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Doctors' Answers to "Frequently Asked Questions" - Migraine Headache

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 10/18/1999]
Question: I just started my first year of college in August of 1999.
Since I've been here, I've been under a lot of stress so
I've been getting frequent headaches. I've been using my
Midrin to get rid of the headaches. Also, I've only had
one period since I've been here (it's been about 2 1/2 months),
I was wondering if perhaps the midrin use had something to
do with my missed cycles. I occasionally take digoxin for

Answer: Are you taking the digoxin? This occasionally has a mild estrogen like effect in some patients. I doubt the midrin is doing it, probably the stress. But, if your migraines are frequent you need to be on some sort of preventive medication. Beta blockers would block the SVT generally and are preventatives for migraines, two birds for the price of one(maybe). Also, verapamil would be ok with the SVT and is a preventative also. Discuss, this approach with your md.

[posted 08/21/1999]
Question: I am currently on propronol for my migraine headaches and I am feeling very fatigued all the time. Is there any way to counter act some of the side effects without interfering with the medicine?

Answer: Not really, you might try a calcium channel blocker instead. Often works without the fatigue.

[posted 08/20/1999]
Question: Five days ago I started taking Elavil, 50mg, at bedtime as
prescribd by my doctor for migraine headaches. Every morning, I have had a terribly difficult time waking up (very unlike me). What can you tell me about taking this medication for Migraine headaches? Will the sleepy mornings end? All the information I have seen regarding taking Elavil has been for depression. How does smoking marijuana effect the use of elavil? Thank you in advance for your thoughful advice.

Answer: The drowsiness will persist as long as you take the Elavil. Try taking it a few hours before bed instead of at bed. Also, there are other medications to try if you have not. Check out the FAQ section.

[posted 10/18/1999]
Question: I believe I am addicted to percoset. I began taking it 3 years ago to manage the pain of severe migraine headaches. i would have these headaches everyday. Over the years they have relented, but in the last few months they have become so persistent that for two months I have had to go to ER and have an injection of demerol almost every 10 days. What the hell is happening to me?! I'm scared and in fear of my next headache, but I also can't seem to go through life without percoset daily. I feel like a criminal, and I feel like this is going to kill me. I am finally going to a neurologist, but I'm afraid there's no answer. Has the percoset done this to me? How do you get off it? Is there any treatment program or hope? Please have some answer besides "you're a drug addict, deal with being a creep.".

Answer: First, you will need to get the migraines under control, then take on the drug addiction. It is unlikely that you will be able to stop the medications while still having episodic migraines. But, you can do it. The first step is recognition.

[posted 10/16/1999]
Question: How dangerous is imitrex for a patient with a ventricular septal disorder (hole in the septum) and arrythmia (not sure on the spelling)? Imitrex was taken everyday for two years.

Answer: Imitrex is usually only a risk for patients with coronary artery disease(blockage of the coronaries). This is an unrelated cardiac problem and I wouldn't think of any risk. You can discuss it with the scientific department of Glaxo-Wellcome they will have more extensive data on all the trials- 800-334-0089.

[posted 10/15/1999]
Question: I have had migraines since the tender age of 12. I have worn glasses
since 14. I have a history of seeing doctors for my childhood disturbances
and also for my on-going adult emotonal health.
I presently do take a variey of medications, the doctor is about to place me
on a Beta Blocker. However , he claims it will most likely interfere with my
depression and with winter upon us I am concerned. Yes, the migraines are bad.
I was in the emergenccy dept. to be given a drug called
Torodal and gravel in needles. I am in day 8 of the migrain
it just won't go away. It has subsided a little, I am on other
medication but truly do not feel as though they are the cause.
I also got new glasses too. I am on Prozac 20mg 3X dly.
Clonazapam 0.05mg 2X at bed, rantidine 150mg 2X dly,
Carbamazepine 200mg 3X dly, Ventalin inhaler, Beclovent inhaler
and Feverfew a natural product in capsule form.
I have eliminated tylenol\\#3 forever. I am allergic to ASA and
IBPROPHINS and the N-SAID family of drugs.
What are my migraine pill options now ? Please help me !

