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Suggest treatment for chronic migraine

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Posted on Tue, 2 Sep 2014
Question: Chronic Migraine since last 35 years.Pain relieved only by Sumatriptan 50 mg.For prophylaxis I took Divalproex sodium 250 mg daily since last one month. Worked fine but is not effective now. Suggestions required as now an inexplicable sensation on right top of head is felt momentarily. Also took Amitryptlne 25 mg at night daily for one month. Weight 95 kg. Height 174 cm. To control hypertension regularly take 2.5 mg Ramipril in the morning and 25 mg Atenolol at night. MRI and CT Scan normal.
doctor
Answered by Dr. Shoaib Khan (1 hour later)
Brief Answer:
Any issues with sumatriptan sir?

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help.

I would like to first ask whether sumatriptan is still effective for you sir, and how long you have been using it? If at all, sumatriptan is still effective for you then why would you want to experiment with other medications?

Triptans are typically used to treat migraine headaches and are very effective with minimum side effects. Are you worried about the drug interactions or have any other issues with sumatriptan?

I would sincerely appreciate some more information in order to better understand you requirements sir. I am more than happy to be of assistance to you sir.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shoaib Khan (1 hour later)
The increased frequency of rebound headache due to Sumatriptan and failure of Valance 250 mg and Amitriptyline 25 mg in controlling it has forced me to seek for your suggestions.Should I take Valance 500 mg in place of Valance 250 mg ?
doctor
Answered by Dr. Shoaib Khan (2 hours later)
Brief Answer:
Valance 500 mg OD most effective dose

Detailed Answer:
Hello once again sir and thank you so much for your response with that information.

Sir, have you ever thought that the rebound headaches or even frequently recurring migraines could be as a result of a continuous exposure to a triggering factor? I too suffer from migraine headaches and due to my schedule, my sleep cycle goes berserk at times resulting in frequent headaches. I feel the key is to recognize all the triggering factors and eliminating them from your day to day routine. Some of the most common ones include: extreme change in temperatures, long gaps between meals, bad or poor sleep pattern (lack of sleep), hypoglycemia, chocolates, prolonged periods of watching television using the computer or smartphones, etc.

Please try to work on the triggering factors and avoid them completely instead of depending on medications completely.

Next, coming to valance. It is indeed a very good medication for migraines, but please note that the most effective dose of valance is 500 mg once daily. So, you should be taking 500 mg of this medication once daily and not less than this.

I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shoaib Khan (2 days later)
Dear Dr. XXXXXXX
Thanks for your kind reply. I forgot to mention presence of two triggering factors since last 25 years in my life which are 1. Job related stress and 2. Family related stress causing reactive depression for which I was advised Alprazolam 0.5 mg tds. Later considering my rebound headache I was advised Amitriptyline 25 mg at night. But I have observed sluggish memory and loss of libido in me after one year use of Alprax and Tenolol. So in the light of above facts, my last queries are :
1.To decrease frequency of migraine attacks may I take Valance 500 mg od in the morning and Amitriptyline 25 mg od at night regularly ?
2. If yes, how long will I have to take it and then consider for revaluation ?
3. Do you advise me any specific CT / MRI test of brain for any suspected pathological changes in brain due to chronic migraine.
4. Any medication to get rid of sluggish memory and loss of libido ?
With this I finish my all queries. Point wise answers will be highly appreciated.
doctor
Answered by Dr. Shoaib Khan (7 hours later)
Brief Answer:
All queries answered sir

Detailed Answer:
Hello once again sir.

Thank you for the information provided sir, I would be more than happy to help.

1. Yes sir, you can have valance 500 mg OD regularly. But, about the Amitriptyline being taken regularly and at night, it is best you confirm the same with your prescribing doctor. But it is also usually taken regularly.

2. Usually about 6 months to a year. But I think a re-evaluation would be best if conducted after 6 months and not later

3. I would advice an MRI brain, but not due to possible damage caused by chronic migraine but to find the cause for chronic migraine.

4. Both memory loss and loss of libido can have various causes to it sir. But the most common cause for both these symptoms are usually either hypertension, coagulation failure or a vascular condition sir.

I hope I have explained things in a manner best understood by you sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Shoaib Khan

General & Family Physician

Practicing since :2009

Answered : 9409 Questions

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Suggest treatment for chronic migraine

Brief Answer: Any issues with sumatriptan sir? Detailed Answer: Hello sir and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. I would like to first ask whether sumatriptan is still effective for you sir, and how long you have been using it? If at all, sumatriptan is still effective for you then why would you want to experiment with other medications? Triptans are typically used to treat migraine headaches and are very effective with minimum side effects. Are you worried about the drug interactions or have any other issues with sumatriptan? I would sincerely appreciate some more information in order to better understand you requirements sir. I am more than happy to be of assistance to you sir. Best wishes.