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Suggest Treatment For Chronic Migraines And Bad Taste And Dryness In Mouth
Question: I suffer from chronic migraines. I take a preventative daily. I have a Neurologist who infected botox shortly after I suffered a brain hemorrhage. The hemorrhage was found on a head ct after being in the hospital 3 days for pain management of a migraine. Over the course of the past several weeks I have been to the er for pain control as I do not have a prescribed abortive medication. It's getting beyond frustrating. I receive duladid, benadryl, Zofrann and decadron, usually through an IV, I am okay the next day, but by the second or third day my migraine is back, so back to the ER I go. I have called my Neurologist several times, my appointment is for the 21st of this month for more botox, no other help just told due to my history he can not give me anything else? ? I am at my witts end, getting depressed and feeling as if a will never be rid of this pain? Do you have any suggestions?
I also have a very bad taste in my mouth an hour or so before a severe migraine hits and nothing changes it...I then get really bad dry mouth
I also have a very bad taste in my mouth an hour or so before a severe migraine hits and nothing changes it...I then get really bad dry mouth
Brief Answer:
Several options. Some more info would be useful.
Detailed Answer:
I read your question and I understand your concern. Of course if you are having frequent attacks it would be useful to try and prevent them.
There are some points in your story I am not so sure I was able to understand, so perhaps you might help me with some more info.
- Your brain hemorrhage:
*when was it,
*what location in the brain (at least the side),
*what did your doctors say was the cause,
*was there some kind of vascular malformation and did you have treatment
(surgery or endovascular treatment) for it?
*Why can't your neurologist give you something else other then botox?
- Your headaches (to make sure that it is indeed migraine headache or perhaps some other kind of headache):
*when did they start,
*location (does it change sides?),
*character (throbbing, pulsating, constant, pressure-like, sharp),
*usual duration, approximately how many attacks a month?
*exacerbating factors,
*other symptoms like nausea, vomiting, increased sensitivity to light and
sounds,
*family history for migraine.
Also you mention Amitriptiline in medications tried. Amitriptiline is a preventive treatment, are you taking it now? If not why, was it not effective or because of side effects?
If I were to give an opinion solely on the present information, I see no reason not to take prophylactic migraine treatment. There are many options apart from Amitriptiline like Propranolol, Valproic acid, Topiramate, Flunnarizine just to name a few. Some work better in certain patients some in others, so the failure of one doesn't mean another won't be more effective. They are all prescription drugs though.
I am looking forward to your answer in order to give a more informed opinion.
Several options. Some more info would be useful.
Detailed Answer:
I read your question and I understand your concern. Of course if you are having frequent attacks it would be useful to try and prevent them.
There are some points in your story I am not so sure I was able to understand, so perhaps you might help me with some more info.
- Your brain hemorrhage:
*when was it,
*what location in the brain (at least the side),
*what did your doctors say was the cause,
*was there some kind of vascular malformation and did you have treatment
(surgery or endovascular treatment) for it?
*Why can't your neurologist give you something else other then botox?
- Your headaches (to make sure that it is indeed migraine headache or perhaps some other kind of headache):
*when did they start,
*location (does it change sides?),
*character (throbbing, pulsating, constant, pressure-like, sharp),
*usual duration, approximately how many attacks a month?
*exacerbating factors,
*other symptoms like nausea, vomiting, increased sensitivity to light and
sounds,
*family history for migraine.
Also you mention Amitriptiline in medications tried. Amitriptiline is a preventive treatment, are you taking it now? If not why, was it not effective or because of side effects?
If I were to give an opinion solely on the present information, I see no reason not to take prophylactic migraine treatment. There are many options apart from Amitriptiline like Propranolol, Valproic acid, Topiramate, Flunnarizine just to name a few. Some work better in certain patients some in others, so the failure of one doesn't mean another won't be more effective. They are all prescription drugs though.
I am looking forward to your answer in order to give a more informed opinion.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
my hemorrhage was in September, located in the right basal something. The bleed speed on its own and is being absorbed. initially they said high blood pressure, but now not so sure. I have daily migraines, I have one that started just a few hours ago, left sided temporal, same as yesterday. It slowly gets sharper, stabbing, sharp, pulsating. . goes behind the eye. It does switch sides but not usually during the same episode. I have been on most preventative and abortive meds. .. All of witch may work for a time but usually only until the next migraine. I understand rebound migraines and have experienced these when taking vicodine. They say in the er that I'm having rebounds now do to the duladid, but these aren't rebounds, I know rebounds and they come on with a vengeance as soon as the medication wares off. I take amiitriptyline currently, as well as cymbalta for fibrmyalgia. trazadone for sleep and gabapentin for the fibromyalgia.
I was diagnosed with migraines when I was in my 20 while serving in the military. I stayedwith headachesat anearly age. I have a family history of them.
I was diagnosed with migraines when I was in my 20 while serving in the military. I stayedwith headachesat anearly age. I have a family history of them.
Brief Answer:
Migraine, prophylactic treatment needed, consider med overuse
Detailed Answer:
Thank you for that info. It appears the diagnosis of migraine is correct. As for your hemorrhage, although the location is typical for hypertensive hemorrhage, unless you have a long history of uncontrolled high blood pressure it's not that likely at your age, other causes should be considered. I don't see your hemorrhage as an obstacle to preventive treatment.
