Migraine treatment

Approaches to treating migraine 2

In my first blog post about living with migraine, I said I would go into some of the treatments I’ve tried to help with migraine. I mentioned too that I have fibromyalgia and interstitial cystitis. While trying to find ways to prevent & treat migraine, I learned I’m taking part in the genetic equivalent of a carpool. A few other beasts decided to hitch a ride with migraine: fibromyalgia, interstitial cystitis, TMD (TMJ disorder), and vulvadynia. Doctors call these “co-morbid conditions,” or conditions that occur together in a patient. One doctor said something pulled the genetic trigger.

Susan’s poem for today:

My body is a reluctant Uber driver

For many beasts

With no destination

Or payday in sight

~ Susan B., a migraineur

Maybe my body needs to be an overachiever and amass as many conditions as possible to win some kind of prize?

Whatever the case…

Over the years, I’ve seen six neurologists. All have tried to treat migraine the traditional way. I learned early on that I have chemical sensitivities. Lucky me. Finding the right mix of medications have proven difficult. I frustrated every neurologist I went to see. I know each one wanted me to keep trying the medications they prescribed. At the time I sought treatment, I was working full time so I didn’t have patience for anything that added to my discomfort and pain or prevented me from functioning.

Each neurologist I saw prescribed medication combinations to try to prevent migraine, ease pain, and aid sleep. Often they also recommended supplements or changes in diet. Some of the supplements to add have been magnesium, B-2 (riboflavin), and butterbur. I knew to avoid aspartame, nitrates, MSG and its friends that are masquerading siblings (look for the word “glutamic”). For more, go to: https://www.verywellhealth.com/supplements-that-prevent-adult-migraines-4062641. I did see an allergist and GI specialist and learn I don’t have true allergies to food and environment, nor do I have Celiac disease. I’ve had to go with my own “elimination diet” when it comes to what I can and cannot have to avoid symptoms. I haven’t tolerated supplements well, so I’ve also had to find foods that are rich in B vitamins, magnesium, etc.

Doctors often prescribe medications used to treat other conditions, considered for off-label purposes, to treat migraine. Migraineur and advocate Teri Roberts wrote an article about the various preventive medications that I will include in this post. Drugs for lowering blood pressure, preventing epileptic seizures, managing anxiety and depression, or delaying the progression of Alzheimer’s disease are among the many medications used to prevent migraine.  See https://migraine.com/blog/migraine-preventive-abortive-rescue-medications/.

I just wish more medications were available that were only meant for preventing migraine. The problem for me has been the side effects and my sensitivities to medications. Some people can take the biggest dose of medications without incident. I was taking starting doses and found myself with more debilitating nausea, dizziness, drowsiness, and GI problems. The worst were medications for depression and anxiety. Those took me down the rabbit hole of depression.

Doctors have written about the analgesic properties found in the use of antidepressants for migraine treatment, as well as for increasing serotonin levels. Often at the lowest doses, they’ve helped people end the migraine cycle with the added bonus of better sleep and treatment for anxiety and depression. Some of the drawbacks though are weight gain, GI problems, dry mouth, and suicidal thoughts. I do think the last symptom needs to move to the front whenever doctors prescribe these medications.

I was properly diagnosed with depression and anxiety in college, but I have lived with anxiety attacks since age 6. I did understand why the older and newer anti-anxiety and depression medications were attractive to neurologists I saw. The majority of the tricyclic antidepressants (TCAs) made my eyes and mouth so uncomfortable that I was drinking a lot of water. That just made my IC symptoms flare. When I would titrate down from doses to end treatment, I would develop debilitating anxiety and often would sink into depression for months.

I did try the newer antidepressants the selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). I’ve found that depression increased with the former, while the latter left me feeling void of emotion. And none did squat to end migraine’s reign of terror on my body.

Because I am prone to depression and anxiety, I have declined prescriptions for the newer antidepressants. We are our own best advocates. I learned over time that we choose who treats us. We choose what goes into our bodies.

That said, I have heard great things from other migraineurs who found success with Cymbalta and Savella. Don’t let my experience prevent you from giving treatments a test run: https://www.healthline.com/health/antidepressants-for-migraines.

Now because I did tolerate the TCAs better, I agreed to try doxepin. I have been taking doxepin for approximately four years. I can tolerate this medication at 75 mg but any higher and I am ravenous with hunger – especially for sugar. At this time, I take 50 mg. and it does help me sleep.

As for managing the attacks themselves, I was first given prescription NSAIDs and other pain-relieving combinations not unlike Excedrin. The second neurologist I saw told me about triptans, or migraine abortives, that help stop migraine attacks in their tracks if you get to them early enough.  Some required two doses but still weren’t causing a direct hit on my symptoms. Others were expensive, and I was usually down for the count after the migraine attack lessened: https://migraine.com/migraine-treatment/triptans/

My latest triptan, Relpax, has been the best out of the triptan class. It’s now a generic, eletriptan, but I only receive 18 tablets for a 90-day supply, so six for each month. I have never taken the medication as directed. I would run out if I took a second one the day of an attack. (At the time of this writing though, I take fewer of these because of the new migraine prevention drug, Emgality.) For more information about eletriptan, go to https://www.webmd.com/drugs/2/drug-64733/eletriptan-oral/details

In my next post, I will tell you about the alternatives treatments I’ve undergone to treat chronic migraine. Let me know what medications you have tried that has helped prevent migraine attacks and brought relief from symptoms.

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