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What Causes Persistent Headaches Despite Taking Medication?
Question: Dear Dr.
My daughter aged 17 years is taking following medicines for vascular headache (migrane) from 11 Feb 2017 as per doctors advise.
1. Migiplex 5 ( Flunarizine 5 mg plus propranolol 40 mg) - 1 daily at bed time
2. Divalproex sodium 250 mg - 1 daily at bed time
3. Tab Auxem D ( Naproxen 250 mg plus domperidone) 2 times a day
4. Headset tablet on SOS.
As there was no improvement in the headache Dr. on 25/2/2017 added 25 mg sertraline HCL 1 daily in the morning. Now after taking this medicine for 10 days, she is highly irritated and aggressive and angry.. Is it the side effects of sertraline hcl medicine.. i feel so.. If it is so can she stop this medicine from tomorrow. Dr. treating her is available only on 11/3/2017 for consultations. I want to consult the dr. on 11th. Is Suddenly stopping sertraline hcl 25 mg after taking for 10 days cause any side effects ? Kindly advise for stopping this medicine. And also your 2nd opinion on treatment. Earlier to above prescription of present dr. she has been taken Flunarizine 10 mg for about 2 months, propranolol 40 mg for 1 month and Divalproex sodium for 1 month. from another Dr. with not much improvement in head ache. All reports including MRI head is OK. Is it migrane headache ? She is band type persistent headache. No other medical problems diagonized so far. Some times intensity of head ache increases. No improvement in headache with above medicines
Thanks,
XXXX XXXXXXX
F/o XXXXXXX (patient)
My daughter aged 17 years is taking following medicines for vascular headache (migrane) from 11 Feb 2017 as per doctors advise.
1. Migiplex 5 ( Flunarizine 5 mg plus propranolol 40 mg) - 1 daily at bed time
2. Divalproex sodium 250 mg - 1 daily at bed time
3. Tab Auxem D ( Naproxen 250 mg plus domperidone) 2 times a day
4. Headset tablet on SOS.
As there was no improvement in the headache Dr. on 25/2/2017 added 25 mg sertraline HCL 1 daily in the morning. Now after taking this medicine for 10 days, she is highly irritated and aggressive and angry.. Is it the side effects of sertraline hcl medicine.. i feel so.. If it is so can she stop this medicine from tomorrow. Dr. treating her is available only on 11/3/2017 for consultations. I want to consult the dr. on 11th. Is Suddenly stopping sertraline hcl 25 mg after taking for 10 days cause any side effects ? Kindly advise for stopping this medicine. And also your 2nd opinion on treatment. Earlier to above prescription of present dr. she has been taken Flunarizine 10 mg for about 2 months, propranolol 40 mg for 1 month and Divalproex sodium for 1 month. from another Dr. with not much improvement in head ache. All reports including MRI head is OK. Is it migrane headache ? She is band type persistent headache. No other medical problems diagonized so far. Some times intensity of head ache increases. No improvement in headache with above medicines
Thanks,
XXXX XXXXXXX
F/o XXXXXXX (patient)
Brief Answer:
Unfortunately I see too many medications.
Detailed Answer:
Hi welcome to Health care magic,
Unfortunately I see too many medications.
I would want to get her more fully investigated including --
x-ray para nasal sinuses and Orbits.
x-ray cervical spine.
A proper dental check up.
Carotid doppler to rule out any vascular malformations in temples.
I would try Omeprazole with domperidone 20 plus 10 twice a day, and only paracetamol.
And continue Propranolol 10 mg 3 times a day as preventive.
Add vitamin B-12 and calcium.
The rest all cause side effects.
Divalproex sodium is used for epilepsy and can damage liver, and since it is not helping it should be withdrawn gradually.
Using Naproxen frequently is also dangerous. It can damage kidneys.
Flunarizine can lead to severe extra pyramidal side effects (contortions of body). And in any case it is not helping--so should be gradually withdrawn.
Now regarding Sertraline--do not withdraw suddenly. Yes the changes in her behavior are definitely due to Sertraline. Make it alternate days till you see your doctor.
If all tests are normal, a Psychiatric evaluation may be called for.
You can revert back.
Regards
Unfortunately I see too many medications.
Detailed Answer:
Hi welcome to Health care magic,
Unfortunately I see too many medications.
I would want to get her more fully investigated including --
x-ray para nasal sinuses and Orbits.
x-ray cervical spine.
A proper dental check up.
Carotid doppler to rule out any vascular malformations in temples.
