Psycho-Babble Medication Thread 700825

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Any meds for migraines safe on while on SSRI?

Posted by Jax on November 5, 2006, at 23:33:20

Hi there

I'm currently on 30mg Paxil (tapered down from 60mg) and 1.5mg of Klonopin (down from 3mg). In the last 3 months I've started having migraines for the first time in my life. After many blood tests, my doc and I have concluded that these have been brought on by the tapering of the meds. (Which has taken 6 months). My doc prescribed Imitrex for the migraines and I questioned if they would interact with my meds, to which she assured me they wouldn't. Luckily I mentioned which meds I was on when I went to a different pharmacy (I was short on time before going away to go to my usual) who told me the migraine meds and my current meds would definitely intereract and I should not take them. I asked the pharmacist if there was anything else I could take (prescription wise - OTC stuff just wasn't working) and she couldn't think of anything.

So - does anyone out there know of a good med to take for migraines while you're on an SSRI?

Thanks
Jax

 

Re: Any meds for migraines safe on while on SSRI? » Jax

Posted by yxibow on November 6, 2006, at 6:08:54

In reply to Any meds for migraines safe on while on SSRI?, posted by Jax on November 5, 2006, at 23:33:20

> Hi there
>
> I'm currently on 30mg Paxil (tapered down from 60mg) and 1.5mg of Klonopin (down from 3mg). In the last 3 months I've started having migraines for the first time in my life. After many blood tests, my doc and I have concluded that these have been brought on by the tapering of the meds. (Which has taken 6 months). My doc prescribed Imitrex for the migraines and I questioned if they would interact with my meds, to which she assured me they wouldn't. Luckily I mentioned which meds I was on when I went to a different pharmacy (I was short on time before going away to go to my usual) who told me the migraine meds and my current meds would definitely intereract and I should not take them. I asked the pharmacist if there was anything else I could take (prescription wise - OTC stuff just wasn't working) and she couldn't think of anything.
>
> So - does anyone out there know of a good med to take for migraines while you're on an SSRI?
>
> Thanks
> Jax

The tapering of the Paxil may have brought on migraines in someone susceptible to them -- Paxil has been used to treat migraines.


From Drugs.com interaction engine

paroxetine and sumatriptan (major Drug-Drug)

Description:

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.


In other words dosage would have to be monitored very closely with major migraine medications (triptans, e.g.) in order to prevent serotonin syndrome. In fact tricyclics are used in migraine therapy.

It leaves you with OTC with Excedrin Migraine or any OTC NSAID (ibuprofen, naproxen, acetaminophen, aspirin) combined with a portion of a caffeine tablet. The caffeine constricts blood vessels in the head.

This combination is not without concern; theoretically NSAIDs and Paxil can cause internal bleeding though this is most likely due to an accentuation of those susceptible to the dangers of COX-1/COX-2 inhibiting compounds and stomach lining/upset.

There also exist esoteric prescription NSAIDs like sulindac and piroxicam and flurbiprofen, but these are generally more for types of arthritis.


There are also agents which will mask the pain but not necessarily fully treat the symptoms. Caution should be used with these for habituation and interaction with Klonopin:

Fiorinal (C-III) - contains a barbiturate family compound.

Micrainin - meprobamate (Miltown) and aspirin

Stadol NS (C-IV) (nasal) - butorphanol tartrate nasal spray; narcotic weaker than Fiorinal variants

-- Jay

 

Re: Any meds for migraines safe on while on SSRI?

Posted by ronaldo on November 6, 2006, at 9:31:33

In reply to Any meds for migraines safe on while on SSRI?, posted by Jax on November 5, 2006, at 23:33:20

Hi Jax,

"Low levels of Serotonin have been associated with several disorders, notably depression, MIGRAINE, bipolar disorder and anxiety."

http://en.wikipedia.org/wiki/Serotonin

"SSRI drugs are designed to allow the available neurotransmitter serotonin to be utilized more efficiently. A low level of utilization of serotonin is currently seen as one among several neurochemical symptoms of depression. Low levels of serotonin in turn can be caused by an anxiety disorder, because serotonin is needed to metabolize stress hormones [citation needed]."

http://en.wikipedia.org/wiki/SSRI

Seems like you need something to increase your serotonin levels. Maybe your SSRI is stealing all the available serotonin?

