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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for severe headaches and jaw pain

Answered by
Dr. Sukhvinder Singh


Practicing since :1998

Answered : 1306 Questions

Posted on Tue, 2 Sep 2014 in Hypertension and Heart Disease
Question: Hellow,

I had severe headaches and jaw pain. I was recently diagnosed with hypertension and put me on Bystolic along with Topamax and Maxalt for the headaches. They took a EKG and the readings
sinus rhythm (slow)
vertical axis
minor right-precordial repolarization disturbance, consider
feminine pattern
small negative T in V2
with flat or low negative T in V3
Normal variant of ECG

Brain scan was normal as well.

My question is. With the reading for this EKG, could the Topamax and Maxalt cause harm to my heart or is everything normal?
Answered by Dr. Sukhvinder Singh 2 hours later
Brief Answer:
Maxalt is contraindicated in anginal heart. ds.

Detailed Answer:
Dear Madam
1. The ECG is best interpreted by reading its graph and knowing clinical details. It would be great if you can upload a scanned copy of your ECG graph on top right hand corner of this page. You can also send it to YYYY@YYYY with ATTN DR SUKHVINDER XXXXXXX in subject line.
2. Occasionally, say less than 1% of patients, reported slow heart rate with TOPAMAX (topiramate). Hence it is uncommon but known. If you had mentioned actual heart rate in ECG , it would have been great. Bystolic (nebivolol) also causes slower heart rate. But this will not cause damage to heart usually. It is recommended that if you ever have heart rate less than 50 bpm or you feel dizzy/have transient blackouts, do consult your doctor in emergency room.
3. Maxalt or RIZATRIPTAN is not given to patients with coronary or anginal heart disease. It is contraindicated in such patients. As I can see from your previous questions, you have under gone cardiac stenting. Hence you must discuss it out with your doctor again, before starting this medication and tell him everything about your heart disease.
Feel free to discuss further.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Sukhvinder Singh 1 hour later
Dr. Sukhvinder XXXXXXX

Thank you, for contributing to my question. I was put on Bystolic 3 days prior to this EKG. Six days after the EKG, I continued to have the same symptoms. Then he put my on Topamax and Maxalt. I guess where I am gong with this, with these medications not knowing I had heart disease. Could this have made my institution worse. I did have to have a stent put in month later.

Thank you XXXXXXX
Answered by Dr. Sukhvinder Singh 8 hours later
Brief Answer:
please see details.

Detailed Answer:
Dear madam
1. It seems that your query is in retrospect.
2. The rate in current ECG is about 62 beats per minute. Addition of topiramate and rizatriptan may be done with careful observation.
3. Since your ischemic heart disease was not known at time of starting rizatriptan, it was not contraindicated.
4. Rizatriptan is given at time of acute attacks of migraine and not for continuous prevention. Hence precipitation of cardiac event will occur around the same time and not after weeks. The mechanism proposed for ischaemic complication of rizatriptan is coronary artery spasm where it causes sudden focal contraction of blood vessel supplying to heart muscle. As a result of this contraction the lumen of vessel narrows and blood supply to heart muscle may dramatically decrease. This leads to anginal pain or heart attack. The presence of cholesterol deposit or plaque increases this propensity for spasm. If there was spasm in your blood vessel at time of angiogram, contribution of rizatriptan is likely else not.
Rizatriptan increasing coronary obstruction by increasing plaque burden in few weeks is unlikely.
Hope this helps.
Above answer was peer-reviewed by : Dr. Shanthi.E

The User accepted the expert's answer

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