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Migraine, venous angioma. Taking maxalt, zolpidem. Tried amitryptylline. Have done MRI. Suggession?

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Practicing since : 2001
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I am 54YO otherwise healthy WF w hx of Migraine HA since 20ish. Taking Maxalt 10mg and works well but my family practice physician believes I have to take too frequently and need a preventative. I keep a HA log and avg about 1/wk, always in the AM...I have to take zolpidem to sleep on most nights...trying to get off of that but it's taking months...sometimes, I have 3-4 days in a row where I wake up early 5-6AM w the consistent trigger that I can determine. I tried amitryptylline 10mg and had too many SE and tapered off of it after it got to therapeutic level. I have had 2 MRIs and have a small venous angioma, no change in MRI after one u have a suggestion of what you would add to the existing regimen for prophylaxis?
Posted Tue, 10 Jul 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 7 hours later
Hello and thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the symptoms you are experiencing.

Regarding the migraine prophylaxis, Maxalt (rizatriptan benzoate) is only a abortive medicine for the treatment of acute attacks of migraine and does not have any role in the prevention of migraine.

Migraine treatment consists of management of individual migraine episodes as well as prophylactic treatment to prevent future episodes. Migraine prophylaxis involves avoidance of trigger factors, lifestyle advice followed by consideration of medications. As you don't have any known trigger factors, medication prophylaxis
is necessary to reduce the frequency and severity of migraine attacks and thereby improve the quality of life and prevent medication overuse headache.

Commonly used medicines for migraine prevention are: beta blockers (propranolol), calcium channel blockers, Antidepressants like Amitriptyline and anticonvulsants like Divalproex or sodium valproate, Topiramate and Gabapentin. Recently there is interest in usage of Botox for chronic migraine.

My recommendation for you is to see your Neurologist for initiation of preventive medicines for migraine. Choice of drugs can be made on the basis of efficacy of drug, adverse events, patient preference, headache profile, and the presence or absence of coexisting disorders. Prophylaxis is usually required for a period of 3-6 months and some time more than one medicine may be required for prevention of migraine.

I thank you again for submitting your question. I hope you have found my response to be helpful.

If you have additional concerns I would be happy to discuss them with you.

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
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