"Less-Is-More" Approach to Migraine Management?

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    I have had migraines for over 20 years, starting at age 30.  Having tried almost every preventative medication, and all the triptans, I am now on the following regimen:  Lyrica 100mg (morning and evening), Ambien 12.5mg pm (for sleep), and Imitrex 100mg as needed, which can be as much as 4-6 times per week.  I've been on amitriptyline and Imitrex for over 20 years, but recently stopped the amitriptyline because of a worsening constipation problem.  I have not noticed any increase in headaches, and because of my age (52) I am VERY interested in reducing the number of drugs I'm taking.  Over the years I've tried Topamax, Depakote, Cymbalta, Effexor, Paxil, Verapamil, etc., and found the side effects (nausea and constipation) intolerable, with no reduction in headaches.  Inderal LA DID help, but made me very depressed. 

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    My neuro is to the point where if I have more than 4 headaches per week she wants to put me on a Medrol (steroid) dose-pack, which stops the headaches but makes sleep impossible.  On the other hand, I've had a lot of success lately with Advil, which I avoided for years because of the "rebound headache" effect, but it really helps my back and neck pain which I KNOW causes headaches at times.  (I always take it with food.)  OK - so my question is, have you noticed or found through observation/experience that some people just do better with a "less is more" approach?  I am so tired of the next new "blockbuster" - people are now telling me about Treximet, etc., etc., and I just want to cut back, not try something new and possibly dangerous, at my age!  Thanks so much for your time, you provide a great service!  Meg.

     

     

    Answer:

     

    Dear Meg;

     

    Certainly, the "less-is-more" approach works for some people. However, with newer research indicating that Migraine may well be a progressive brain disease, we still recommend that anyone who has three or more Migraines a month continue exploring preventive options with their doctors. For more about this, please see:

    • The Evolving Role of Migraine Prevention
      Dr. Elizabeth Loder discusses the role of prevention, especially in light of research indicating that Migraine may be a progressive disease that can cause brain damage.

    • Is Migraine a Progressive Brain Disease?
      Examining the connection between Migraine disease, brain lesions, cerebral infarction (stroke), and the frequency of migraine attacks.

    • Yes, Migraines Can Cause Brain Damage
      Study results are again indicating that Migraineurs who experience frequent Migraine attacks and/or have a long history of Migraines are at increased risk of "silent brain damage."

    None of this is a reason to panic. It IS reason to keep working with your doctor to prevent as many Migraines as possible and to treat those we do get to stop them as soon as possible.

     

    It's easy to feel as if you've tried everything out there, but there are so many medications that can be used for Migraine and headache prevention that it's literally impossible. You can find a list of potential Migraine and headache preventives in Migraine preventive medications - too many options to give up!

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    There's another possible complication of frequent use of steroid packs that you might want to discuss with your doctor. Over time, frequent use of them can cause problems with joints. We've recently see one young Migraineur who had to have knee surgery after too frequent use of steroid packs.

     

    The bottom line here, Meg, is that there are still options available for you to explore to reduce your Migraines and improve your quality of life.

     

    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.

     

    In the long run, Meg, most people would love to take fewer medications (or none at all). We'd love to see that happen too, but we have to take a look at the possible long-term effects of Migraine and do the best we can.

     

    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 September 19, 2009.

Published On: September 19, 2009