Preventing Migraines
 

I am going to the doctor next week to talk about Migraine Prophylaxis. I have moderate-severe migraines 1-4 times a week.

I have Maxalt and it works well, but I run out before the end of the month, which TERRIFIES me...

I am wondering what people have tried, and what worked.

Hi BadWolf .... I live with Relpax - another Triptan like Maxalt. AND my dear doctor prescribes TWO boxes per month. I get twelve tablets instead of six.
Won't your doctor do the same?
If he does, will your insurance pay for it? The precious Triptans cost as much a gold.

Have you tried any migraine prevention meds? I was on Topamax for years and it did wonders for me! It drastically cut down the frequency of my migraines. The only migraine med I could tolerate that helped when I did get a migraine, was Amerge. I have since developed an allergy to it :(

Try what Wren said, ask your dr to prescribe more. Majority of insurance companies will only cover about 9 pills every month. When I switched over to my husband's insurance, BCBS, they would cover more per month...I was shocked!

Good luck,
Nanc

Welcome BadWolf, :Wave-Hello:

Ask your doctor to put in an override for Maxalt to your insurance company. (Mine did, and when I needed them, I was getting 30/month). The good news is that Maxalt is now available generically, though it may still take a few more months until we see any appreciable price reduction (usually about 6 mo. after going generic).

People can make suggestions about what worked for them prophylactically, but everyone is different, and the only way to find what will work for you is trial & error. Possibilities include medications, supplements, and diet (avoiding food triggers).

migraine prophylaxis

There is hope. I've gone from >15 per month (definition of chronic) to about 4 per month with a combination of diet & myofascial release trigger point therapy.

Also, see if you can find a headache/migraine specialist (one whose practice is limited solely to migraines). That made a huge difference for me. I bounced between 4 neuros who claimed they treated them, but really didn't know squat compared to the headache guy.

Doc

Hi BadWolf,

What has helped me for prophylaxis, in the past, is gabapentin 1200mg /day divided into 3 or 4 doses, as regularly spaced as possible. This is off label I think and you'd have to check with your insurance if it would be covered, but I think it would.

I've tried Topamax before and it seemed to work at 100mg /day but I had to suspend d/t side effects. Some may have been a coincidence, so I may try it again if I need something.

Depakote is a first-line prophylactic med and helps a lot of people.

Without prophylaxis, my first-line treatment is Zomig (zolmitriptan). If I don't take it in time, I sometimes have to chase it with an NSAID. I know what you mean about needing more than 6 ... I've had months with 18/30 days of headache.

If I don't take the Zomig soon enough, it usually doesn't work. Sometimes I can get by with indomethacin or ibuprofen, but for the really bad ones I have tramadol (addictive -- I do not use it often).

Sorry you suffer with these beasties. :( Good luck with the override for more Maxalt -- you should be able to get as much med as your doctor says you need to have. Good luck finding a good prophylactic too. Sometimes that is really the best route... it's so much easier just not getting all those headaches.

Take care, and welcome to Neurotalk!

waves

There seem to be many different causes of Migraine but every doctor I've seen has told me that the biological process that is widely thought to lead to the symptoms is a spasming of a particular blood vessel that runs from the spine/neck to your head (sorry if you already know that!).

Some people can easily highlight the causes of their migraines and do pretty well at managing them, e.g. hormones or foods like nuts/chocolate can be triggers.

Some, including myself, suffer them simply through stress and being both mentally and physically tense (hence the link to the neck area). I only suffer a handful of migraines a year but mine are terrifying - numbness on one side, completely incoherent, often sick, can't see. I usually manage to avoid them through exercise and meditation, as I've yet to try a medication that prevented them.

Some people I guess just get them and finding a root cause or trigger can be hopeless.

You're lucky you've found something that works for you - is there any reason you can't get a repeat prescription to keep stocked up? Would the doctor rearrange your appointment if you tell them you're running too low? There's also a chance that the medication will still have a positive effect after you run out as it'll still be in your system for a short time :)

Starting with the last first... Maxalt (rizatriptan) and other triptan abortives have very short half-lives (2-3 hrs), which is why they're taken at short intervals. Not likely to still be around the next day or longer.

