Friday, May 11, 2012

My Top 25 migraine treatments

Disclaimer: This is just how these things worked for me -- not what is statistically proven to work well for most people. I advise trying everything and anything before dismissing any course of treatment out of hand.

I was going to do this list from last to first in effectiveness -- for suspense -- but then I decided most people want to know what works best first so why bother being coy?

It was kind of difficult to rank these, especially the ones in the middle, but they fall into three basic categories: Stuff that worked at least for a time, stuff that didn't work at all for headaches but was useful in other ways and stuff that didn't work and in fact made things worse. When it was tough to decide which slot something should go in, I looked at things like cost and unpleasantness as tie breakers.

I suppose I should note that I am currently on an antidepressant, doxepin, prescribed by my current neurologist, but I've only been on it for about a week, and although so far it hasn't been very helpful and makes me very, very sleepy besides -- I hate to weigh in on it till I've given it a fair trial.

Anyway, without any further ado:


Number 1 (drum roll)

Triptan drugs (Maxalt, Relpax, Frova, among others)
I was actually a little surprised when I realized how much I have depended on this class of drugs over the past nine years. Relpax was the first drug I was prescribed for migraine, and currently I'm using Maxalt. I've tried some of the others when given samples, and they all seem to work about the same for me.
You'd think I'd be more grateful for the medicine than enables me to have a somewhat "normal" life (whatever THAT is) -- but no, all I can do is insult them. Mainly I object to the side effects, which for me are overpowering fatigue and a general sense of malaise and spaciness.

But without them, I probably would be spending 4-5 days a month in bed and I doubt I would have been able to continue being employed (what kind of job do you know of that gives you that much sick time?) However, there are other issues with them, like that you shouldn't take them too often or you will start developing what they call "rebound" or medication overuse headaches. And for me, I almost have to take the stuff before I know for sure the headache is going to turn into a migraine or it isn't effective. This makes it difficult not to take it too often. Frustrating. But still, as I said, I don't think I'd have been able to keep working without them.

2) Tofranil PM (a tricyclic antidepressant)
Tricyclics are an older class of antidepressants that are probably more often used to treat migraine these days. Aaaaahhh Tofranil. Of every preventative drug I was on, this one worked the best for the longest. And it helped me sleep better and feel more cheerful. Got about 10 full months of relief before developing a tolerance (I guess is what happens. Side effects were dry mouth and slight constipation. Easily tolerated in exchange for the benefits.

3) Topomax (an epilepsy medication)
This was highly effective for about eight months, but I had to increase the dosage every couple months or so. By the end when I was on the maximum dosage before it quit working, I felt like I was slowly being poisoned to death. It messes up your appetite so you lose weight, which I didn't mind, but it also has cognitive side effects leading it to also be referred to affectionately as "dope-omax" and "stupid-max." Actually, it was kind of funny sometimes. I'd try to say a simple word like "match" or "car" but what came out was "penny" or "house." Also, oddly, it makes carbonated drinks taste bad.

4)Coenzyme Q10 (this supplement is related to mitochondrial DNA)
I read that studies find CoQ10 can cut migraine attacks by about half, so I thought it was worth checking out -- I believe it has helped. At first the improvement was dramatic, and I felt very hopeful about it, but as with most things, its effectiveness waned with time. But anyway CoQ10 is the best supplement I've tried so far for migraine, it is reasonably cheap, has few side effects and is probably good for some other stuff as well, so it's still part of my daily regimen.

5) Hormone replacement therapy
I've been on bio-identical progesterone prescribed by my gynecologist for about the past four months, and I believe it has helped, but it seems as if its effectiveness has begun to wane. I'm going to keep on it and see how it goes.

6)Wild yam extract (taken for hormonal support)
For the first few months I took it, it seemed to be effective, but after that, it didn't seem to make much difference.

7)Progesterone creme
See Wild yam, above. The reason I rated it lower is that it's more expensive. Wild yam is quite cheap. Neither had any noticeable side effects.

8)Topical magnesium supplement
This, too, seemed to be helpful for a few months. I'm not sure what's with that. Could be psychological, I suppose. Who knows?

9)Meditation
You know, I can't really claim this doesn't work. I was just thinking about it again this morning and I bet if I checked into a monastery for six months and meditated about 10 hours a day I could kick this. Seems like it's worth trying, anyway. If that says anything about how I feel about migraine. While my sporadic attempts at using it haven't seemed to help to avert attacks, sometimes I use breathing exercises to cope with the pain, and it is moderately helpful for that.

10) Dr. Steve's lozenges (made of stuff like ginger, feverfew and some other herbs)
Dr. Steve contacted me from this blog, and his remedy seemed to help at first, then lost effectiveness (deja vu all over again, right?). He was really nice about sending me free samples to try, though. I suggest at least giving it a try.

11) Yoga
I find yoga enjoyable and it helps with relaxation and stress reduction, which you'd think would help a great deal. Which is why I think that stress is not one of my significant triggers, because even when I was doing yoga weekly, it did not substantially disrupt my pattern of migraine attacks. However, if stress is a trigger for you, I HIGHLY recommend yoga. If you find the right teacher, it's wonderfully trance inducing.