[edit] Serotonergics
"Serotonergics are substances which affect the neurotransmitter serotonin or the components of the nervous system which utilize serotonin. Serotonergic nootropics include serotonin precursors and cofactors, and serotonin reuptake inhibitors:

5-HTP - more bioavailable form of tryptophan[citation needed], precursor to the neurotransmitter serotonin, promotes relaxed poise and sound sleep[citation needed].
Griffonia simplicifolia a natural source of 5-HTP (an alternative in countries where 5-HTP not legal, freely available.)
Theanine - Found in tea. Increases GABA and dopamine levels in the brain. Increases alpha-wave based alert relaxation.
Tryptophan (requires Vitamin B6 and Vitamin C) - Essential amino acid. Precursor to serotonin, found in high concentration in bananas and poultry (especially turkey), also in milk, promotes relaxed poise and sound sleep."

http://en.wikipedia.org/wiki/Nootropic#Serotonergics

Try drinking a cup of tea and eating a banana and popping a Vit B6 and a Vit C tablet.

Sorry can't help you more than this.

Let me know if it works...

....Alan

 

Re: Sorry Jax make that a glass of milk instead. (nm)

Posted by ronaldo on November 6, 2006, at 9:48:29

In reply to Any meds for migraines safe on while on SSRI?, posted by Jax on November 5, 2006, at 23:33:20

 

Re: Any meds for migraines safe on while on SSRI?

Posted by Phillipa on November 6, 2006, at 10:01:43

In reply to Re: Any meds for migraines safe on while on SSRI?, posted by ronaldo on November 6, 2006, at 9:31:33

Ibuphopeb is all I ever use . As I was told I couldn't use Imitrex back when I got a lot of headaches. So how does a headache interfer with serotonin? Love Phillipa

 

Re: Any meds for migraines safe on while on SSRI? » Phillipa

Posted by johnnyj on November 6, 2006, at 14:16:52

In reply to Re: Any meds for migraines safe on while on SSRI?, posted by Phillipa on November 6, 2006, at 10:01:43

Hi,

Did you have any start up anxiety on luvox? I am really thinking of trying it and am a little scared right now. What dose did you start at? I was thinking of starting really low at 12.5-mg. I would have to split the tabs but that is ok I guess. Any advice about it? Thanks
PS: I would like to stay away from benzo's if possible.

johnnyj

 

Re: Any meds for migraines safe on while on SSRI? » johnnyj

Posted by yxibow on November 6, 2006, at 15:50:37

In reply to Re: Any meds for migraines safe on while on SSRI? » Phillipa, posted by johnnyj on November 6, 2006, at 14:16:52

> Hi,
>
> Did you have any start up anxiety on luvox? I am really thinking of trying it and am a little scared right now. What dose did you start at? I was thinking of starting really low at 12.5-mg. I would have to split the tabs but that is ok I guess. Any advice about it? Thanks
> PS: I would like to stay away from benzo's if possible.
>
> johnnyj

Luvox is the least likely to cause anxiety in general as it is the most sedating of all medications.

But you have to work out the scenarios with your doctor first as to what caused the migraines. As I noted, Paxil is used for migraines, and if you are suceptible to migraines, the migraine therapy, if it is interrupted, the migraines will return.

I know some people prefer not to use benzodiazepines, but it is one of the better options with a problem of migraines + a serotonergic medication besides OTC medication.

Just my 2c

-- Jay

 

Re: Any meds for migraines safe on while on SSRI? » Phillipa

Posted by yxibow on November 6, 2006, at 15:51:33

In reply to Re: Any meds for migraines safe on while on SSRI?, posted by Phillipa on November 6, 2006, at 10:01:43

> Ibuphopeb is all I ever use . As I was told I couldn't use Imitrex back when I got a lot of headaches. So how does a headache interfer with serotonin? Love Phillipa


Is that a joke word for ibuprofen ? :) Otherwise that sounds like a southwest Native American tea.


Triptans and ergot derivatives are not appropriate for "a lot of headaches." Its annoying, but tension headaches don't have the same transmitter firing as what migraine sufferers have, nor are they accompanied by auras and other visual phenomenon.


Now "cluster headaches" are different, and are more rare and treated with oxygen, Imitrex, ergots, and lidocaine, among other things.


Imitrex (sumatriptan) and its cousin half a dozen or other triptans work as agonists of 5HT1x receptors. This is in conflict with SSRIs which also form reuptake inhibitance at those receptors as well as other 5HT locales.


The combination of the two can cause Serotonin Syndrome if the doctor(s) do not adjust the dosage of the two agents. It may mean forgoing a portion of the SSRIs if the migraines are intolerable and can't be managed by other non medication therapy, or tolerating the headaches and using NSAID/caffeine combinations and sticking with the full amount of SSRIs being used.


I had a very mild episode with Robaxin and whatever else I take for my problems -- it was made before P450 interaction testing and I was flushed and the like until we reduced it below th e threshold of medications. But that's nothing like a true clinical episode of Serotonin Syndrome which includes high fever, delirium, and a chain reaction of other really bad things, to put it mildly.

 

Re: Any meds for migraines safe on while on SSRI? » yxibow

Posted by Phillipa on November 6, 2006, at 19:33:50

In reply to Re: Any meds for migraines safe on while on SSRI? » Phillipa, posted by yxibow on November 6, 2006, at 15:51:33

Jay I'm sorry but I'm not perfect and either is my spelling. But ibuprophen is what I use and I would say Johnny if you want to try luvox it is a very good med without startup sideeffects at least for me. Paxil made me have diarrhea and I was in a hammock sleeping for three months til my body adjusted to it. I stand by the luvox recommendation. Love Phillipa ps caffeine creates anxiety

 

Re: Any meds for migraines safe on while on SSRI? » Phillipa

Posted by yxibow on November 7, 2006, at 2:01:06

In reply to Re: Any meds for migraines safe on while on SSRI? » yxibow, posted by Phillipa on November 6, 2006, at 19:33:50

> Jay I'm sorry but I'm not perfect and either is my spelling. But ibuprophen

ibuprofen. Its okay... I got the gist of it. I was sort of joshing you, no bad feelings meant.

is what I use and I would say Johnny if you want to try luvox it is a very good med without startup sideeffects at least for me. Paxil made me have diarrhea and I was in a hammock sleeping for three months til my body adjusted to it.


Gastrointestinal upset is probably a fairly common result of starting any SSRI I would imagine. Loperamide (Imodium, the only legal opiate sold OTC because it doesn't cross the blood brain barrier) is my friend. I tend... that way anyhow...


I stand by the luvox recommendation. Love Phillipa ps caffeine creates anxiety


Caffeine certainly does make anxiety with those susceptible to it. But body chemistry changes through life. I used to down 4 shots of espresso in college a day in a thermos, but that's what every college student does in Seattle. My anxiety level was fairly low to modest at the time but I did suffer from dysthymia.


Caffeine plus an NSAID is the only OTC way to stop a migraine or a cluster headache. It constricts the blood vessels. It is a tradeoff, and only to use when an attack is imminent. Otherwise I'm not suggesting people pop aspirin and a small part of a tablet of Vivarin like candy, you are right, it will generate anxiety. But it does work, I dont have migraines but I had a really nasty headache that resembled one if I recall one time and I took some caffeine with ibuprofen, it helped.

-- Jay

 

Re: Any meds for migraines safe on while on SSRI? » yxibow

Posted by Phillipa on November 7, 2006, at 19:19:39

In reply to Re: Any meds for migraines safe on while on SSRI? » Phillipa, posted by yxibow on November 7, 2006, at 2:01:06

Jay before I had bad anxiety I used to pop goody's lots of caffeine in them. And also I worked in CCU and drank a pot of coffee on the 3-ll shift and this was when in my 40's how can a body change so much? Love Phillipa

 

Re: Any meds for migraines safe on while on SSRI? » Phillipa

Posted by yxibow on November 7, 2006, at 22:41:48

In reply to Re: Any meds for migraines safe on while on SSRI? » yxibow, posted by Phillipa on November 7, 2006, at 19:19:39

> Jay before I had bad anxiety I used to pop goody's lots of caffeine in them. And also I worked in CCU and drank a pot of coffee on the 3-ll shift and this was when in my 40's how can a body change so much? Love Phillipa

Well, if your body chemistry is anything like mine or most others on here that is, born with as yet discovered genes and the like that cause biological mental illness, then over time the natural course of things will, naturally change. Right now I'm stuck in the fight for my livelihood. After I got out of a hospital and got treated for OCD in a day treatment program it also was different. In college it was different.


As for caffeine itself, therefore it makes sense that as ones tendency towards anxiety waxes and wanes, one can tolerate more of it. Also there is a tendency to get used to and have tolerance for high amounts of caffeine for some and ironically dropping the level may contribute to a migraine if one is susceptible to them, at least from what little I understand about migraines.


-- Jay

 

Re: Any meds for migraines safe on while on SSRI? » yxibow

Posted by Phillipa on November 7, 2006, at 22:45:24

In reply to Re: Any meds for migraines safe on while on SSRI? » Phillipa, posted by yxibow on November 7, 2006, at 22:41:48

Reminds of the book by Patterson wer're reading about the bird kids. They were taken at birth and given meds and now they have wings, feather, and can fly. Love Phillipa

 

Re: Any meds for migraines safe on while on SSRI? » yxibow

Posted by Jax on November 7, 2006, at 23:30:35

In reply to Re: Any meds for migraines safe on while on SSRI? » Jax, posted by yxibow on November 6, 2006, at 6:08:54

> > Hi there
> >
> > I'm currently on 30mg Paxil (tapered down from 60mg) and 1.5mg of Klonopin (down from 3mg). In the last 3 months I've started having migraines for the first time in my life. After many blood tests, my doc and I have concluded that these have been brought on by the tapering of the meds. (Which has taken 6 months). My doc prescribed Imitrex for the migraines and I questioned if they would interact with my meds, to which she assured me they wouldn't. Luckily I mentioned which meds I was on when I went to a different pharmacy (I was short on time before going away to go to my usual) who told me the migraine meds and my current meds would definitely intereract and I should not take them. I asked the pharmacist if there was anything else I could take (prescription wise - OTC stuff just wasn't working) and she couldn't think of anything.
> >
> > So - does anyone out there know of a good med to take for migraines while you're on an SSRI?
> >
> > Thanks
> > Jax
>
> The tapering of the Paxil may have brought on migraines in someone susceptible to them -- Paxil has been used to treat migraines.
>
>
> From Drugs.com interaction engine
>
> paroxetine and sumatriptan (major Drug-Drug)
>
> Description:
>
> MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.
>
>
> In other words dosage would have to be monitored very closely with major migraine medications (triptans, e.g.) in order to prevent serotonin syndrome. In fact tricyclics are used in migraine therapy.
>
>
>
> It leaves you with OTC with Excedrin Migraine or any OTC NSAID (ibuprofen, naproxen, acetaminophen, aspirin) combined with a portion of a caffeine tablet. The caffeine constricts blood vessels in the head.
>
> This combination is not without concern; theoretically NSAIDs and Paxil can cause internal bleeding though this is most likely due to an accentuation of those susceptible to the dangers of COX-1/COX-2 inhibiting compounds and stomach lining/upset.
>
> There also exist esoteric prescription NSAIDs like sulindac and piroxicam and flurbiprofen, but these are generally more for types of arthritis.
>
>
> There are also agents which will mask the pain but not necessarily fully treat the symptoms. Caution should be used with these for habituation and interaction with Klonopin:
>
> Fiorinal (C-III) - contains a barbiturate family compound.
>
> Micrainin - meprobamate (Miltown) and aspirin
>
> Stadol NS (C-IV) (nasal) - butorphanol tartrate nasal spray; narcotic weaker than Fiorinal variants
>
> -- Jay

Hi Jay

Thanks for all your helpful info. I tend to have bouts of gastritis (inflamed stomach lining) and bad heart burn which took me years to realise were probably the direct result of the meds I was on. Is it likely a caffeine tablet would get my stomach acting up?

Unfortunately I don't have access to all those wonderful medical suggestions you put down as I live in little ol' NZ (no - that's not a new state, it's the country at the bottom of the world LOL...). It sounds like meds are cheaper here, but alas, a lot more restricted...

Thanks
Jax

 

Re: Any meds for migraines safe on while on SSRI? » ronaldo

Posted by Jax on November 7, 2006, at 23:46:05

In reply to Re: Any meds for migraines safe on while on SSRI?, posted by ronaldo on November 6, 2006, at 9:31:33

> Hi Jax,
>
> "Low levels of Serotonin have been associated with several disorders, notably depression, MIGRAINE, bipolar disorder and anxiety."
>
> http://en.wikipedia.org/wiki/Serotonin
>
> "SSRI drugs are designed to allow the available neurotransmitter serotonin to be utilized more efficiently. A low level of utilization of serotonin is currently seen as one among several neurochemical symptoms of depression. Low levels of serotonin in turn can be caused by an anxiety disorder, because serotonin is needed to metabolize stress hormones [citation needed]."
>
> http://en.wikipedia.org/wiki/SSRI
>
> Seems like you need something to increase your serotonin levels. Maybe your SSRI is stealing all the available serotonin?
>
> [edit] Serotonergics
> "Serotonergics are substances which affect the neurotransmitter serotonin or the components of the nervous system which utilize serotonin. Serotonergic nootropics include serotonin precursors and cofactors, and serotonin reuptake inhibitors:
>
> 5-HTP - more bioavailable form of tryptophan[citation needed], precursor to the neurotransmitter serotonin, promotes relaxed poise and sound sleep[citation needed].
> Griffonia simplicifolia a natural source of 5-HTP (an alternative in countries where 5-HTP not legal, freely available.)
> Theanine - Found in tea. Increases GABA and dopamine levels in the brain. Increases alpha-wave based alert relaxation.
> Tryptophan (requires Vitamin B6 and Vitamin C) - Essential amino acid. Precursor to serotonin, found in high concentration in bananas and poultry (especially turkey), also in milk, promotes relaxed poise and sound sleep."
>
> http://en.wikipedia.org/wiki/Nootropic#Serotonergics
>
> Try drinking a cup of tea and eating a banana and popping a Vit B6 and a Vit C tablet.
>
> Sorry can't help you more than this.
>
> Let me know if it works...
>
> ....Alan


Thanks Alan for confirming my suspicion that the lowering of my SSRI (and thus reducing amount of serotonin floating round) could bring on migraines. (Especially as SSRI's are USED for migraines - seems like a no-brainer to me!).

I realised after reading your post that I stopped taking a multi vitamin supplement after I got the first migraine (I was paranoid as to what may have caused them). The migraines just got worse. So I've started taking multi vitamins again, and eating bananas (and drinking tea. Sorry about the milk - just don't like the taste of the stuff). So far I've only had to take one painkiller in the last couple days (About a quarter of the usual). And I'm going to look up any other serotonergic foods...

Jax

 

Re: Any meds for migraines safe on while on SSRI? » Jax

Posted by ronaldo on November 8, 2006, at 7:07:14

In reply to Any meds for migraines safe on while on SSRI?, posted by Jax on November 5, 2006, at 23:33:20

Hi Jax,

Dr Ivan Goldberg says topirimate is good for the prevention of migraine. I don't know if it is compatible with SSRI's.

Check it out:

http://www.psycom.net/depression.central.topiramate.html

ciao

....Alan

 

Go to point no. 25 Jax

Posted by ronaldo on November 8, 2006, at 7:38:57

In reply to Any meds for migraines safe on while on SSRI?, posted by Jax on November 5, 2006, at 23:33:20

go to point no. 25 Jax

 

Re: Any meds for migraines safe on while on SSRI? » Jax

Posted by yxibow on November 8, 2006, at 13:23:13

In reply to Re: Any meds for migraines safe on while on SSRI? » yxibow, posted by Jax on November 7, 2006, at 23:30:35

> > > Hi there
> > >
> > > I'm currently on 30mg Paxil (tapered down from 60mg) and 1.5mg of Klonopin (down from 3mg). In the last 3 months I've started having migraines for the first time in my life. After many blood tests, my doc and I have concluded that these have been brought on by the tapering of the meds. (Which has taken 6 months). My doc prescribed Imitrex for the migraines and I questioned if they would interact with my meds, to which she assured me they wouldn't. Luckily I mentioned which meds I was on when I went to a different pharmacy (I was short on time before going away to go to my usual) who told me the migraine meds and my current meds would definitely intereract and I should not take them. I asked the pharmacist if there was anything else I could take (prescription wise - OTC stuff just wasn't working) and she couldn't think of anything.
> > >
> > > So - does anyone out there know of a good med to take for migraines while you're on an SSRI?
> > >
> > > Thanks
> > > Jax
> >
> > The tapering of the Paxil may have brought on migraines in someone susceptible to them -- Paxil has been used to treat migraines.
> >
> >
> > From Drugs.com interaction engine
> >
> > paroxetine and sumatriptan (major Drug-Drug)
> >
> > Description:
> >
> > MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A receptors.
> >
> >
> > In other words dosage would have to be monitored very closely with major migraine medications (triptans, e.g.) in order to prevent serotonin syndrome. In fact tricyclics are used in migraine therapy.
> >
> >
> >
> > It leaves you with OTC with Excedrin Migraine or any OTC NSAID (ibuprofen, naproxen, acetaminophen, aspirin) combined with a portion of a caffeine tablet. The caffeine constricts blood vessels in the head.
> >
> > This combination is not without concern; theoretically NSAIDs and Paxil can cause internal bleeding though this is most likely due to an accentuation of those susceptible to the dangers of COX-1/COX-2 inhibiting compounds and stomach lining/upset.
> >
> > There also exist esoteric prescription NSAIDs like sulindac and piroxicam and flurbiprofen, but these are generally more for types of arthritis.
> >
> >
> > There are also agents which will mask the pain but not necessarily fully treat the symptoms. Caution should be used with these for habituation and interaction with Klonopin:
> >
> > Fiorinal (C-III) - contains a barbiturate family compound.
> >
> > Micrainin - meprobamate (Miltown) and aspirin
> >
> > Stadol NS (C-IV) (nasal) - butorphanol tartrate nasal spray; narcotic weaker than Fiorinal variants
> >
> > -- Jay
>
> Hi Jay
>
> Thanks for all your helpful info. I tend to have bouts of gastritis (inflamed stomach lining) and bad heart burn which took me years to realise were probably the direct result of the meds I was on. Is it likely a caffeine tablet would get my stomach acting up?
>
> Unfortunately I don't have access to all those wonderful medical suggestions you put down as I live in little ol' NZ (no - that's not a new state, it's the country at the bottom of the world LOL...). It sounds like meds are cheaper here, but alas, a lot more restricted...


Yes, I know NZ can be even stodgier than England on scheduled drugs, though you do have a form of oxycodone.

It is conceivable that caffeine could cause gastritis I suppose by its mechanism or interactions with any anxiety you might have. I was not suggesting a large caffeine tablet, those are way too high for the purpose, just a small dose of caffeine, plus any NSAID that is sold, hopefully ibuprofen or paracetamol. I can't believe PHARMAC has restrictions on either. Is there private pay for over the counter medications ?

-- Jay


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