When this thread was started (last August) Maxalt was still under patent, and very expensive ($14 to $17 per tablet, and it could take up to 3 tablets to knock out a migraine). Insurance companies put limits on how much they would pay for each month. (I understand BadWolf's plight very well—I was in a nearly identical situation.) If you got more migraines than they decided you were allowed to have, you were out of luck. Doctors can put in requests for overrides on those monthly allotments, but you have to have a doctor willing to go to bat for you, and an insurance company that can see reason (good luck! :rolleyes:)

Maxalt has since come off patent, but the price is still high (and allotments low) and likely will be for the next few months at least.

Doc

grand mol migraines
 

Hello,
I have had this weird feeling in my right eye and no that a migraine is coming. It's one that looks like a lightening bolt and it zips across my eye in a zigzag shape. Today I had a big one at 12:45pm lasted 20 min. 20 min. later a small one in the same eye., again lasting 20. min. In all total today 4 in 4 hours. I just laid my head down shut my eyes and sort of tried too sleep. I am 60 yrs. old and this is the first time i have had so many at one time during a day. I have had them start in left eye and wander over too the right eye and then it was gone and done with, and man oh man the headache that follows that.
Now I did have them in my early 20's and the doctor gave me some blue & white capsule that seemed too help and a couple of trips to the chiropractor. And by gosh they were gone for 40+ yrs.
The darn thing came back in Jan.2014 only a couple of times., but today was the weirdest of having that many.
Has anyone out there have these kinds of migraines.

Yes, Stretchismyname
I had this symptom you are describing, the one with the zigzag light in one eye, 3 or four time.
I will describe my symptom the fallowing way: I had had headaches on and off for some months, but never went to the doctor for it, and was never diagnosed with Migrane headache. I had also had 2 episodes of vertigo, described as the ceiling moving above me.
One day I noticed a visual disturbance in my vision in the left eye. I had a ring of zigzag bright light on the outer aspect of my left eye visual field. I could see through the hole in the middle of it. Mine also lasted about 20 - 30 minutes. The second time I had it, I noticed the ring got bigger and bigger and finally dissapeared out towards the left of the visual field.
I went to my opthomologist. He added up the symptoms and sent me for a stat MRI of the brain, and called me later with the result. I had a cerebral aneurysm, and he already had called a neurologist for me.
Now, this aneurysm was noticed only incidentially, so I was glad it had been noticed in time( it did not rupture) and I had the aneurysm emboliced in time. It could have been there for some time.( they are often asymptomatic)
So this probably had nothing to do with the aneurysm part. BUT.----I was now told that this symptom with the visual disturbance was MIGRANE AURA. I went to a neuro opthomologist who told me that one can have this AURA MIGRANE without actual pain. He said this is calle a ancephalic migrane.
I have since had migrane in the form of a sharp, short lasting ICE PICK pain
that comes and goes. When it comes, it is momentary only and then comes back with another "jolt" in an hour or so, and then goes on for the day and goes away for a while. Weeks at the time. No medicine has helped me.
Until now< I have developed Neuropathy, and the neurologist has put me on Amitripthyline for the nerve pain. He said it would also help the migrane.
But I have now a multiple multiple magnification of prior headache, and I am awaiting further medical help and diagnosis.

I am now wondering, and I will try to research this, if, and what is the connection between Migrane/cerebral aneurysm/vasculitis/hypertension ???

Does any one have any experience in theese combined/related?? conditions??

Thanks for reading.

Hi Stretch, welcome.

In the 1960s, my mother was treated for migraine with phenobarbital.

I agree that definitely sounds like migraine aura. It's not unknown to have migraines early in life, then they stop, and may come back decades later. Often, migraines are painful but benign, but they can also be symptoms of something more serious.

Please see your doctor about this asap. Nowadays there are much better and safer medications, and doctors who specialize solely in migraines.

Doc

I have pretty bad migraines for years now, but so far none of the others you mention. XX
My BP (unless I have a migraine) is always in the lower end of normal.

relation of migraine to cerebral aneurysm

relation of migraine to vasculitis

relation of migraine to hypertension

You might also try the same searches on goggle scholar.

