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Doctors' Answers to "Frequently Asked Questions" - Migraine Headache
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.
Answer: Not really, you might try a calcium channel blocker instead. Often works without the fatigue.
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.
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.
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.
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).
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]
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]
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
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
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
Migraines & Mental Status [posted
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
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
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
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
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]
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
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
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
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
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
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
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
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
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
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
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.
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.
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.
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.
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
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
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.
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.
Answer: Youve tried the usual things. You dont 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).
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
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.
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
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.
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.
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.
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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