Answer: Two possibilities. One is preventive which your doctor is undertaking. Of interest is the fact that nortriptylene(an antidepressant) is often used to prevent migraines-have you tried this with your depression? Also, neurontin is sometimes helpful as is dilantin in occasional patients. I would be reluctant to use beta blockers with your depression, but it may not worsen the depression and is worth a try since they are very effective in migraines. Secondly, are the treatment drugs like Zomig and Imitrex- I assume you are using these with the onset of the migraines? Very, very effective to abort one as it starts. Daily caffeine also helps most migraine sufferers, sometimes even taken as pill(excedrin for example).

[posted 08/10/1999]
Question: My wife has Migraine headaches. She is one to try everyone and
She tried a new doctor (internal med + migraines) who put her on
I read your entire FAQ on Atenolol. She has all the symptoms, fatigue
and is taking 25mg. She also normally has normal to low BP (110/70 down
100/60). Now she is down to 90s/over high 50s and low 60s. She feels
terrible at the low BP, plus fatigue.

Because I am a long time diabetic, I know that she is a border line
diabetic. It is not bad enough to show in an A1c test, but I see it now
then when she has abusive foods that take her glucose to 180 for a short

I did not see even ONE mention of Migraine headache in your FAQ's.

IS Atenolol a proper course of treatment.? She has been on it only a
time, but I am considering having her stop taking it.

Thank you..


Answer: Atenolol is a beta blocker and this class of drugs is one of the preventive drugs used in migraine headaches. Other drugs would be calcium channel blockers, dilantin, aspirin, neurontin, tri-cyclic antidepressants-for the short list.

Migraines [posted 1/14/99]
Question: I am a 28 year old female. In the last six months, I have experienced migraine headaches. They are located in my temple area, behind my eyes, and in the front of my head. I have experienced visions of a fan moving around and around. This would last for five or so minutes, where I would need to lay down. My doctor prescribed nortriptylene HCl, 50 mg. I was wondering if this is something I would need to take forever and what side effects does it cause? My sexual drive is no longer existent.

Answer: Well, if you don't get them very often, Imitrex works great for most patients and wouldn't have side effects. There are two types of migraine treatment - prevention and acute care. Your medication (as well as several others- beta blockers, calcium channel blockers, etc.) is preventive. If you get numerous migraines, prevention plus acute treatment is necessary. Occasional ones do better with Imitrex or equivalent.

Are Migraine Headaches Indicative of Vascular Problems [posted 12/10/98]
Question: I have just recently been suffering from severe pain, localized behind my Right eye. I have also noticed pupil changes. There is no N/V associated with this pain and nothing I have taken seems to alleviate it. I first noticed all of these symptoms after having been put to sleep for a Cystoscopy and Ureteroscopy, which immediately made me worry about an embolus. I went to see my physician, who agreed that it could have been a small clot but he didn't want to be too aggressive, instead he would just watch it. He gave me Imitrex for the headaches to see if it would help. The only thing it did was cause my heart rate to increase to 140. I have had two cardiac ablations for Innapropriate Sinus Tachycardia, and don't have much of an SA node left. Now I am on Norpace CR, and my EKG's reflect Sinus arrest with escape beats and my doctor is talking of a pacemaker.With all of this said, I would like to ask if there are any alternatives to treating this pain without causing other problems. I've been on Beta Blockers in the past, I take Aspirin daily and I still have pain. Please help.

Answer: Did you see an eye doctor? You're assuming a vascular cause, when I would want to ensure that you don't have glaucoma. A neurologist would follow, an optho-neurologist if one is available in your home town.

Cafergot for Migraine Headaches [posted 11/24/98]
Question: I am writing to hopefully find some information regarding any possible or known long-term effects of taking Cafergot. My father - now 80 - has taken this (or its substitute) for his headaches for decades. Can you offer us any assistance or direction? Thank you.

Answer: Cafergot is a drug which causes arterial spasm or narrowing. In the presence of a migraine, it reverses the arterial dilation responsible for the migraines; but, can cause myocardial infarction, stroke etc. Most physicians will not use this drug in patients over 60 or with cardiac disease for this reason. 

