Miscellaneous
May 15, 2012 | 
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Preventatives on the left, abortives on the right, and me stuck in the middle
- This is a post taken from excerpts from comments I shared between another migraine patient and I in regards to preventive migraine treatment. I wanted to share it in a blog post, as I didn’t want the information to be overlooked in the comments section. With that said, here is my non-medical, non-authoritative, non-expert, simpleton opinion. If you haven’t tried preventatives to decrease the frequency of the migraines or other headache conditions, I absolutely think you should.
The American Academy of Neurology (AAN) just issued new guidelines on preventive medications for migraines, and listed them according to “proven to be helpful” and “probably helpful.” Drugs that were “proven” to be helpful were given a “Level A” rating. Among the A rating drugs “proven” to be helpful, one triptan made the list, and it was Frovatriptan (Frova). The other medications receiving a Level A rating were the following: [1]
Divalproex sodium (Depakote)
Sodium valproate (Depacon)
Toprimate (Topamax)
Metoprolol (Lopressor, Toprol-XL)
Propranolol (Inderal)
Timolol (Blocadren, but no longer sold under that name in the U.S.) [1]
Personally, I have not had any luck with the anticonvulsants reducing the frequency of migraine attacks, and I can’t tolerate the side effects either. Some patients, including myself, refer to Topamax colloquially as “Dopamax”, as it can make some patients feel like their mind has turned into mashed potatoes. My mind felt slower, my wit duller, and I couldn’t ever find my car keys. I still can’t find my cars keys most mornings, so the latter example may only apply to me. Matter of fact, do a search for the slang word “Dopamax” (a completely made up word by patients on the medication) on Google and you will see over 14,000 results. However, this drug has received a Level A rating as proven effective from the AAN, and it is widely reported as helpful in a great deal of patients in reducing the frequency of migraine attacks. All of our bodies are different, and this might just be the medication you need for relief. I know of migraine patients that swear by it, and you couldn’t take it out of their medicine cabinet with a SWAT team, so this may be a medication you want to talk to your doctor about adding to your arsenal.
Next, I would try an herbal supplement (I know, I know, don’t give me that look) called Butterbur, that is used as a headache preventive as well. It is widely reported that Native Americans used the root of Butterbur to treat headaches and some types of inflammation. There are also a variety of double-blind studies that show that Butterbur is effective for reducing the frequency of migraines, and may even relieve a migraine in progress.[3] One of the better known and recommended forms of this herb is a patented drug called Petadolex. I take this medication and I do believe that it has helped in reducing the frequency of migraine attacks, but I have not had any success with it relieving the pain of the attack once it has started. I like Petadolex, as they have a patented process for removing all of the unnecessary alkaloids from the Butterbur that can be toxic to the liver and may cause some cancers, leaving only the good stuff to prevent migraines. I order my Petadolex online and I am signed up for monthly delivery. I order from here: http://www.petadolex.com/
I have also had some success with a beta-blocker called Metoprolol (Lopressor, Toprol-XL) and take this medication daily. Propranolol (Inderal) and Toprol-XL are recommended by the American Headache Society as a preventative for migraine headaches. [3] Both of these medications received a Level A rating by the AAN as well and are stated by the AAN as a proven effective medication for the prevention of migraine attacks. [1]
Another factor you may want to consider is your diet, and the amount of essential vitamins you are fueling your body with, such as vitamin D, magnesium, vitamin B6 and vitamin B 12. Studies have shown that a lack of these essential vitamins can lead to a host of health problems, including migraines. [4] [5] Unfortunately, none of these essential vitamins are included in sufficient amounts in the junk food most of us put into our bodies, so you might need to talk to your doctor about taking supplements. I have done extensive research with Oreos and chocolate cake, but I have no solid evidence that they are increasing my vitamin levels sufficiently, the rigorous research continues . You might also need to have your vitamin D levels checked, as many people, not just migraine patients, have a low level of vitamin D, which can cause all sorts of problems, including headaches.
Other over the counter medications that were rated as “probable efficacy” in the prevention of migraines were: magnesium, riboflavin, histamine SC, and the herbal supplement feverfew. [2] Feverfew has been used for centuries in Europe, and many people find relief from acute pain from migraine, and well as a reduction in frequency of attacks. [2] I have had some luck with feverfew in combination with magnesium, vitamin B2, vitamin D, and certainly think you should give it a try if your doctor approves. Feverfew can increase a bleeding risk, much like aspirin, so be certain you have talked to your doctor before taking this supplement
Some antidepressants can work as a preventive for migraines as well, and may help with the depression and anxiety often associated with migraine patients. Talk to your doctor about which medications might be right for you.
