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Suggest Treatment For Headache With Severe Back And Knee Pain
Question: Hi,
Currently suffering from a migraine type headache on the left side of my head where a small mastoid effusion was recently detected by CT when I bumped the right side of my head on a freezer door. Currently on 200mg topamax and 80mg inderal LA daily for my migraine headaches, which occur usually 2x per week. Fiorcet, Excedrin, Tylenol, motrin/naproxen, do not seem to put a dent in it. I take Tylenol and motrin daily for daily headaches and severe back and knee pain. I have no insurance and have been to the ER so often with pain and blindness they now treat me as though I am just an addict. Please suggest options as to what I should do and how to manage this debilitating pain.
Currently suffering from a migraine type headache on the left side of my head where a small mastoid effusion was recently detected by CT when I bumped the right side of my head on a freezer door. Currently on 200mg topamax and 80mg inderal LA daily for my migraine headaches, which occur usually 2x per week. Fiorcet, Excedrin, Tylenol, motrin/naproxen, do not seem to put a dent in it. I take Tylenol and motrin daily for daily headaches and severe back and knee pain. I have no insurance and have been to the ER so often with pain and blindness they now treat me as though I am just an addict. Please suggest options as to what I should do and how to manage this debilitating pain.
Brief Answer:
sheesh.. two most common meds not mentioned.
Detailed Answer:
So... the most common migraine stopping medication is the tryptans (sumitryptan.. imitrex and many, many others). Each is 75% likely to work and there is an almost independent roll of the dice... so that mostly even if you fail one, the next one has an almost 75% likelihood of working. THerefore, trying a couple or three different ones (one at a time!) is very very likely to be a treatment. They are moderately expensive but not compared to weekly er visits.
Then, amitryptiline is the most effective preventative (at least it is very good at it if no number one). It acts differentlly from the others.
100% oxygen inhalation is another treatment that is very effective and never used.
Third, other irritations of the brain are likely to trigger migraine. Bright lights, stress, wtihdrawal from caffeine, drugs of abuse, or alcohol. Cigarettes can have an interacdtion with migraine but not as commonly as the others. Some people report odd triggers such as odors or emotional triggers. Most find that lowering CNS stimulation (quiet dark room) helps.
This can also include sinus irritation or even slurpees as triggers.
sheesh.. two most common meds not mentioned.
Detailed Answer:
So... the most common migraine stopping medication is the tryptans (sumitryptan.. imitrex and many, many others). Each is 75% likely to work and there is an almost independent roll of the dice... so that mostly even if you fail one, the next one has an almost 75% likelihood of working. THerefore, trying a couple or three different ones (one at a time!) is very very likely to be a treatment. They are moderately expensive but not compared to weekly er visits.
Then, amitryptiline is the most effective preventative (at least it is very good at it if no number one). It acts differentlly from the others.
100% oxygen inhalation is another treatment that is very effective and never used.
Third, other irritations of the brain are likely to trigger migraine. Bright lights, stress, wtihdrawal from caffeine, drugs of abuse, or alcohol. Cigarettes can have an interacdtion with migraine but not as commonly as the others. Some people report odd triggers such as odors or emotional triggers. Most find that lowering CNS stimulation (quiet dark room) helps.
This can also include sinus irritation or even slurpees as triggers.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I've never been given a tryptan, which I suspect is due to a family history of CV issues (none personally) and also perhaps because I take Effexor and Wellbutrin? I don't know how high the risk is for serotonin syndrome with these drugs on top of a tryptan?
Brief Answer:
let us say the risk is huge...
Detailed Answer:
which it isn't.
This is likely the reason someone is not giving the most common migraine medication.....
Serotonin syndrome includes mental confusion/blurring/sedation and flushing, perhaps some nausea and diarrhea. It occurs only when all the medications are present and stops rapidly when they are not. So....... informed consent would be to give all the options and let someone decide if they want a small risk of some side effects for, oh, 6 hrs or so ? in exchange for a better than 50% likelihood of 50% reduction in migraine.
just saying.
let us say the risk is huge...
Detailed Answer:
which it isn't.
This is likely the reason someone is not giving the most common migraine medication.....
Serotonin syndrome includes mental confusion/blurring/sedation and flushing, perhaps some nausea and diarrhea. It occurs only when all the medications are present and stops rapidly when they are not. So....... informed consent would be to give all the options and let someone decide if they want a small risk of some side effects for, oh, 6 hrs or so ? in exchange for a better than 50% likelihood of 50% reduction in migraine.
just saying.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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