Migraine Headaches [posted 11/10/98]
Question: I saw silvery, wavy lines out of my right eye, lasting approx. 3 minutes. After that I got a horrendous headache on the left side of my head. I did not know what medication to take, if any, or what to do. I did lie down and closed my eyes (this happened about 9:00 p.m.) and went to sleep. I did not sleep very well during the night. The headache subsided eventually during the night and I got up and came to work. I just am unfamiliar with what it was, I imagine it to be a migrane, but I do not know for sure. What do you think? I would appreciate any information you could provide me with.

Answer: Well, most likely a migraine. However, if new or a change in your pre-existing headache pattern(which it sounds like), you should get a CT of the head and a neuro exam from your md to rule out other problems.

Migraines & Serotonin [posted 11/6/98]
Question: I read in a health journal that low levels of seratonin trigger migraine headaches. Has this really been proven?

Answer: Inferred.

Migraines & Mental Status [posted 11/3/98]
Question: I am a chronic migraine sufferer. From Sep/Oct 97 - Mar 98 I took approximately 50-60 Fioricet pills combined with about two bottles of Bayer PM, 20 Naproxens, and some Imitrex. Since Mar 98, I have decreased drug usage and I have been seeing a counselor for stress. During that time frame taking that much medication, Can this impair mental functions such as behaviors, impulses, hyper-activity, etc. I think it does, as well as a pharmacologist I have already talked to, but I am looking for a 2nd opinion. Can you help me? I need an answer as soon as possible because your response may have career implications for me. Thankyou

Answer: It would usually be sedating due to the butabital and the antihistamine. Occasional patients have agitation with antihistames(the PM part). The rest would rarely cause problems with mental status.

Migraines in Children [posted 10/30/98]
Question: My son has appeared to get migraines for at least a year now but in the spring they became excessive (4 in six weeks). His doctor treated a "possible" sinus infection and put him on Zyrtec 1x per day to treat allergies. She thinks that possible allergies are not the origin of the migraine problem but may exacerbate them. But, now every time I try to wean him off the Zyrtec, he seems to get a migraine! How can I separate the two problems? Is Zyrtec now a permanent part of his life? Is this a train we will be able to get off eventually?

Answer: Was his sinus problem documented with x rays ,etc? Zyrtec would not trigger migraines. But, some males suffer from cluster migraines that are commonly misdiagnosed as sinus conditions. Antihistamines will sometimes have an effect for unclear reasons. The real question is whether he has two problems or a variation of one. However, if it works I'd stay on it, no major long term problems.

Diet's a Factor in Migraines [posted 10/16/98]
Question: I am 37 yrs old and have had "migraine equivalents" since October 1995. These are not accompanied by aura or nausea, I have a headache on both sides of my head which can last for days and make me feel sluggish, confused, with blood shot eyes and varying-sized pupils. I have tried the usual medications: beta blockers, channel blockers, Indocin, SSRI. Because I have low blood pressure, I couldn't tolerate the betas and channels and the Indocin gave me a raging headache. I like the Prozac because I have more energy, but the headache and symptoms are still there. I can't afford to be a "zombie", what next?

Answer: Sometimes diet can be a major contributor. Get a list from your physician of foods to avoid on MAO inhibitors. These can trigger headaches in many people, especially the cluster variety of migraines. Alcohol can be a major trigger as well.

New Migraine Medication? [posted 10/13/98]
Question: I recently heard that there is a "new" drug on the market that can for some people, eliminate migraines altogether. Is this true? And if so, has it been approved and on the market? And if this is so, what is the name of the drug (generic?) Also, I am taking Imitrex tablets with good results-why would I want to take the nasal spray?

Answer: There is a follow up drug which is similar to Imitrex,very similar. As to the nasal spray, it works faster with less side effects. But, if you are happy with the pills stay with them.

Caffeine & Migraines [posted 10/9/98]
Question:I thought caffeine was one of the causes of migraines. I have found that if I have to take more than 3 fiorinal on a certain day, I wake up with a doozy of a headache the next morning... why?

