr. G emailed back that unless there was a rash, it was probably not a problem.  I had no rash and the tingling disappeared the next day.

The other side effect I was most concerned about was mental cloudiness.  Some people have reported so much mental fog and forgetfulness that the drug has earned the nick-name Dopamax!  I’ve had a little trouble with finding the right words, but that seems to be passing.  I’ve found that my ability to multi-task, or keep a sequence in my mind is somewhat impaired.  I have to concentrate harder, write more lists since my ability to make a mental list is less than usual.

I’ve been pretty sparse with the posts here the last few weeks and I put that down to adjusting to the new medication.  I am lucky that I’m not spacier still.  After nearly 50 years you get used to the way your brain works, and to find your thinking change is a big adjustment.  It’s like re-routing around road work.  I’ve always had a good internal GPS system, but these days I have to pull out a map.  And check it again every few minutes.

- Megan

Block head image courtesy of Stefan; road work image courtesy of Hubbers.

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When is it Time to Use Migraine Preventive Medication?

September 6th, 2008

When is it time to use Migraine preventive medications?  It has been a difficult decision for me, as it may be for many of you.  There are clear medical guidelines, and recent research that backs them up.  And yet it is not an easy step to take.

3 or more Migraine attacks per month

Headache specialists will generally prescribe Migraine preventives if you have 3 or more Migraine attacks per month.  My HA doctor told me his guideline is one per week, on average (which sounds very much like 3 or more per month).  If you think about it, a Migraine every week, or nearly every week, is a threshold level for having a serious disabling impact on your life.   Every week you will lose hours or a day or more to pain, photophobia, nausea, whatever package of symptoms you tend to have.  You will miss work, family time, social time.  You will waste hours in a darkened room.

Silent Brain Damage

There’s more to it than the impact on our daily lives.  Recent research shows that Migraine attacks at a frequency of 3 or more per month, over an extended period of time, leads to brain damage.  The evidence is now very strong that Migraine is a progressive brain disease; it worsens over time.  The more frequent, and longer time since onset of Migraine attacks, the greater risk of damage.  The damage shows up as lesions in the white matter of the brain.  The researchers called it “silent brain damage” because there are no known effects of this damage – yet.

Teri Robert, author of Living Well with Migraine Disease and Headaches, discussed the implications of this research in her recent article on My Migraine Connection,  “Yes, Migraines can Cause Brain Damage.”  Teri gives us an excellent explanation of the research, concluding that:

Migraineurs who experience frequent Migraine attacks and / or have a long history of Migraines are at increased risk of “silent brain damage,” brain damage that (so far) does not seem to cause any symptoms. This again shows that reducing the frequency of Migraine attacks (aka Migraine headaches) is critical.

So why wouldn’t you go on preventives?

I have averaged 7 Migraine attacks per month for the last 9 months.  I have been considering preventive medication for the last 8 months.  My hesitation comes from:

I suspect that many of you who are reluctant to try preventives have some of the same reasons.  Please do leave a comment to share your thinking.

I will be starting preventive medication in less than two weeks when I next see my headache specialist.  I believe in a holistic approach to dealing with Migraines,
including (among other things)  relaxation, meditation, rest, exercise, physical therapy, massage, diet,
trigger-avoidance, and appropriate use of
medications.   At this point, preventive medication is appropriate!  I need to stop losing 6 – 9 days a month to Migraines.

I have my hesitations about the “better living by chemistry” theory.  I think there are inherent conflicts involved in our pharmaceutical production being governed by a profit motive.  However,
that does not mean that drugs don’t save lives and prevent or mitigate disability.  We need drugs
available, and we need much better choices in drugs than we have now.  Holistic approaches
can reduce Migraine frequency, they can help, but cannot change our inherent neurological make-up.  I use supplements and diet to care for my overall health, but if I got appendicitis you bet I would go willingly to that surgeon.  Knowing that I am at risk of brain damage, you bet I will take the drugs that reduce that risk.

- Megan Oltman

Embarking on the pharmaceutical unknown.  Wish me luck!

Pill image courtesy of [O*] ‘BharaT; brain image courtesy of Gaetan Lee.

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