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Suggest remedy for severe migraine post hysterectomy surgery

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Posted on Mon, 14 Dec 2015
Question: I have had migraines for 31 years. I had a hysterectomy with left ovary removed. I was told my migraines would get better, however over the last 6 weeks I have had 5, when I may have one a month during menstrual cycle. I take Inderal and fioricet . Have been on multiple antidepressants in the past and trokendi with no help. Concerned about the increase in frequency, no real change in pattern. I have awakened twice around 3:00 a.m with visual aura, never awakened with the actual pain, that usually starts 20-30 minutes later. I am unable to take triptans. I feel like I am out of options at this point. Any advice would be appreciated.
Thanks
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern in face of this increase in frequency.

Since your attacks have increased it is obvious that the preventive treatment with Inderal is not being effective anymore. If you are on a low dose it may be tried to increase to 160mg a day, but if the dosage is already high enough then other options should be tried.

Main preventive treatment classes are antihypertensives like Inderal, antidepressants which you say have been exhausted and antiepileptics like trokendi. Another antiepileptic with different mechanism of action than trokendi would be valproic acid which is a first line prophylactic treatment.
If that is ineffective or can't be taken for some reason, among antihypertensives there are calcium channel blockers like verapamil or flunnarizine which can also tried.
If it's been only 6 weeks since your surgery though I would give it some more time before switching treatment, hormonal fluctuations may stabilize eventually, so I would wait for 4-6 more weeks.

Other then medication another option now is botulinum toxin injections (popularly known as botox). It is an approved drug for migraine prevention when preventive treatment fails, consists in injecting the toxin in certain points in you scalp, if effective injections have to be repeated every 3-4 weeks.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (21 minutes later)
I meant to add that my hysterectomy was 7 months ago. I am now on Inderal LA 240mg and have been for two months. Should I ask my pcp to try the depakote? Check hormone levels?

Thanks again!
doctor
Answered by Dr. Olsi Taka (39 minutes later)
Brief Answer:
Read below

Detailed Answer:
Thank you for the additional info.

I am not really sure that the worsening is directly related to the hysterectomy. You mention to have removed only the left ovary. The uterus doesn't produce hormones itself, it is only affected by them to produce menstruation, it's the ovaries which produce estrogen and progesterone. So if your right ovary is intact it would continue to produce hormones and shouldn't affect your migraine. The fact that the worsening is coming over 5 months later supports that. So hormone levels are not that necessary.

Inderal is already at the highest possible dose. So as I said other options should be looked. Depakote is a very valid first choice. The others remain the same ones I mentioned calcium channels blockers and botulinum toxin.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

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Suggest remedy for severe migraine post hysterectomy surgery

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern in face of this increase in frequency. Since your attacks have increased it is obvious that the preventive treatment with Inderal is not being effective anymore. If you are on a low dose it may be tried to increase to 160mg a day, but if the dosage is already high enough then other options should be tried. Main preventive treatment classes are antihypertensives like Inderal, antidepressants which you say have been exhausted and antiepileptics like trokendi. Another antiepileptic with different mechanism of action than trokendi would be valproic acid which is a first line prophylactic treatment. If that is ineffective or can't be taken for some reason, among antihypertensives there are calcium channel blockers like verapamil or flunnarizine which can also tried. If it's been only 6 weeks since your surgery though I would give it some more time before switching treatment, hormonal fluctuations may stabilize eventually, so I would wait for 4-6 more weeks. Other then medication another option now is botulinum toxin injections (popularly known as botox). It is an approved drug for migraine prevention when preventive treatment fails, consists in injecting the toxin in certain points in you scalp, if effective injections have to be repeated every 3-4 weeks. I hope to have been of help.