Hi,

I suffered a TBI and ear damage in an explosion in Iraq 4 months ago. I was knocked out for a couple seconds. Initially, I thought I was OK, I had headaches and tinnitus right afterward, but was told these would go away with time. Then, I developed Eustachian Tube Dysfunction followed by a nasty "staph like" drug resistant infection. I have tubes in both ears.

Although I had headaches from the time of the blast, the headaches became much worse about 2 1/2 months ago. This was troubling because it was about 1 1/2 after the blast injury. Most of the time I have minor head pain...more of discomfort variety. Then they got more severe. I began to get migraine like headaches (2-3 a day)...some so severe it would bring me to my knees. I would have to lie down in total silence. (sensitive to light and sound). Usually, they would last about an hour or two--in which I couldn't do anything. No specific trigger...they might happen as I was sitting calmly reading...you never know. Also, I got other TBI symptoms...dizziness, I was irritable...even at minor things. I also began to forget things...like shopping lists.

Anyway, I've been seeing neurologist. I was intialkly prescribed Tramadol for the pain, and then Nortriptyline for migraine prevention. I started at 25mg once at night. That decreased the headaches probably about 50% then moved to 50mg at bedtime. That didn't really help the headaches anymore, but I began to notice the side effects. I was REALLY drowsy and I started to have mood swings (I'd be sad or anxious for no reason). So, we decided to go back down to 25mg again. Also...my DR is trying to get me off to use Naproxen instead of Tramadol if I can. That was last Tuesday.

This week has been rough. So far, the moods got worse as i went down. I had a pretty bad anxiety attack Friday for no reason at all. The headaches have come back...worse with the 25mg than before. Still better than nothing, but not as effective as before. Naproxan does nothing for me except upset my stomach, Tramadol works...but it isn't as effective as when I first started taking it (it takes more for the same effect).

So...my question...what migraine preventative medications are peaple using? My Dr mentioned Blood pressure medication and possibly anti seizure. What about side effects? Does anyone take a combo (anti depressant and hiogh blood pressure). Help..this really gets me down. I don't like the way I feel with the Nortriptyline....but I can't stand the pain...that is worse.

Nate

I'm very sorry. I know how debilitating these headaches can be.

I'm not sure you are really going to like the answers...especially in terms of the fatigue part of the medications. However, by combining meds, using small dosages, taking them at night...etc. things can be done to help with side effects.

The Tramadol doesn't make the greatest sense to me. I have not heard of folks taking this for relief of migraine pain, although each person is an individual. Sometimes meds cause a rebound reaction, actually making the migraines come more often. I would be concerned that this medication might cause this.

The Nortriptyline is a fairly common preventative; although there is one called Elavil in that class that is more commonly prescribed. I suspect that they are very similar. They can cause drowsiness and if this is your case, it is best to take them at night and to try to keep the dosage small.

The medication that has probably had the best results is Topamax. It is FDA approved for migraine prevention. However, this medication is NOT without side effects. The worst is that can cause a strange memory loss. However, Topamax might be more effective than many meds and some get nice results when they take it with a med like Nortiptyline. Small amounts of both can be effective. Please inquire about this medication, but recognize that although it can be very helpful, it is somewhat "tricky" in terms of side effects.

To stop the pain, I would ask your doctor about adding Imitrex to the Naproxan. There was a study that showed these two things in conjunction work VERY WELL. In fact, someone recently came out with a combo tablet.

There are some vitamins that might help with migraine prevention. You can take a calcium/magnesium tablet, a B50 tablet and Co-Q10. Other natural things to experiment with: Feverfew and Butterbur. These things will not likely replace medications, but might help to keep them from getting to high dosages.

Ask your doctor about Axid for your stomach or see if you can find it over the counter. Don't take "just anything" because sometimes these meds can give a very headache sensitive person more headaches.

One more thing, if you are not doing so already, keep a food dairy or at least pay attention to the foods you eat. Once you are prone to getting headaches, you might "trigger" easily. Certain foods can make you more "prone." Some are obvious like wine, chocolate and aged cheeses.