12) Exercise in general -- bike riding, walking and running mainly
Although exercise has been effective in the past at eliminating headaches of the tension variety, I've had very limited success in using it to beat migraine. I used to have this working theory that whoever said you couldn't run away from your problems wasn't running far enough or fast enough, but when it comes to migraine, even a daily, moderate to strenuous regimen has not been sufficient for me to outrun it. However, as I said before, if stress is a significant trigger, I think it could be helpful.

13) Neurostimulator
To be honest, I'm really not sure where to rank this one, which is why I decided just to stick it in the middle. If I were to do a cost-benefit analysis, considering all factors, I'd say my return on the investment is slight at best. A previous blog post contains more details about my experience with this device. However, I can't say it hasn't helped at all. It's possibly saved me from having to take meds a couple of times a month, but I'm not completely convinced of that. I am going to try turning it off for a few weeks -- maybe even a month -- to compare. So far though every time I try turning it off, when I start getting a headache I get scared and turn it back on. I don't know if it helps, but it might,

14) Nasal rinses with a neti pot
Great for the sinuses, and can be rather soothing to an achy head, especially when the saline solution is heated to about 100 degrees, but I don't think it ever significantly decreased the frequency or intensity of my migraines. However, I have not had a sinus infection since I started using it, and I was plagued with them previously.

15)Chiropractic adjustments
I tried this for about three months and enjoyed getting my back cracked and doing this thing where these electrodes were placed at the base of my skull, and at first I thought it was helping, but after a while it was back to the same old same old -- I'd have kept doing it anyway, because as I said it was enjoyable, but it was effing expensive and my insurance didn't cover it.

16) Biofeedback
Tried it for a few sessions, but quit going when I realized that a good yoga class gave me more benefits than the techniques the practitioner was teaching me. Not a bad concept, but to my mind, for serious relaxation yoga and meditation are probably more effective.

17)Dr. David Buchholz's regimen
I cut out a whole list of foods he claims are triggers for some people for about three months. Stuff like bananas, avocados, onions, cheese, nuts, fresh baked baked baked goods -- a lot of things that are hard to avoid, but I did it. Didn't seem to make a bit of difference.

18) Food allergy and sensitivity testing
This, too, came back a whole long list of stuff I should avoid, and for about three months I diligently culled them from my diet (with occasional lapses -- sue me) This diet included avoiding milk and dairy products, chicken eggs, sugar, vinegar, yeast, olives, mushrooms, venison (that one was tough to avoid, lemmee tell ya) red beans, and I forget what all. Also, you weren't supposed to eat the same thing twice in four days, to avoid developing new sensitivities through repetitive eating. So, at the same time you're taking out a bunch of dietary staples, you're supposed to increase the variety of your diet. A recipe for frustration is what that is. Doing this diet the best I could for about three months didn't appear to make a dent -- but on the plus side, I lost about 10 pounds. I still feel kind of superstitious about those foods, and try to avoid them when I can, but I don't really believe my triggers are food related.

19) Butterbur
nada, nothing, zip, zilch.

20)Wild oregano oil
I tried this a long time ago, on the theory that my (rather mild) pollen allergies were a trigger. I still believe they are, but this stuff didn't seem to help too much. This was something I tried a long time ago, and my memory of it is a little fuzzy. Mostly I remember it tasted nasty. I thought it kind of helped for a little while, but truly, I barely remember.

21) Acupuncture
This wasn't very helpful. Mostly I ended up with throbbing pain at the base of my skull from the actupuncturist using increasingly large needles in an attempt to stab the migraine into submission.

22) Seasonique birth control pills (this was prescribed by a nurse practitioner at my gyno's office after a discussion about whether my hormone levels were causing migraines) It's been a while, but I seem to recall side affects of insomnia and headaches and no benefits.

23) Amitriptyline HCL (another antidepressant) Not quite so dramatic -- but it didn't help and after a couple of weeks I was having suicidal thoughts out of nowhere, which was freaky, so I had to get off it.

24) Celexa (an antidepressant) I was prescribed this by the Worst. Neurologist. Ever. So I wasn't surprised when it didn't work. The first time I took it I had raging insomnia and woke up the next day with a migraine that knocked me out for two days. I was too scared to give it another try.

25)Beta blockers -- otherwise known as blood pressure medicine. Although I have heard these work well for some people, they caused me to feel so weak and sick and shaky I couldn't make it a whole week on the stuff. I think I tried two -- propranolol and nadolol.


26) okay, I know I said 25, but I thought I should mention a few other things I've tried including various homeopathic remedies, aromatherapy remedies, magnetic bracelet... I'm pretty sure there are a few other wacky things I've tried over the years as well but overall, this is a reasonably comprehensive list. Also, for clarification, don't talk to me about over the counter headache meds like Exedrin Migraine, Advil Migraine, Tylenol, BC powders or anything like that. Those things haven't been effective for me for years.

P.S. Sorry, was reading over this and realized I never mentioned Allegra -- I believe my mild pollen allergies do contribute to the critical mass of my migraines, as they tend to be slightly more frequent during the spring tree pollen season and the fall ragweed season. This year, I popped an Allegra each morning. Obviously it did not eradicate my migraines, but I believe it probably helped me to avoid taking stronger drugs on some occasions. I'm not sure where I would place it -- somewhere after CoQ10 in my box o' tricks to thwart migraine.

Stuff I still haven't tried:
Botox, depacote, reiki, hypnosis, a couple other antidepressants I've heard have helped some people -- cymbalta is one, but I dont' remember the other one right off hand -- I think I read about it on the Mayo Clinic website;