Doc

Dr. Smith
Thanks for the hint regarding the google search, and thanks for the links.
I have found that usually there is not much suggestion of relation between migrane and hypertension.
I found that there is relations between migrane and cerebral aneurysm. This presents with an increased headaches with aura before a rupture of an aneurysm.
But, from what I understand, migrane does not cause aneurysm.
Aneurysm is usually a cogenital condition of the vessels. (By the way, aneurysm is also familial) Family members of aneurysm patient, should be screened.
So, I guess, a person who has both, could have an exacerbation of migrane before a rupture of an aneurysm?
Then, should people with migrane go through the screening?
There definetly is relations between vasculitis and aneurysm, and that is obvious, vasculitis being a disease of the vessels, and could cause weakening in the wall.

I read the links posted here for Migrane profelaxes.
I am not so familiar with the new first line drugs like Maxalt and Divalproex.

But I am familiar regarding other first line like antidepressant like Amitripthyline . Also Betablocker, Propanolol.
I also see that Calcium Chanal Blocker is good as a second line of defence for migrane.
Dr. Smith, I used to be on Toprol for hypertension, but I was taken off a year ago due to the BP had become low ( probably due to starting on Amitripthyline and Lyrica)
Now I am having exacerbation of headache, and my BP is high.
I was given high dose of Steroid, due to flare up of vasculitis, so that has helped the headache but not the BP. I think something else might be going on. I am going to see my cardiologist. I think he should do a echocardiogram. Perhaps I should get back on Toprol.

I don't know. I have no family history of aneurysm. My migraines were chronic (more then 15/month) at their worst, and screening for aneurysm was never mentioned.

Neither Maxalt (rhizotriptan) nor Depakote (divalproex) are exactly new; both are old enough to be out of patent and available generically. AFAIK, Depakote is sometimes used prophylactically for migraine, however Maxalt is an abortive.

It sounds to me like you might want to have an updated discussion with a migraine specialist (not just a neurologist who says they can treat migraine) on treatment options, and formulate a plan for you that takes into account your medical history and individual needs, which may include one or more of preventative, abortive and/or rescue medication.

Preventive, Abortive, and Rescue Medications - What's the Difference?

Migraine Headache Treatment & Management

Doc

Dr. Smith
Yes, I agree. I am looking for a headache doctor. The problem is that today in modern medicine, all the medical specialties are again devided into sub specialties, and one can be running around for ever. One can actually be dead before any diagnosis is found. I do not trust doctors. I am always cautious. And I do not take their word for things right away. I have too many bad experiences.
Doctors often like to see you come to the office, and they find nothing wrong at the time, just " fallow up" next time. So that they just can have a constant revenew coming in for their cash flow .
You know the old saying " see no eveil, hear no evil" ???
What you do not know, you are not responsible for.
The first time I went to a specialist that I thought specializing in migrane( which I had been told I had, migrane without pain, only now, 2 years later, I have migrane WITH pain), this doctor comfirmed that I had it and said "
Enjoy the fire works!"
( meaning the bright light flashing before your vision)

Seriously,: I am looking to get a good referal from a doctor to recomend me to a headache specialist.

I will tell you. I make up my own theories, and then I ask the doctor for the tests. because they need this little push some times.
I still have no answers to electrofyiong vibration down my spine, and bulging spasmic temporal pain.
My neurovascular doctor called me yesterday, he will arange for a temporal artery biopsy. This way, I can hopefully rule out temporal arteritis.
I still do not know where to find the headache doctor, and I still do not know why I had this pain.

Thank you so much for reading,
best wishes
Synnove

I got several "good" referrals from doctors that turned out to be wombats, so BT-DT; I can empathize. It was only by accident that my orthopedist asked me offhandedly if I had seen "the headache guy", and things began to change.

Here's one possible site:
Florida - Migraine and Headache Specialists

Other leads here.

An initial visit is pretty standard now, and not always a bad idea. It can give patients the oportunity to size up the doctor too, before too much time is invested with one who just isn't a good match.

There are also some decent articles by goggling: what to expect first visit [specialty]

Doc

Dr. Smith
Yes, I agree regarding the initial visit to a doctor. I think I have to modify the way I conduct myself in regard to what will be discussed during that visit.
A patient should actually be able to have a free consultation with a doctor
in order to decide if this doctor's servises will be the right one.
Other professionals offers this.
Yes, I will be checking the list, I actualyy looked yesterday, and I noticed one of the neurologist on this list was a neurologist I saw at the Cleveland Clinic some 2 years ago, recently after all my neuro problem started.
But at this time, there were so many different issues, that headache were not adressed. And I did not know this doctor had as subspecialty Migrane.

