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Suggest treatment for migraine

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Posted on Fri, 3 Jun 2016
Question: doctor said my head nerves were tight so migraine increased a lot. i ws suffering from migraine from my childhood but since 1 year it has increased a lot. now one month back it increased so much that i even could be able to do my routine work so i went to a neurologist . he suggested my some antideprresant and pain killer but that caused me severe low bp ,dizzyness and insomnia. then i tried migrainil also but it also caused increased heartbeat and low bp. i have been taking neprosen for last 5-6 years but frequency of migraine attacks were low that time . from last month i m having headaches daily. kindly suggest
doctor
Answered by Dr. Ishu Bishnoi (1 hour later)
Brief Answer:
Migraine treatment

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. You are suffering from migraine for quite a long time. As your migraine has increased in severity and frequency both, I will explain you both abortive and preventive therapy

Abortive therapy means stopping an attack. You have already been prescribed Migrainil (ergotamine) for it. As you have developed side effect from it, you can take

:Triptans like Sumatriptan, Zolmitriptan after proper prescription
:Dihydroergotamine nasal spray after prescription. There is less chance of low BP with it.
: Combination of Acetaminophen-Dichloralphenazone-isometheptene after proper prescription.
:Strong NSAIDS combination like Diclofenac-Paracetamol after prescription
:If still no relief, you can take Acetaminophen-Codeine combination.

There are sustained release patch formulation which are applied on arm and give relief for 8-12 hours (NSAID patch).

Preventive therapy - This therapy is given to decrease the frequency of attack. It prevents the migraine. It includes

: Avoiding food which can induce migraine like Cheese, chocolate etc.
: Avoid stress (mental and physical). You can start Yoga to make you calm and decrease stress. It will really help you.
: Carefully observe other factors which can induce migraine like season variation, sudden temperature change, bright light, vibration etc. Avoid them.
: Psychological therapy like Biofeedback.
: Botox injection to delay migraine.
: Some drugs like Propranolol, antidepressants (which you have already taken), anti epileptics (Gabapentine) etc. You can start either of one after proper prescription.

I have mentioned all the options. You can't start it your own, but you can discuss it with your doctor. It will help you in better management of your pain. Hope it will help you.

Thanks. Take care.

Dr Ishu Bishnoi
Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Ishu Bishnoi (23 hours later)
thanx. for how long I can take preventive medicines or pain relievers.
coz I am having headaches daily now a days. and even sometimes during migraine pain my eyesight become blurred also. Doctor also did VEP test but that was normal. I m taking naprosen almost daily but due to its sideeffect I want to discontinue it. Please suggest
doctor
Answered by Dr. Ishu Bishnoi (2 hours later)
Brief Answer:
Preventive therapy duration

Detailed Answer:
Hi XXXXX, thanks for asking from HCM.

It is good that you have thought about side effects of painkillers, because they affect almost every organ in body.

As migraine pain is very severe and you are aware of that, painkillers are continued for long duration under supervision. Long term use of Naproxen can cause
: Ulcer and bleeding from intestine/stomach
: Asthma attack
: low haemoglobin
: Kidney damage

You have to regularly visit your doctor and get routine blood investigations done every month. It will help you in detecting side effect at early stage. Regarding gastrointestinal side effect, you can take
: Tab Pantoprazole after proper prescription. It prevents ulcer, bleeding.
: Discontinue Naproxen intermittently whenever you do not have any pain attack. It is used as "Abortive therapy", so no need to take it when you do not have pain.

Regarding duration of preventive therapy, try to continue it during severe and increased frequency of migraine. Identify that time of year when you do not have or less frequent migraine, discontinue preventive medication under supervision during that time. However continue other measures of preventive therapy to abort attack.

And if you do not want any medication, you can discuss "Botox therapy" with your doctor. It usually gives relief for 3 months.

Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ishu Bishnoi (3 days later)
I have realise that due to this migraine pain in last few years my memory ,concentration etc has also affected . is it possible. Is dere any suggestion regarding this. because even if i take medicine for headache these problems are persistant.
I have started tryptomer 10mg from last 3 days and my got relief in migraine pain to an extend. but still vision become blurred most of the time.
doctor
Answered by Dr. Ishu Bishnoi (37 minutes later)
Brief Answer:
Cause and treatment of Memory/concentration problem

Detailed Answer:
Hi, thanks for asking from HCM.

It is good that you are getting relief. Migraine pain is very severe and it can affect your memory and concentration badly. But you should get relief in memory as soon as your pain subsides. It may take some time. Another reason of poor memory/concentration could be tryptomer(amitriptyline) intake. It causes some sedation and decreases mental alertness. If you have got relief, ask your doctor to reduce the dose.

Regarding visual blurring, if it is present even after pain relief, kindly get your eye evaluation. It could be refractive error. Migraine affects vision only during pain.

You can also follow few tips to enhance memory and concentration
: Avoid mental stress. Do not think much about it
: Start Yoga and meditation to enhance both
: Keep a diary with you to note every important point and to-do list. It will help you remembering things
: Start playing chess/Sudoku to increase analytical ability
: Eat almonds daily
: You can take medication like Ginkgo blob/Amantadine after proper prescription.
Still no relief, you can ask me or consult your doctor. Wait for few weeks for good results.

Thanks. Take care
Above answer was peer-reviewed by : Dr. Sonia Raina
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Answered by
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Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 901 Questions

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Suggest treatment for migraine

Brief Answer: Migraine treatment Detailed Answer: Hi XXXX, thanks for asking from HCM. I can understand your concern. You are suffering from migraine for quite a long time. As your migraine has increased in severity and frequency both, I will explain you both abortive and preventive therapy Abortive therapy means stopping an attack. You have already been prescribed Migrainil (ergotamine) for it. As you have developed side effect from it, you can take :Triptans like Sumatriptan, Zolmitriptan after proper prescription :Dihydroergotamine nasal spray after prescription. There is less chance of low BP with it. : Combination of Acetaminophen-Dichloralphenazone-isometheptene after proper prescription. :Strong NSAIDS combination like Diclofenac-Paracetamol after prescription :If still no relief, you can take Acetaminophen-Codeine combination. There are sustained release patch formulation which are applied on arm and give relief for 8-12 hours (NSAID patch). Preventive therapy - This therapy is given to decrease the frequency of attack. It prevents the migraine. It includes : Avoiding food which can induce migraine like Cheese, chocolate etc. : Avoid stress (mental and physical). You can start Yoga to make you calm and decrease stress. It will really help you. : Carefully observe other factors which can induce migraine like season variation, sudden temperature change, bright light, vibration etc. Avoid them. : Psychological therapy like Biofeedback. : Botox injection to delay migraine. : Some drugs like Propranolol, antidepressants (which you have already taken), anti epileptics (Gabapentine) etc. You can start either of one after proper prescription. I have mentioned all the options. You can't start it your own, but you can discuss it with your doctor. It will help you in better management of your pain. Hope it will help you. Thanks. Take care. Dr Ishu Bishnoi