Answer: Caffeine is usually a treatment not a trigger of migraines. Some patients with a big caffeine habit will trigger migraines if they withdraw caffeine, possibly this is the source.

Migraines [posted 10/2/98]
Question: Vascular headaches. What are the current meds that are available now for this disease? Am sensitive to many meds. Reglan caused extreme restlessnes almost to point of panic, and severe cramping & insomnia. Inderal has been suggested by my GP. Are there any others, beside these two. I'm using Cafergot now, but need a daily preventative med. BP sometimes becomes elevated with these headaches. I use Cardizen 300 CD daily for a BP problem.

Answer: I assume you mean migraine like headaches? Calcium channel blockers like cardiazem are often useful, you might try some related cousins if this is not the answer. Also, beta blockers as well as aspirin are used as preventive. Very useful with co-existing hypertension. Watch your pulse rate if combining calcium channel drugs and beta blockers. Some have tried neurontin also with mixed results. Lastly, Imitrex during the onset of headache is extremely effective. Do not take with cafergot-try the nasal spray first. Usually very effective in aborting a migraine. Less effective in cluster migraines.

Migraines / Vertigo [posted 8/13/98]
Question: I suffer from both migraines and vertigo. 3 years ago, my doctor at the time said that these two things were related. They both come and go at different times. Sometimes I'm dizzy for 2-3 weeks and I may or may not get a migraine during that spell. Are these two things really associated? My current doctor just hems and haws when I mention them. I'm taking duradrin and imitrex for migraines and meclizine for vertigo.

Answer: They can be if the migraine vasospasm affects the area of the brain that is responsible for balance, etc. However, this is not common. You can test this very easily. If you have onset of a migraine and vertigo, relief of the migraine with Imitrex should relieve the vertigo if they are related. However, more commonly, they are unrelated.

Migraines and Daypro, Zomig [posted 8/11/98]
Question: What can you tell me abokg˙¤hese 2 drugs? Does someone who suffers from migraines take these 2 drugs? What is the best recommend prescription for migraines?

Answer: Daypro is a non-steroidal anti-inflammatory drug usually used for treatment of mild pain. Like any drug with analgesic properties, it can be used to relieve some of the pain of a migraine. However, this drug's onset is fairly slow, so would not be my drug of choice for painful migraines. I've never heard of Zomig. The current best treatment for migraines is Imitrex. This usually relieves the pain very rapidly.

Miacalcin and Migraines [posted 8/7/98]
Question: Has anyone heard of a connection between miacalcin and migraines? Since starting Miacalcin in November, I've had a dramatic increase of migraine auras, which had about vanished since my menopause in 1975. I'm now up to two episodes of aura per day. This is the only change I've made in my medications in recent months.

Answer: According to the literature this is not a problem, but I have one patient with a similar problem. I'm hard pressed to find a connection, but there it is. Stop it for a month or so and restart it and see if it correlation with your migraines.

Zoloft and Migraine Headaches [posted 8/6/98]
Question: Three years ago I was given a prescription for Zoloft to help control chronic combination headaches that had a strong migraine component. All the usual anti-inflammatory medications and other migraine treatments were tried with little or no effect. The Zoloft (100 mg) works remarkably well, however, the side effects of reduced sex drive and weight gain are really becoming tiresome. Are there any alternative medications that might control the migraines without the mentioned side effects? Also, if Zoloft should prove to be the best treatment, is there medical literature available that has dealt with this kind of use? I noticed no mention of it in the Zoloft related FAQs.

Answer: You say all the others have failed, but what have you tried? For example, have you tried calcium channel blockers? Tri-cyclic antidepressants sometimes work (imipramine, etc.) without the same sexual depressive effect that SRI antidepressants have. This is currently not an approved use for SRI antidepressants, but we use a lot of drugs in a pragmatic way that help/work. Usually with migraine sufferers, we work through a list of medications to see what will work with the least side effects.