I don't know whether amitriptiline is the best choice in your case considering you are taking another antidepressive such as cymbalta, apart from not finding it effective it would contribute to the dry mouth sensation you seem to be experiencing as well as other added common side effects.
If you have high blood pressure then logical treatment would be with drugs which prevent migraine attacks as well as lower blood pressure. The most used is propranolol but also calcium channel blockers like verapamil and in some trials ACE inhibitors (lisinopril) or ARBs (candesartan) have shown good effect.
I would try antiepileptics like valproic acid or topiramate only if the above fail, because of the possibility of their added side effects to gabapentine, duloxetine and trazodone.
Some supplements like magnesium, riboflavin, coenzyme Q10 have also shown beneficial effect in some patients.
I would also like to invite you to consider the possibility of medication overuse headache since you seem to be visiting ER so often. Medication overuse criteria include headache for over 15 days a month, overuse (at least for 2 days a week) of drugs for over 3 months and headache worsening during medication. If medication overuse headache is the case, then prophylactic treatment wouldn't be as effective and detoxification is needed first.
I hope to have been of help.
Migraine, prophylactic treatment needed, consider med overuse
Detailed Answer:
Thank you for that info. It appears the diagnosis of migraine is correct. As for your hemorrhage, although the location is typical for hypertensive hemorrhage, unless you have a long history of uncontrolled high blood pressure it's not that likely at your age, other causes should be considered. I don't see your hemorrhage as an obstacle to preventive treatment.
I don't know whether amitriptiline is the best choice in your case considering you are taking another antidepressive such as cymbalta, apart from not finding it effective it would contribute to the dry mouth sensation you seem to be experiencing as well as other added common side effects.
If you have high blood pressure then logical treatment would be with drugs which prevent migraine attacks as well as lower blood pressure. The most used is propranolol but also calcium channel blockers like verapamil and in some trials ACE inhibitors (lisinopril) or ARBs (candesartan) have shown good effect.
I would try antiepileptics like valproic acid or topiramate only if the above fail, because of the possibility of their added side effects to gabapentine, duloxetine and trazodone.
Some supplements like magnesium, riboflavin, coenzyme Q10 have also shown beneficial effect in some patients.
I would also like to invite you to consider the possibility of medication overuse headache since you seem to be visiting ER so often. Medication overuse criteria include headache for over 15 days a month, overuse (at least for 2 days a week) of drugs for over 3 months and headache worsening during medication. If medication overuse headache is the case, then prophylactic treatment wouldn't be as effective and detoxification is needed first.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Yogesh D
I do take lisinopril for blood pressure now, so bp no runs 113/74, I do not have a history of high bp. My head pain is not worse during medication, and it had only been in the past several weeks that I get a new migraine two to three days after being seen in the ER, usually I am there once maybe twice a month when it's lasted a couple of days with little or no relief. There are months where I don't have the need to go to the ER. I have been on magnesium, propranolol, as a few others that you have mentioned. I do plan on discussing discontinuing the amitriptylyne at my next appointment as it has not seemed to make a difference.
Brief Answer:
If all alternatives explored wait for botox.
Detailed Answer:
I understand. So it seems it is only this last month that the attacks have increased in frequency, I thought they were even more frequent for a long time.
In that case perhaps therapy with botulinum toxin (botox) has been effective and it's the wearing off period. Usually it should be applied every 12 weeks.
If you have tried all the other options I listed, including valproic acid and topiramate, then it seems your neurologist has explored the recommended alternatives.
So for now I would consider amitriptilyne interruption and the scheduled reinjection of Botox. I wouldn't hurry into taking more drugs as you already are taking several central nervous system acting drugs for fibromyalgia and sleep as well as migraine attacks, at times poly-pharmacy reaches a point where it can be harmful.
Remember that you should have realistic expectations, the efficacy of preventive treatment is not established by making attacks disappear altogether (although desirable), most often they only reduce frequency and intensity. Of course, if on the other hand they are becoming more frequent with amitriptilyne there is no reason to continue it. I imagine it has already been recommended to you that a headache diary would be useful as well in identifying the causes for this exacerbation of the pain, there are many possible external factors (sleep, food, wheather, physical activity etc).
I wish you good health.
If all alternatives explored wait for botox.
Detailed Answer:
I understand. So it seems it is only this last month that the attacks have increased in frequency, I thought they were even more frequent for a long time.
In that case perhaps therapy with botulinum toxin (botox) has been effective and it's the wearing off period. Usually it should be applied every 12 weeks.
If you have tried all the other options I listed, including valproic acid and topiramate, then it seems your neurologist has explored the recommended alternatives.
So for now I would consider amitriptilyne interruption and the scheduled reinjection of Botox. I wouldn't hurry into taking more drugs as you already are taking several central nervous system acting drugs for fibromyalgia and sleep as well as migraine attacks, at times poly-pharmacy reaches a point where it can be harmful.
Remember that you should have realistic expectations, the efficacy of preventive treatment is not established by making attacks disappear altogether (although desirable), most often they only reduce frequency and intensity. Of course, if on the other hand they are becoming more frequent with amitriptilyne there is no reason to continue it. I imagine it has already been recommended to you that a headache diary would be useful as well in identifying the causes for this exacerbation of the pain, there are many possible external factors (sleep, food, wheather, physical activity etc).
I wish you good health.
Above answer was peer-reviewed by :
Dr. Prasad
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