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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest better treatment for migraine

hello i am Cheryl and i have had migraine for 11 years now i have had a C.A.T. scan and they said nothing is wrong can you help me. i have been taking excedrin for 11 years and sometime they don t even help i have had precrption migraine medication and they don t work. Can you help i can t stand have these any more they come 4 times a day.
Thu, 12 Dec 2019
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Neurologist 's  Response
Hi,

The advice I can give you is a bit limited as I don't know what your migraine medications are/or what you have tried but I will do my best. First, you should be cautious about how much over the counter medication you take (advil, motrin, excedrin, tylenol etc). If you take it more than 3-4 days per week you risk developing a chronic daily headache known as "medication overuse headache". If that has happened, and it may well have since you have been suffering from uncontrolled headaches for so long, you would need to slowly back off of the medications. A 1-2 week steroid taper can also be used to help wean you off of the medications.

As far as migraine medications, there is a class of medications known as "triptan" which include imitrex, maxalt and zomig to name a few, which work as rescue medications to try and prevent the migraine from peaking and abort it. They do not prevent a migraine from happening in the first place.

For migraine prevention, medications such as topiramate, amitriptyline, nortriptyline, valproic acid, beta-blockers (particularly propranolol), verapamil, candesartan, gabapentin, venlafaxine and memantine are some that can be tried. They take time to work, but the goal is to reduce the frequency and severity of migraines.

If typical preventative medications do not help, then botox injections can be used. Also, there is a new class of medications which include Emgality, Ajovi and Aimovig which are preventative medications that have been shown to work in individuals even if they have not responded to other conventional medications.

You should find a headache specialist to help you manage your headaches, as I suspect that you have more than one type of headache affecting you. For a headache to be classified as a migraine it has to last 4-72 hours along with other specific features. However, that being said, it is not impossible for other types of headaches to have migrainous features without being a true migraine.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Janne Nissinen, Neurologist
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