Migraines in Children [posted 8/5/98]
Question: I have an 11 year old daughter who suffers from migraines. The problem is she has a bad headache every day and now she has not been attending school because of it. She has tried periactin and it didn't work. Now she is on 20 mg of amitriptyline and so far it hasn't worked. She started at 10 mg, one week later increased to 20 mg which she has been on for 5 days, but it still didn't help. Tylenol with codeine doesn't help, neither does fiorset. We have also tried imitrex. One tablet which did nothing. They headaches started after a severe sinus and ear infection. She got better, got another infection a few weeks later and has never recuperated. They did a cat scan and it did show some fluid in one sinus but that's all. They are currently doing MRI's of the brain and c-spine. She did have arnold chiari 3 1/2 years ago, but had surgery and a wonderful recovery. The doctors do not think this is at all related, but we are still searching for answers. She has been allergy tested in the past - last time 4 years ago, but we are going to redo this as well. What have you found effective preventative wise, as well as in pain, relief for children this age.

Answer: First you start with migraines, then switch to sinus headaches and finally arnold chiari. I think the first thing is to focus on the cause of the headache. Coming up with treatment solutions is pointless unless you have a better idea of the type of headache you are treating.

Migraine Treatment [posted 8/4/98]
Question: I would like information on the recently approved nasal spray used to treat migraines.

Answer: I suspect you are talking about Imitrex. Imitrex initially came out as injectable only, then followed pills and finally nasal spray. The spray comes in 20 mg single dose vials - to be used once and thrown away. Comparing injectables to pills to nasal spray, the nasal spray works more rapidly than pills, but less rapidly than injectable. Most of my patients who have used it have less systemic side effects than the injectable (feeling of band pressure etc.) and in general prefer this to the pills. It is a little bulky, but nothing severe - about the size of a small pill container in volume.

Zoloft for Migraine Prevention [posted 7/23/98]
Question: I have been prescribed Zoloft in combination with Toprol for the treatment of chronic headaches (most likely migraines). What is the success of this medication for this type of treatment?

Answer: About 10-20%. There is a long list of potential migraine preventing drugs. Start with one and work through them all to see which ones work for you.

Cluster Migraine Headache Treatment [posted 7/22/98]
Question: How long can I use Stadol NS? Are there any side effects? Also, I was just put on a regiment of neurontin and Pericatin. Is this an effective treatment for cluster headaches? Any adverse side effects? I am 60 and have had these clusters for about 1 1/2 years.

Answer: You can use Stadol NS for long periods, but like any opiate derived type(this one is synthetic) will develop addiction and the negative problems associated with that. Cluster type migraines differ from "regular" type migraine in that the usual treatment and preventive medications may not be effective. However, they do work about 20% of the time and it is worth trying the list of preventive medications and drugs like Imitrex during the onset. I have never used neurontin and periactin for cluster migraines. Neurontin might be one to try, but I'm baffled by periactin. However, few things work so they may be worth a try (after traditional drugs). Lastly, clusters are very unusual to develop at your age. You might want to see a specialist if you have not.

MAO Inhibitors and Migraines
Question: What is an mao inhibitor and how would it work as a preventative medicine for migraine headaches?

Answer: An MAO inhibitor stands for monoamine oxidase inhibitor. This is a class of drugs initially used to treat depression, and now occasionally used for other uses like treatment of migraines and chronic pain. These drugs act at the peripheral cholinergic and adrenergic synapses by inhibiting breakdown of neurotransmitters, thus elevating these chemicals in the critical interface between neurons. These drugs can be effective in migraine prevention in some patients and are usually used if other medications fail in prevention.

Migraine Headaches and Ponstel
Question: I experience migraines generally during menstruation. I've read about taking mefanamic acid (Ponstel) 3 - 4 times a day for a few days during my cycle. Is this drug recommended? Are there any side effects that I should be concerned about?

Answer: Ponstel is an analgesic which is thought to have its effect around prostaglandin inhibition. While this would help the pain, it probably would not affect the incidence or severity of the migraines. Women who experience this type of migraine have several options. First, try a birth control pill with varying amounts of estrogen/progesterone. It seems that the ratio of estrogen to progesterone is the trigger for migraines, not the actual hormone level. You may have to try several, but start with a high estrogen pill and if that doesn't work try a high progesterone pill. Second, try a preventative medication starting about mid-cycle which you would stop at the end of your period. Beta blockers, calcium channel blockers, and some antidepressants are the best. Third, have you tried Imitrex during a migraine? Most patients swear by this drug.

