Hi Mark,

The Cymbalta was prescribed to aid with my mood (depression) and for pain relief; I guess it’s used to relieve pain for people enduring fibromyalgia. The dose I was on for the past year was 60 mg; this aided slightly in mood and did nothing for headache pain. A Neuro I saw then added 25 mg of amitryptiline; this afforded a slight reduction in pain and slightly more when it was increased to 50 mg. However, the side ffects were pretty intense. Because of this I was transitioned to 50 mg of nortryptiline while remaining on the 60 mg Cymbalta.

More recently when I met with 2 Psychs and discusse the side effect issues with both TCA class A/Ds, they thought that Cymbalta would be the best choice for two reasons: i. they thought a higher dose would afford better pain control, ii. the higher dose may alleviate some of the depression that they felt I was still in. Over the past month, I’ve done 2 weeks on 90 and 2 weeks at 120 mg. At 90 there was a significant reduction in pain that didn’t occur at 60 mg. At 120, there may be slightly more reduction, but it’s hard to know for sure. However, both doses display far more efficacy than the 60 mg dose, which in my opinion was ineffective. Two notable side effects are an increase heart rate (up 10 bpm) and an increase in my blood pressure, which is already high.

So, why is a Psych the prescribing doc? It relates to two Psychs and one NeuroPsych believing that my current headaches are from depression, rather than the mTBI. Personally I do not believe this to be the case. It is currently the prescribing Psych who is currently trying to determine which is the causative etiology.

Awesome thought on the Pain Specialist; I’m seeing one in Nov. I wish I had been on this forum much earlier as I believe this specialist will be immensely beneficial. Also, I really, really appreciate the options for headache control. I’ll definitely be bringing these as possible options to my next appointment.

Lastly, that link to the Cornell presentation is fantastic… thanks!!