Other things I would suggest are getting some exercise. Slow, moderate, exercise (e.g. walking, Pilates, Yoga, Tai Chi, etc.) are good ways for migraine patients to get some physical activity, without the overexertion that can trigger a migraine in some patients. So grab the leash and take the dog for a stroll or find a local facility to try some of the suggested activities. Even using videos at home can be effective, and can be bought cheaply over the internet. I have also found that getting a massage can help reduce the tension and anxiety that can trigger my migraines, and can be a wonderfully needed break from the hustle and bustle of daily life. I actually have a prescription for one massage a week (Thank you Dr. Robbins!) and these work wonders for relaxation and releasing tension in muscles that trigger my migraines.
You may also want to try aromatherapy. I have had success with peppermint oil and rub it on my temples and forehead, as this can give that tingling feeling that can sometimes help reduce pain and the smell of peppermint can help with the nausea. I also rub this on my pillow when I have a migraine so I can smell the peppermint, as my sense of smell gets so strong during an attack that I can smell my dogs like they are in my lap. I also like the product CryoDerm, which is a topical roll-on ointment that contains Menthol as the active ingredient. I rub this on my neck, shoulders, temples, and forehead when I feel tension or a headache starting to occur and it can help ease muscle tension and sometimes keep the headache from progressing as quickly.
As you probably are aware, you are going to have to try combinations of these medications and supplements, play with the dosages, and give them time to work. Don’t expect to see any change until at least a month or so of taking them per your doctor’s orders. Basically, I have to take a shotgun approach to treating my migraines, as there is just nothing in existence I have found that stops the migraine in its tracks. Even when I have to go to the ER (maybe once a year) for strong opiate and nausea medication injections, when everything else has failed, it doesn’t stop all the pain, but it does reduce the pain and nausea allowing me to finally go to sleep, which allows my brain to “reboot” as I call it.
Finally, read and learn as much as you can about your specific headache condition, as knowledge is power, especially in the world of a migraine patient. Many doctors are not aware or as educated as they should be in the treatment of headache disorders and medications, and in the end, your body and input to your doctor is going to determine what works best for you.
If you are suffering from headaches of any type, and your current method of treating them isn’t working, talk to your doctor about adding preventatives to your treatment plan to decrease the frequency of attacks. If your book shelf doesn’t look like mine, and your medicine cabinet does not contain the copious amounts of preventatives and supplements that mine does, perhaps it should.
As always talk to your doctor about these medications and supplements before you begin taking them, and get their educated opinion on what they think you should try or what could be contraindicated for you based on current medications you are taking. Remember, I am just a migraine patient, and all I am sharing is my opinion based on my personal experience of living with chronic migraines for over 30 years. You should always talk to your doctor before beginning any exercise, medication, or herbal supplement program.
Please feel free to share your experiences and what you have found that works best for you. I hope my comments are of some use to those of you suffering. Take care of yourself, give yourself a break, remember you are not alone, and as always, try your best to “Keep Calm and Carry On.”
Wishing you all the best in life and your treatment,
Jeff Poleet
Chronic Migraine Patient
References:
1. Silberstein S, et al “Evidence-based guideline update — pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78: 1337-45.
2. Holland S, et al “Evidence-based guideline update — NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78:1346-53.
3. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A (December 2004). “Petasites hybridus root (butterbur) is an effective preventive treatment for migraine”. Neurology 63 (12): 2240–4. PMID 15623680.
4. European Journal of Neurology (2004;11:475-7), Genomics Research Centre (GRC) at Griffith University in Brisbane.
5. “Journal of Headache and Pain”; The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?; S Prakash, NC Mehta, AS Dabhi, O Lakhani, M Khilari, ND Shah; 2010
*Additional Sources and article review: By John Gever, Senior Editor, MedPage Today
Published: April 23, 2012; Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania. Full Article may be read at: http://www.medpagetoday.com/MeetingCoverage/AANMeeting/32304?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app
DISCLAIMER: I am not a healthcare provider, and I do not provide any medical advice, diagnosis or treatment. The information presented here is designed for general informational purposes and discussion only, and is not intended to replace a physician’s judgment about the appropriateness or risks of a procedure, medication, product or diagnosis. Always consult your doctor about any medical questions or conditions you may have.