Migraine Neuralgia
Question: Is there any link between cluster migraine, migraine neuralgia and Horner’s Syndrome?

Answer: Some patients who suffer migraines will develop Horner's Syndrome after a migraine. This are usually classic migraines rather than cluster type, but I suppose this has been reported. I don't know of any specific link between the neuralgia and Horner's.

Question: What seems to be the most effective treatment for migraine?

Answer: The best current treatment is Imitrex oral or injectable. That is for headaches while they are present. There is a wide array of preventive methods which vary widely from individual to individual.

Migraine Headaches
Question: What have you found to be effective treatment for migraine headaches? I have had migraines for 20 years and am still searching for a solution. The headaches were pre-menstrual, but I had an hysterectomy in December 1996 and continue to have them. The only other trigger appears to be lack of sleep and fatigue.

Answer: There are several treatments possible for migraines. First, there are preventive medications. These are several and range from aspirin to beta-blockers to certain antidepressants like nortriplyene. Second are acute treatments. These include ergotamine, Imitrex, narcotics, and caffeine. There is a whole list of preventives. Generally, women who experience migraines can start the preventive medications about a week before their period and get relief if it is going to work. Preventive means less frequent and less severe migraines, but usually not absent. Occasionally, certain birth control pills will work by changing estrogen/progesterone levels, but this is usually a last step.

Migraine Headaches
Question: A friend at work told me that she saw an advisory on the news warning about Stadol. I take this drug occasionally to help relieve the pain associated with migraine. Are there any new warnings about this drug I should know of? My pharmicist new of nothing new but reiterated its addictive potential. Are there any treatments I have overlooked in my quest for a pain free life? I currently take 100 mg elavil, daily 0.15mg/day climara, fioricet, imitrex-tab or injection, and stadol as necessary.

Answer: Stadol (butorphanal tartrate) is a synthetically derived opiate antagonist. It seems to have fairly good pain relief characteristics and may be administered IM or by a nasal spray. It may cause drowsiness, occasional low blood pressure, and occasional high blood pressure (rare). The major problem with this drug is the occasional patient with elevated blood pressure. I'm not sure what the problem about the news warning was. Other treatments that you have not mentioned are beta-blockers, regular low dose aspirin therapy, and other antidepressants.

Lighting as a Cause
Question: My step-mother has suffered from migraine headaches for many years. After she retired from teaching high school her frequency of headaches diminished to almost none. She decided to substitute teach for a period of time and on day one she ended up with a migraine. Day two also brought a another migraine. She uses a doctor prescribed, self administered injection to relieve the pain. After thinking over what was different in the teaching environment that might cause migraines, she came across an obvious difference. Every room in the school contained fluorescent lighting. On days three and four, she taught class with some of the lights off in her immediate area and resulted in no migraines. Has fluorescent lighting been considered as a cause of migraines, and is there some type of protective glasses that would help the situation?

Answer: Many things trigger migraines - from different foods to changes in weather. Lights are on this list as well, although less common. Glasses may help. Have her discuss this with her eye physician for a prescription. Also, the injectible drug (Imitrex) now comes in a pill form that is a lot more convenient.

Migraine Headaches/Vision Problems
Question: I am a 50 year old male. Ever since I was in High School I have been experiencing a visual occurrence. It begins with a blind spot that moves to where ever my point of vision is focused. It then gradually transforms into wavering, sparkling, low curved arch that will also move to where I am looking when my eyes closed, as well as open. If I am unable to take steps to help this situation this will last for about a 1/2 hour, ending with a headache on the left side of my head that lasts for a few hours. On the other hand if I take a couple of over the counter pain relievers and can lie down and close my eyes, the "vision problem" only lasts for 10 minutes or so and the headache practically does not occur. Several Years ago I read an article in Smithsonian Magazine that described this malady as a type of migraine headache. I have asked my doctor and my eye doctor about this condition, both of whom had little to offer. Is this some form of migraine headache? Is there something better that I can do when it occurs? Has there been any research to find out what causes this problem? Should I be trying to find if there is something that is triggering this condition?