I would try Omeprazole with domperidone 20 plus 10 twice a day, and only paracetamol.
And continue Propranolol 10 mg 3 times a day as preventive.
Add vitamin B-12 and calcium.
The rest all cause side effects.
Divalproex sodium is used for epilepsy and can damage liver, and since it is not helping it should be withdrawn gradually.
Using Naproxen frequently is also dangerous. It can damage kidneys.
Flunarizine can lead to severe extra pyramidal side effects (contortions of body). And in any case it is not helping--so should be gradually withdrawn.
Now regarding Sertraline--do not withdraw suddenly. Yes the changes in her behavior are definitely due to Sertraline. Make it alternate days till you see your doctor.
If all tests are normal, a Psychiatric evaluation may be called for.
You can revert back.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks madam for the quick response & advice.
Madam, X-ray for sinuses already done and O.K. Carotid doppler not done. X-ray of cervical spine not done as there has been no pain in the back or neck & Teeths are O.K. so dental check up not done. As advised I am going for these check up and tests. Before consulting doctor for headache/pain she used to take paracetamol, dispirin and zuper table occasionally whenever pain frequency increases, but these medicine have no effect on her headache for reducing pain. Now even Naproxen & headset on SOS (Naproxen plus Sumatripan) is also not effective and of no use. Is it due to overuse of this medicine ?
Kindly advice for any medicine which can be taken on SOS to control headache, when intensity of pain increases.
Earlier doctor given ketoflam P tablet for SOS but it was causing drowsiness & giddiness, even though this medicine appears to have some effect to control pain.
Sertraline hcl 25 mg daily she used it for 10 days only, now as per your advice she has now started taking it in alternate days. Flunarizine 10 mg she used it for almost 2 months and now on reduced dose of 5 mg for last 15 days.
Divalproex sodium 250 mg she is using it for that last 1 and half months. Due to side effects as mentioned by you, I will talk to my doctor to reduce or stop these medicine.
Taking low doses of Flunarizine & Divalproex sodium for the period as mentioned above causes immediate side effects ?
Kindly prescribe medicine to be taken on SOS or on daily basis for reducing headache as requested above and your kind further advice.
Regards,
XXXX XXXXXXX
F/o XXXXXXX (Patient)
Mob. No. 0000
Madam, X-ray for sinuses already done and O.K. Carotid doppler not done. X-ray of cervical spine not done as there has been no pain in the back or neck & Teeths are O.K. so dental check up not done. As advised I am going for these check up and tests. Before consulting doctor for headache/pain she used to take paracetamol, dispirin and zuper table occasionally whenever pain frequency increases, but these medicine have no effect on her headache for reducing pain. Now even Naproxen & headset on SOS (Naproxen plus Sumatripan) is also not effective and of no use. Is it due to overuse of this medicine ?
Kindly advice for any medicine which can be taken on SOS to control headache, when intensity of pain increases.
Earlier doctor given ketoflam P tablet for SOS but it was causing drowsiness & giddiness, even though this medicine appears to have some effect to control pain.
Sertraline hcl 25 mg daily she used it for 10 days only, now as per your advice she has now started taking it in alternate days. Flunarizine 10 mg she used it for almost 2 months and now on reduced dose of 5 mg for last 15 days.
Divalproex sodium 250 mg she is using it for that last 1 and half months. Due to side effects as mentioned by you, I will talk to my doctor to reduce or stop these medicine.
Taking low doses of Flunarizine & Divalproex sodium for the period as mentioned above causes immediate side effects ?
Kindly prescribe medicine to be taken on SOS or on daily basis for reducing headache as requested above and your kind further advice.
Regards,
XXXX XXXXXXX
F/o XXXXXXX (Patient)
Mob. No. 0000
Brief Answer:
disprin tablet in a glass of water and take with Omeprazole instant
Detailed Answer:
Hi XXXXXXX When headache is severe, ask XXXXXXX to dissolve a disprin tablet in a glass of water and take with Omeprazole instant--(quick dissolving).
There is no drowsiness.
Side effects of drugs sometimes can be instant and sometimes after using for some time.
Revert back to me with reports.
Regards
disprin tablet in a glass of water and take with Omeprazole instant
Detailed Answer:
Hi XXXXXXX When headache is severe, ask XXXXXXX to dissolve a disprin tablet in a glass of water and take with Omeprazole instant--(quick dissolving).
There is no drowsiness.
Side effects of drugs sometimes can be instant and sometimes after using for some time.
Revert back to me with reports.
Regards
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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