Posted in headachedrugs, Miscellaneous | 
Tags: anxiety, chronic daily headache, chronic migraine, Depakote, Dopamax, exercise, feverfew, Headache, headache medications, magnesium, massage, nausea, Petadolex, pilates, preventative, preventive, Tai Chi, Topamax, topiramate, vitamin b12, vitamin b6, vitamin D, vitamin D deficiency, vitamin supplements, walking, yoga | 
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Poster seen in Robbins Headache Clinic
It was a little over a year ago that I had the pleasure of meeting Dr. Robbins. Like most headache/migraine patients I had spent many years bouncing around between Family Practice doctors, Internists, Allergists, Neurologists, all to no avail. At the time I walked into Dr. Robbins clinic, I had little expectation that I was going to find any answers, let alone any actual treatments that would reduce the frequency or severity of my migraines. I was haggard, depressed, hadn’t slept well in weeks, and was tired of going through the same routine with doctor after doctor. I’m sure he was glad to see me too.
My wife (who is an Anesthesiologist) received a recommendation to the Robbins Headache Clinic from asking several colleagues if they had any idea of who might be able to help me with my migraines, and Dr. Robbins was mentioned. As we reside in Arkansas, the prospect of traveling all the way to Chicago for treatment did not sound appealing, at all, and I was reluctant to commit to an appointment with a physician I had never heard about, especially if it included flying across the country. In all honesty, I was jaded, and felt at that time that there was no one who could help me. Like most of you reading this blog, I was already convinced that this would be a waste of time and money. However, being a curious creature, I decided to do what everyone does these days when they want to start an investigation into a person’s expertise and character, and I was very methodical in my Google search. (I actually have a black-belt in Googlefu, so I was confident I would find an excuse not to make the appointment.) Once I began reading his hundreds of articles and several books, my doubts began to diminish. Then, I came across his curriculum vitae (CV), (which to a layperson such as myself, I knew to be a Latin word meaning, “much smarter than you will ever be.”)
I began pouring over the CV for obvious signs that he was not the doctor for me (e.g. majored in Bowling during college, or perhaps spent 9 years doing “magnetic therapy” in a foreign country that I couldn’t locate on a map. The problem was, Dr. Robbins has the longest and most extensive CV I have ever read in my life. Matter of fact, not only had he authored at least two books, but also had written over 200 peer reviewed articles that had been published in every reputable medical periodical in existence. As I began to analyze his CV like a forensic detective surveying a crime scene, I began to realize that even for a person with a degree in English Literature and a minor in Philosophy, this was going to take an extensive amount of time, and coffee, in order to absorb all the information contained therein. I got through half of his CV before I conceded defeat. Joyce’s Ulysses took less time for me to read, and I think I even understood more of that book than all the letters attached to Dr. Robbins’ name, except the MD.
I began to realize that this doctor was better trained in headaches, pain management, and preventative medication than all the other doctors I had ever seen, combined. So without admitting to my wife that she was right about scheduling an appointment with his clinic, I reluctantly scheduled an appointment, and began planning for another horrible experience with a doctor that didn’t understand my migraines. As I stated above, I arrived looking like a walk-on for the TV series The Walking Dead.
Dr. Robbins greeted me with a big smile, and so did his staff, and as I looked around the waiting room, I began to notice several things different about his clinic that I had never seen in other doctors’ offices. Covered from wall-to-wall was literature on headaches/migraines, including handouts of his most recent studies and published articles. As I sat in the waiting room, perusing the various literature, I noticed a sign on the entryway into the office, which simply read: “Keep Calm and Carry On.”