Answer: This is a fairly classic description of an ocular migraine headache. Migraine headaches occur when there is a spasm of the small arteries in the head. Curiously, some do not produce pain, but only this ocular sensation called a sclotoma. Sclotomas are described as flashing or wiggly lights. Mine tend to be snowflake shaped and pulsating, but there are many types. If you are having frequent headaches there are several preventive methods of dealing with migraines. These include beta blockers, calcium channel blockers, aspirin (once a day), and different antidepressants, especially nortriptline. Once the headache starts, Imitrex is helpful. Caffeine is also tried and true help. There are different medicines available. Discuss this with your doctor. Foods can trigger headaches, especially the tyramine containing foods. These are alcohol (especially beer and malt scotch), heavy cheeses, red wine, and any food containing tyramine. Not every migraine sufferer will have food triggers. If your physician does not have expertise in migraines, I'd ask to be referred to one who does.

Question: I take 40 mg Nadolol and 50 mg Nortriptyline daily for migraine prevention. Still, I feel migraines coming on almost daily but am able to stop them most of the time with two Excedrin tablets. Occasionally, I take 4 to 6 Excedrin in a day. Am I putting myself at risk using this amount of Excedrin? I use Imitrex injections once per month or less when the Excedrin doesn't work.

Answer: Exedrin is a combination of aspirin/acetaminophen/caffeine. The long term toxicity of the combination is in the renal stream. Taking these doses for ten years or so would decrease the function of the kidneys leading to eventual kidney failure or insufficiency. You might want to try caffeine alone, or a combination if each separately. Also, have you tried to increase either of your preventative drugs? Certain diets help occasionally, especially low tyramine diets.

Migraine Headaches
Question: I am a migraine patient under the care of a neurologist. After trying all of the preventive and abortive medications Imitrex, amitryptiline, verapamil, wigraine, DHE-45, etc. my doctor has put me on the chronic pain control of oxycontin each day. I have quite severe breakthrough pain, however. How is such pain usually treated?

Answer: You’ve tried the usual things. You don’t mention beta-blockers. Also, sometimes stopping birth control pills helps. Especially low tyramine diets are helpful in some patients. You can get a list of these from your physician(the same list to avoid for MAO inhibitors).

Migraine Headaches
Question: Do you consider the use of Imitrex as a means of controlling difficult and frequent migraine headaches to be ill-advised? If so, what would you recommend to be safe and effective? Tylenol #3, anti-inflammatory drugs, Elavil, and other prophylactics have been tried, but were found to be ineffective.

Answer: Imitrex seems pretty safe. There is some question as the patients age increases, but younger patients (less than 50) seem at low risk. Long term use of this drug has not been researched. What preventives have your tried? For example, you don't mention calcium channel blockers, beta blockers, and occasionally Tegretol. Are you on birth control pills, which are a known risk factor?

Medication for migraine headaches
Question: I am a sufferer of migraine headaches, and have recently been helped by a neurologist that has given me my life back. I've been hospitalized several times, constant vomiting, dehydration, and allergic reactions to almost every medication available. The question is related to my medication. I've been put on methergine for preventative measures, but I know the drug is not a "good" one because I have to go off of it every six months to take a "drug holiday". The truth of the matter is, I don't understand just how bad it is, or what it can do. Yale New Haven has supported this drug as preventative treatment for migraines. I have just gone back on the drug and my neurologist and I both agree it would be a good strategy to stay on a lower dosage. However, the lower dosage is not effective.

Answer: Methergine (fmethylergonovine maleate) is a synthetic ergot alkaloid. These drugs can cause constriction and spasm of arteries in excessive doses. Hypertension, coronary artery spasm or blockage(causing a heart attack) or spasm of small arteries in organs or skin causing necrosis are the major concerns. Like most drugs physicians would prefer the lowest dose that is going to work.

