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    Can Propranolol and Prednisone be taken together for migraine headache?

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Posted on Tue, 29 Mar 2016 in Headache and Migraines
Question: I have been suffering with a migraine/tension headache for the past 17 days. I have a history of migraines that occur with my menstrual cycle, which about when this one started. After a week of taking NSAI's I saw my PCP who administered a shop of torydol & followed with hydrocodone if needed. Neither worked for very long. I stopped taking everything for 2 days & saw no improvement. So my PCP put me on Flexiril at bedtime for 2 nights hoping that would break the cycle & then start my on propranolol to prevent migraines.
The Flexiril did not work so she prescribed prednisone for 6 days. I took the first dose on Friday & felt better for a few hours and the my pain level skyrocketed up to an 8! I was sent to the ER for a headache cocktail of anti-naseau, torydol, Benadryl & magnesium in an IV. Also took a CT scan which was normal. They also had to add morphine to get the pain level down to a 2. Today, which is the day after the ER visit, I am still at a level 2 pain level, which is functioning, but uncomfortable. The only thing I have taken today is the prednisone. I know I can take ibuprofen if needed, but it was suggested that my blood pressure may be a little high & that may be causing the headache. So, my question is, can I start the propranolol while on the prednisone which is taping down from 6 pills? Today was 5 pills. Tomorrow will be 4, etc. or should I wait until the prednisone is done? My PCP is not available over the weekend. Also, I have allergy induced asthma & the literature I read says I shouldn't take propranolol if I have asthma, but my PCP knows I have it and what medicines I take for it.
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Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Menstrual migraine out of control?

Detailed Answer:
Good evening....sorry that you're having such trouble with your headaches. Migraine headaches are defined as a severe headache which typically affects 1 side of the head, which is throbbing, highly debilitating, and accompanied by at least 2 of the following symptoms (phono/photophobia, nausea, or vomiting). Duration of the headache is also at least 4 hrs. and at most 72 hrs. Now, that's the definition. If this describes your headaches and they are occurring within several days of the onset of your period getting better after the period starts within 24-48 hrs. then menstrually related is a compelling reason. If you have unremitting migraine headaches for 5 days or longer then, the classification of STATUS MIGRANOSUS is reasonable to consider which is then, best treated in a hospital setting for a 3 day protocol of DHE 45. If your headaches don't appear to fulfill the requirements to be either menstrual migraines or status migranosus then, the other type of headache likely would be severe acute tension type headaches. I would then, have tried something such as IV Depakene run over 1 hr. in the ER followed by a prescription of rapidly titrated Topamax to a maximum 100 or 200 twice daily. I might even consider high dose ibuprofen (800-1200mg) as a 1 possibly 2x dose for acute breakthroughs avoiding use of this regimen more than twice weekly.

Yes, we now know that we can start prophylactic medications on someone before waiting until other medications have been totally washed out or tapered down.

If you were my patient I would be tracking your headaches over several months to see if you don't have at least 2 different types of headaches which what I suspect is going on without you being aware. Then, I would be in a better position to attack the headaches with the best interventions (which may not be pharmacological either). I would look for triggers, exacerbants, amelioratives, and lifestyle changes as well as sleep behaviors, psychological parameters, and of course, metabolic issues that could be exacerbating or precipitating your headaches.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you like but just keep in mind what I've said about that process and call TECHNICAL SUPPORT if necessary.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

This consult request has taken a total of 44 minutes of time to read, research, and respond.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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