If you are a coffee drinker, cut back or eliminate it. What I sometimes do, since these meds can make a person fatigued, is drink a cup with half regular coffee and half decaf coffee in the mornings when I am very fatigued. Then decaf the rest of the day.

Generally, you should avoid coffee and caffeine. Then if you get a a very bad migraine, go ahead and drink some coffee with your medication because it will help to get rid of it.

I have been battling these things for a long time and I know what I am talking about. If your doctor does not have an interest in this topic, please seek a second opinion. I do wish you better days ahead.

Everybody is different when it comes to headache medications. I'm kinda in the same boat as you are, have had post-concussion syndrome for 3+ years. For me headaches are the worst symptom and what I'm being treated for the most. Wake up with them and they just don't go away, varying in intensity throughout the day.

The first medicine I was prescribed was Amitriptyline ha, was a long time ago so I forgot what kind of side effects it had on me. But it did nothing for my headaches.

Then I was put on Nortriptyline for about 2-3 weeks, I too didn't really like it and for me it had no effect on my headaches. Actually made them worse for the first couple days.

After that I was put on Propranolol for two weeks and that made me feel like ****. Got no sleep the first night on it and never found it effective so my doctor (just seeing my family doctor at this time) took me off of it.

Then I was put on Topomax which did seem to help a little but my doctor noticed it gave me a racing heart so I had to stop taking it.

After Topomax I was put on Depakote, which was the worst medication I ever took. I had to go to the ER the second day of taking the medication due to a resting heart rate of 160+. Obviously I didn't stay on that.

After that my doctor referred me to a neurologist were he put me back on propranolol at an 80mg dosage for 5 weeks because I guess 2 weeks was too short to find out if the med was effective.

During those 5 weeks I moved so I followed up with a different neurologist. And of course I found no change, besides the side effects. So she doubled my dosage to 160mg and I have been on that for almost a month now with a follow appointment in 2 weeks. Propranolol is a beta-blocker (not sure what that means) but it affects blood pressure and lowers the heart rate along with other side effects. I still have a headache everyday..all day long, and I hate this medication and can't wait to get off it - with the increased dosage the side effects are just plain terrible.

Also, I have had Tramadol as prescription somewhere in that mess. I found when I took it really gave me awareness back when I had a headache and made me feel better, more motivated etc. But that would only last for about 4 hours then I would crash harder then I was before, and yeah taking to much will cause rebound headaches and only make things worse.

Hope some of that information helps you, those are all of the medications I have tried..just going through guess and check with meds really.

Hi, I'm Beth. Cymbalta helps me. It's antidepressant with something in it to help pain. It is expensive but worth it/ God bless you.

After several years of migraines, and Imitrex, we are crossing our fingers that my partner may have found some relief. The migraine clinic she went to took her off all her prophylactic meds and switched her from oral to injectable Imitrex . . . and her headaches increased in frequency and severity! She shot through her three month supply of Imitrex in a little over a month! Her "aura" warning consists of severe nausea and vomiting. She also exhausted her FMLA coverage at work, and being desperate to not miss more work until she has more coverage from FMLA, we began to consider everything.

She is now taking feverfew and magnesium. The magnesium has also helped greatly with constipation, so if you suffer constipation and migraine, check into this. She is continuing with melatonin and amitriptyline, as she works 12 hour rotating shifts on graveyard. She has also returned to taking oral Imitrex if she feels a migraine coming on. In a week her employer is putting her on days. . . . . . . and we are preparing for the complete sleep schedule change. Won't be easy. . . .

Like I said, we have our fingers crossed that we have found something that will help her get more control and have fewer headaches. It is true, don't neglect looking into other parts of your body that may affect your headaches.

Nate,

As an Iraqi war veteran you are entitled to free neurofeedback, which could help you with your headaches. Find a local provider and ask them if they participate in the free neurofeedback for veterans program. Since it is free, it would be worth a shot for you.