I have a question now that I am looking back at the origional MRI of brain:
One or two findings were never discussed 10 finding "left posterior frontal lobe congenital venous angioma" and 2 " bilateral vertebral arteries impingement on the Medulla"

I wonder if theese can have anything to do with the headache.

All best wishes
Synnove

Some are beginning to.
doctor get acquainted visit
I've seen them more with PCPs/GPs/Family Doctors and OB/GYNs than specialists, but it can't hurt to call and ask.

The kind of specialist I'm thinking of doesn't treat anything BUT headaches/migraines—their practice is limited to just that. Granted, they—or entire clinics/practices that treat only headaches—are likely to be found in metropolitan areas, and usually—but not always—associated with hospitals.

Doc

Thanks.
Yes these are some good ideas. I will be keeping this in mind, and be a little more asertive. You know, when we realy think of it, it is our health and our lives, and only the very best is good enough.
All the best

Also when you think about it, half of all doctors are below average. ;)
The guy/gal who graduated at the bottom of their med school class is still called, "Doctor". :eek:

Doc

migraine symptoms
 

Dr Smith I read a post on here about a med that is good for migraines that involve vertigo. The person who posted did not know the name. I probably should go on something as migraines are getting more prevalent. Are there a lot of side effects with most preventative. I have avoided them for this reason and dealt with these several times a yr.

My first event I ended up in the ER I was told it was labyrinthitis. I was in my 50's. I suffered and still do from balance problems. I still get vertigo attacks but not always with headache. I get aura as well lasting up to about 15min. I don't get the bad pain with this but the next day if I bend over or cough I feel the pain -mostly one sided. I was told all this was migraine when I went to balance therapy. I think this throws my balance off then I stay dizzy for a long time thereafter. I wake up often with dizziness...or aura.

DO ANY OF YOU GET THIS FEELING WHEN WATCHING TV OR ON THE INTERNET THAT YOUR HEAD or EEYES DROP/MOVE OR SHIFTS ? IT IS HARD TO DESCRIBE AFFECTS THE VISION SORT OF A DIZZY FEELING BUT NOT EXACTLY

Can you define "more prevalent"? Whether or not to go on a preventative is a judgment call between doctor and patient, and whether or not an effective abortive can be found.

There are side effects with every medication, so it's always a benefit vs. risk situation.

FWIW, one of my first (and worst) migraines sent me to the ER too. The pain sent my BP dangerously high, but they gave me some kind of rescue med that worked.

What you describe sounds like it could definitely be migraine; I think I mention earlier in this thread (haven't looked :o) about acephalgic (or silent) migraine—that have an aura, but not necessarily any pain associated with them. There's also silent migraine with vertigo (a.k.a. vestibular migraine). <---Check this one out and see what you think.

Migraines can most definitely be multi-day affairs. I'm totally wiped out the day after—kinda like a hangover.

Not sure if I understand your last paragraph. TVs & Computers can cause something called computer migraine.

It's possible to have more than one (and possibly several different) migraine types—individually, or simultaneously.

Do you ever lose vision in one eye?

Doc

IllPn

I think balance problems and vertigo can also be caused by neuropathy, autonomic neuropathy.

I have had migrane aura in the form of visual disturbance. It was a zigzac lightening bright ring in the visual field in one eye. The ring got bigger and bigger and finally diisapeared out to the side. This was an aura without headache. I have since had different type oh headache.

I very often , should say regularly, wake up with sensory symptoms that so far has not been explained, in spite of EEG monitoring twice. Doctors thought it was simple partial seizure at first, but that is luckily ruled out.

One doctor, a neuromuscular neuropathy specialist, said she thought this symptom was a MIGRANE VARIANT. I was wondering, perhaps this was similar to your symptoms?

Did you ask the neurologist to have a 72 hour video monitored EEG ? Or a simple one night sleep study? A lot of symptoms can be detected with this.

So, I too, am learning that migrane can come in so many different forms.

Dr. Smith IS A SPECIALIST ON THIS.

All the best

Have you felt any side effects from Maxalt? I am having a difficult time swallowing after taking the medicine.

Welcome 1Flanders. :Tip-Hat: