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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by pattisun on December 2, 2013, at 11:08:07
Need help, been on SSRIs for almost 20 years due to severe anxiety and mild depression.
I now suffer severe migraines and that medication interferes with my SSRI.
Anyone on a successful combination for their migraines?
Thanks
Posted by ed_uk2010 on December 2, 2013, at 12:32:45
In reply to Anyone with successful migraine treatment who's on, posted by pattisun on December 2, 2013, at 11:08:07
> Need help, been on SSRIs for almost 20 years due to severe anxiety and mild depression.
>
> I now suffer severe migraines and that medication interferes with my SSRI.
>
> Anyone on a successful combination for their migraines?
>
> ThanksMany people with anxiety and depression suffer severe migraines - there seems to be a link between the two conditions. As a result, a lot of people take meds for both problems. I replied in more detail to your post above.
Posted by pattisun on December 2, 2013, at 15:34:18
In reply to Re: Anyone with successful migraine treatment who's on, posted by ed_uk2010 on December 2, 2013, at 12:32:45
THANKS for the feedback!
>
> Many people with anxiety and depression suffer severe migraines - there seems to be a link between the two conditions. As a result, a lot of people take meds for both problems. I replied in more detail to your post above.
Posted by Partlycloudy on December 2, 2013, at 17:45:27
In reply to Re: Anyone with successful migraine treatment who's on, posted by pattisun on December 2, 2013, at 15:34:18
> THANKS for the feedback!
> >
> > Many people with anxiety and depression suffer severe migraines - there seems to be a link between the two conditions. As a result, a lot of people take meds for both problems. I replied in more detail to your post above.
>
>
Hi there. I am a lifelong sufferer of migraines, since infancy. I also have depression, anxiety, PTSD, and panic.After many years of trying different combinations with neurologists, this worked for me: zonisamides another anticonsulant, that I take as a preventative twice a day. I titrated slowly up to my present dose. Topamax had worked, but my hair fell out and I became quite stupid.
I also take a nutritional supplement call Migralief, which is a proprietary blend of feverfew, magnesium, and riboflavin. Purchased at a health food store, it is specifically called out by neuroloists. Made by Quantum Health.
Finally, for breakthrough headaches - when I ignore my triggers and do something stupid - I have a CURE in the form a nasal spray called Migranal. It is ergatomine based and works within 15 minutes.
My psychiatric meds are: clonazapam (anxiety), Lexapro (depression), Trileptal (depression and insomnia), Ambien CR (insomnia) and Wellbutrin XL (depression).
Good luck with your migraines, and be persistent. I am so glad I was, after so long.
Take care
Partlycloudy
Posted by SLS on December 2, 2013, at 18:21:43
In reply to Re: Anyone with successful migraine treatment who's on » pattisun, posted by Partlycloudy on December 2, 2013, at 17:45:27
> Topamax had worked, but my hair fell out and I became quite stupid.
What dosage of Topamax were you taking?
How long were you at this dosage before cognitive impairments emerged?
Thanks.
- Scott
Posted by Partlycloudy on December 2, 2013, at 19:22:08
In reply to Re: Anyone with successful migraine treatment who's on » Partlycloudy, posted by SLS on December 2, 2013, at 18:21:43
Sorry, Scott I can't recall. It was at the low end of titration, which was great, the headaches were under control. But I was shedding like my cat and being as eloquent as she is, too. It was, as they say, a No Brainer.
I am bad at keeping track of dosages of meds that don't work!
PC
Posted by rjlockhart37 on December 5, 2013, at 18:52:39
In reply to Anyone with successful migraine treatment who's on, posted by pattisun on December 2, 2013, at 11:08:07
there is 2 meds i know of the severe migraines, Maltex, and Topamax...which is off label, but i've read many times its used for migranes....
r
Posted by jono_in_adelaide on December 5, 2013, at 21:39:11
In reply to Anyone with successful migraine treatment who's on, posted by pattisun on December 2, 2013, at 11:08:07
I've taken triptains with SSRI's with no problem many times, but if you dont want to take a triptain, try ibuprofen 800mg plus prochlorperazine (Compazine) 10mg
Posted by jono_in_adelaide on December 5, 2013, at 21:40:27
In reply to Anyone with successful migraine treatment who's on, posted by pattisun on December 2, 2013, at 11:08:07
If you're looking at a preventative, propanolol has been shown to be the most effective and best tolorated agent, its also dirt cheap and doesnt cross react with your SSRI
40-80mg twice a day
Posted by Partlycloudy on December 6, 2013, at 13:18:41
In reply to Re: Anyone with successful migraine treatment who's on, posted by jono_in_adelaide on December 5, 2013, at 21:40:27
> If you're looking at a preventative, propanolol has been shown to be the most effective and best tolorated agent, its also dirt cheap and doesnt cross react with your SSRI
>
> 40-80mg twice a dayThis treatment made me exceptionally depressed, to the point of weeping, at the 40 mg dose. Wouldn't it have been great if this stuff worked for everyone? Not so.
PC
Posted by ed_uk2010 on December 6, 2013, at 14:23:23
In reply to Re: Anyone with successful migraine treatment who's on, posted by jono_in_adelaide on December 5, 2013, at 21:39:11
> I've taken triptains with SSRI's with no problem many times, but if you dont want to take a triptain, try ibuprofen 800mg plus prochlorperazine (Compazine) 10mg
Yes, this is a very effective combination.
Posted by ed_uk2010 on December 6, 2013, at 14:27:55
In reply to Re: Anyone with successful migraine treatment who's on, posted by jono_in_adelaide on December 5, 2013, at 21:40:27
> If you're looking at a preventative, propanolol has been shown to be the most effective and best tolerated agent, its also dirt cheap and doesnt cross react with your SSRI
>
> 40-80mg twice a dayThe sustained release brands may cause slightly fewer side effects than plain propranolol, but may be somewhat more expensive. Not everyone responds to or tolerates propranolol (I don't!), bu at least there are plenty of alternative options! Propranolol cannot be taken by asthmatics. Propranolol is certainly a first-line preventive med for frequent severe migraines, or those that don't respond well to acute pain relief or triptans.
Some triptans may be safer with SSRIs than others, so check with a pharmacist for advice.
Posted by pattisun on December 6, 2013, at 16:10:29
In reply to Re: Anyone with successful migraine treatment who's on, posted by ed_uk2010 on December 6, 2013, at 14:23:23
> > I've taken triptains with SSRI's with no problem many times, but if you dont want to take a triptain, try ibuprofen 800mg plus prochlorperazine (Compazine) 10mg
>
> Yes, this is a very effective combination.
>
>
Thanks for all the suggestions. I can't take NSAIDS or aspirin although i do sneak ibuprofen in on occasion, taken with a caffeine tablet. I always have access to compazine because my headaches come with extreme nausea. The compazine is helping with my Celexa withdrawal (trying to find a low enough level to stop the SSRI storm I had), hope these facial twitches/ spasms Stop for good! (I have another post, right above this one) talking about all that
Life's a series of adjustment!!
Posted by jono_in_adelaide on December 6, 2013, at 16:45:58
In reply to Re: Anyone with successful migraine treatment who's on, posted by Partlycloudy on December 6, 2013, at 13:18:41
If propranolol isn't an option for you, I'd try atenolol (doesn't cross the blood/brain barrier to any appreciable degree, so no depression)
If this doesn't work or isn't tolerated, amitriptyline 50mg at bedtime is a good bet, though there are some SSRI's it cant be taken with (fluoxetine,paraoxetine)
For an acute attack, I don't bother with triptains any more, I take 800mg ibuprofen (4 of the 200mg otc tabs) and 10mg Stemetil/Compazine (which we can buy otc in Australia in small packs)
Metoclopramide 10mg is another option if Stemetil/Compazine doesn't agree with you
Posted by jono_in_adelaide on December 6, 2013, at 16:49:24
In reply to anyone with successful migraine treatment who's on, posted by pattisun on December 6, 2013, at 16:10:29
If NSAID's arnt good for you, I'd defiantly ask your doc about trying s triptain - the idea that they interact with SSRI's is a bit outdated
Given that you cant take NSAIDS, I'd take
*a triptain
* 2 tabs of acetaminophen/paracetamol (perhaps with caffeine either from a pill or a cup of coffee)
*10mg Compazine
Posted by ed_uk2010 on December 8, 2013, at 2:18:51
In reply to anyone with successful migraine treatment who's on, posted by pattisun on December 6, 2013, at 16:10:29
>I always have access to compazine because my headaches come with extreme nausea.
Compazine + 1000mg Tylenol can work for acute migraine. Have you tried that combination? If you can tolerate very low doses of ibuprofen, it may substantially increase the effectiveness of the Tylenol dose, even if you only take half an OTC tablet.
Posted by ed_uk2010 on December 8, 2013, at 2:20:25
In reply to Re: anyone with successful migraine treatment who's on, posted by jono_in_adelaide on December 6, 2013, at 16:49:24
> If NSAID's arnt good for you, I'd defiantly ask your doc about trying s triptain - the idea that they interact with SSRI's is a bit outdated
I think there's a metabolic interaction between specific SSRIs and specific triptans, but most are not affected. I'd have to check my book for the details!
Posted by ed_uk2010 on December 8, 2013, at 2:23:28
In reply to Re: Anyone with successful migraine treatment who's on, posted by jono_in_adelaide on December 6, 2013, at 16:45:58
>10mg Stemetil/Compazine (which we can buy otc in Australia in small packs)
We can't buy the tabs here OTC but we can get the prochlorperazine 3mg buccal tablets OTC, to dissolve under the upper lip. They're more rapidly and completely absorbed than the plain swallowed tablets and specifically recommended for migraine.
2 x 3mg buccal tabs replace one 10mg dose of Stemetil. Do you have them where you live? Thought it might be worth a try for you.
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