Day 25 of Migraine, No options but 500mg Depakote or Topamax?

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  • Full Question:

    I am on the 25th day of migraine. I take Imitrex 100mg tablets for the pain. I saw my neurologist on day 10 and he prescribed Depakote 250mg at bedtime. He also scheduled me for a sleep study, showing mild sleep apnea. Apparently I stop breathing about 12 times per hour, but no lowered blood oxygen levels. On my next visit to the neurologist, (day 20 of migraine) he increased the Depakote to 500mg daily and said I have no other options besides another preventative medication called Topamax. Can you help?

    Thank you for your continued efforts. Michael.

     

    Full Answer:

    Dear Michael;

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    Depakote taken as your doctor has prescribed it may help prevent future Migraines, but it's not going to stop your current Migraine. Switching to Topamax or any other preventive is not the answer to stopping the current Migraine either. One of the best methods of stopping such a long Migraine is IV infusion treatment. There are several medications that can safely be used this way, preparing the way for developing preventive regimens that can work for you. There's information on this in IV Treatment of Refractory Migraines.

     

    Once your current Migraine is stopped, the purpose of the Depakote would be to reduce the frequency and severity of future Migraines.

     

    Whether the sleep study showed lowered blood oxygen levels or not, sleep apnea can disrupt your sleep, and that can be a Migraine trigger. Did the specialist at the sleep lab recommend trying CPAP for the sleep apnea. This is certainly something worth following up on.

     

    If your doctor isn’t able to help you, it may well be time to consult a Migraine and headache specialist. It’s important to note that neurologists aren’t necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.

     

    Good luck,
    John Claude Krusz and Teri Robert

     

     

    To review other questions from our Ask the Clinician Column,
     browse the Ask the Clinician archives.

     

    If you need help finding a  Migraine and headache specialist,
     visit our listing of Patient Recommended Specialists.

     

     

    About Ask the Clinician:

    Dr. Krusz is a recognized expert in the fields of headache and  Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and  Migraines. You can read more about Dr. Krusz or more about Teri Robert.

     

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    Last updated April 11, 2011.

Published On: April 11, 2011