For reasons I still can’t express, that sign evoked a lot of emotion in me, like it was specifically put there for my benefit. Something about the words conveyed a sense of inequity that was recognized by all, especially the patients, and yet at the same time I conveyed a sense of not surrendering, to keep moving, to keep fighting, “to carry on” despite the onslaught of pain and suffering. I remember thinking that this sign was perfect for a migraine specialist’s office, as I think most of us feel a sense of unfairness about our disease, a certain injustice that we all share. From being unable to control the pain, to the misconceptions of doctors, employers, friends, and even family; a lot of times I think we feel we are fighting a losing battle against not only the medical establishment, but against society as a whole, and yet we continue to fight. We get up every day knowing that today we are very likely to experience the worst pain we have ever felt in our life; traumatic pain, devastating, and debilitating pain, which we have no ability to control. To me it feels like a great deal of the time I am at war, besieged and attacked by my own body and mind, and there is nothing I can do to stop it, nothing. Perpetual warfare, in any circumstance, is enough to drive even the most balanced person to insanity and hopelessness.
My appointment with Dr. Robbins did not go as I expected. He was compassionate, considerate, he listened to what I had to say, and for the first time in my life, I was actually invited to sit down in his office and talk about my migraines. I had never even seen the inside of an actual doctor’s office before, and to this day, it is the only time it has been offered. Not only did I leave his clinic that day with a better understanding of my migraines, but I had weapons (I use that word purposefully, because I am at war) to fight back against the perpetual onslaught of pain, and indignity suffered by all of us. And as it turned out, Dr. Robbins was the only doctor I have ever encountered that was able to help decrease my migraines.
A few months later, I was studying a legal case that surrounded around a set of facts of concerning trademark infringement. The plaintiff in the case tried to claim a copyright infringement against the defendant for the use of a slogan, none other than, “Keep Calm and Carry On.” The plaintiff, as I learned, lost the lawsuit. The poster pictured in the upper left corner had been created by the Ministry of Information by order of the British government in 1939, and was designed as a propaganda poster to increase morale among the British public during WWII. It was distributed around the city squares and government buildings to prepare the public for what was thought to be a certain invasion by the Germans. It was intended to display the unmitigated pride and fearlessness of the British population who were awaiting imminent destruction. The crown displayed on the poster was intended to remind the population that it was a direct message from their King, speaking to his people. The posters were intended to convey the message that no matter what happened: invasion, bombings, complete destruction of town and country, that it was the duty of the populace to remain strong, no matter what agony or suffering would be inflicted upon them. It was meant to invoke a sense of pride, courage, and calm dignity for which the British are commonly known. It was meant as a message for people that were under siege, facing an enemy that they had no ability to control or defeat.
As I sat there reading the case, I understood why I thought it was perfect for a migraine specialist’s office and why it had meant so much to me at the time. I had realized something innately in that poster that spoke directly to the way I was feeling, even though I didn’t realize it at the time, the poster really was meant for me and others like me. It is a message that no matter what happens to us, no matter how unfair the circumstances may be, or the pain inflicted, it is our duty to fight the good fight. As Churchill would later state, “Never give in, never give in, never; never; never; never – in nothing, great or small, large or petty – never give in except to convictions of honor and good sense.” I can’t think of a more apt saying to have in the office of a doctor dealing with people who are chronically ill, and are constantly under threat of bombardment at any second, for the worst pain they will ever experience or imagine.
Since the copyright on artistic works expires after 50 years in the UK, and the phrase was in such common usage, the image is now in the public domain, hence the many companies selling t-shirts, coffee mugs, hats, books, and posters- just like the one in Dr. Robbins’ office. It is amazing to me to think of the history involved in this one simple message, which after 73 years, found its way into my life at a time when I felt the weakest, and has indeed inspired me to fight, and to never, ever, ever, give up. The next time you feel hopeless, helpless, like everything is at its worst and you simply can’t take it anymore, I implore you to remember this story and the history that made it manifest, and to never give up. No matter what is happening, do your best, do your duty to your family and loved ones, and “Keep Calm and Carry On.”
I always welcome any thoughts, experiences, critique, or accolades in regards to my posts. Please feel free to share your stories and comments with me and others. The more we communicate the more we learn, and the sooner we will find better solutions to sustain the imminent bombardment. Thanks for reading, and may you have a pain free day.
DISCLAIMER: I am not a healthcare provider, and I do not provide any medical advice, diagnosis or treatment. The information presented here is designed for general informational purposes and discussion only, and is not intended to replace a physician’s judgment about the appropriateness or risks of a procedure, medication, product or diagnosis. Always consult your doctor about any medical questions or conditions you may have.
Posted in headachedrugs, Miscellaneous | Tags: chronic migraine, cluster headache, depression, disability, Headache, headache clinic, keep calm and carry on, migraine | 6 Comments »