Question: I am taking nortriptyline for prevention of tension headaches even though this is an anti-depressant drug. How does this prevent headaches? Will my system become accustomed to this medication to the point that I will need to take this to keep from becoming depressed (since I am not suffering from depression)?

Answer: There are several preventive measures to prevent migraine headaches. Use of the anti- depressants, particularly nortriptyline is sometimes effective. This is not an official FDA approval for this use of the drug, but is in very common clinical practice. Exactly why the tri-cyclics prevent migraines is unclear. It obviously has something to do with serotonin and cerebral vasospasm, but is not currently known. It will not affect your current or future risk of depression.

Migraine Headache - Blurred Vision
Question:Can migraine headaches cause blurred vision?

Answer: Migraine headaches are caused by spasm or contraction of the arteries of the brain. As a consequence, any area of the brain may be affected if the blood supply to that area of the brain is impinged. Migraine headaches often cause blurred or double vision. There is a peculiar symptom called a sclotoma which is described as lights or whirling of ones vision. Occasionally, visual symptoms are the only symptom of a migraine and there is not pain involved. In these cases, further evaluation is usually performed to ensure no other cause since migraines usually have pain with their onset.

Migraine Headaches
Question: I am a frequent sufferer of migraine headaches. Currently I am taking Imitrex tablets 50 mg without relief. In the past I have taken cafergot suppositories but I have had many side effects with that medication. I have also used butalbitla comp/cod #3. Any suggestions for different treatment plans would be welcomed.

Answer: There are generally two ways to treat migraine headaches. The first is prevention. There are several drugs which are useful. Generally, these are the beta-blockers(usually used in treatment of blood pressure) and some of the anti-depressants. There is a whole list of individual drugs which should be tried to prevent frequent migraine headaches. These can be as simple as a daily aspirin. Secondly, is the treatment of migraines once they occur. This sounds like the approach that you have used. Possibly, focus on prevention may be useful. Also, it is very common for women to have migraines around certain times of their period. Also, certain drugs are known triggers, the most frequent of these are birth control pills. Other causative agents are foods which contain tyramine. You can get a list of these from your physician.

Migraine Headaches
Question: My Friend`s 11 year old daughter gets migraine headaches. When she watches too much T.V., Gets anxious,or does physical activites. Is there any remedy or I know there are no cures.But would a change in diet or alternative medicines,such as herbs.

Answer: Migraine headaches have several treatment possibilities. The first is prevention. Certain foods can cause migraines in susceptible individuals. In general, these foods are high in tyramine. A complete list can be obtained from a physician or nutritionist. These include chicken liver, pickled herring, cheese, yogurt, sour cream, beer, wine, broad beans(like fava), figs, bananas avocados, soy sauce, raisins and chocolate. Second are drugs used to prevent migraines. These include beta-blockers and certain anti-depressants like amitripline, and nortripline. Calcium channel blockers are occasionally helpful and a daily aspirin is helpful in some patients. Treatment during the headache is a different level of treatment altogether. Narcotics are used sparingly due to their addictive potential-but; are effective. Ergotamine preparations are used either sublingually or orally. Newer agents include Imitrex(cerenex) which is available as injection or pill. Other agents are on the horizon but, not currently released in this country.

Low Seratonin
Question: I have heard that migraines can come from low seratonin levels. Is this true? I have an 18 year old daughter that has had them for years. She does not like to take meds so she tries to sleep them off. She tried the Imitrex injection but it put her in such a panic attack that she now refuses to take anything stronger than tylenol pm. Chiropractic Care helped for awhile but then the headaches came back. At one point one Chiropractor was able to snap her out of a migraine by snapping her neck. It took 3 attempts in 30 minutes but by the time she left the Chiropractors office her headache was gone. Can I buy Seratonin in some form for her to try and stop the migraines? She is extremely active between school, work and social activities.

Answer: I don't hear that she has ever tried the preventative medications. These would be beta-blockers, daily aspirin, imipramine, depakote, calcium channel blockers. This is about the order that most physicians try. Success varies;but, can be dramatic. Also, if she is taking birth control pills these should be stopped if possible-a potential causal factor in women.

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