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medication Help Needed - A Complicated Case
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<blockquote data-quote="susiestar" data-source="post: 237283" data-attributes="member: 1233"><p>I have had migraines since I was 4 years old, Wiz since he was 2 and Jessie since she was 3. There are several classes of medications that are used to prevent migraines. Some are older drugs with side effect profiles that are better known, some are newer medications that we are just learning about. These are NOT medications to take to get rid of a migraine when it hits, but medications to take daily to keep from getting migraines.</p><p></p><p>The first class of drugs are beta blockers. These are blood pressure medications and they DO lower your blood pressure. It is often helpful to remember to sit up and stand up slowly, esp the first few weeks on the medication. Propranolol, metoprolol, atenolol are all some examples of beta blockers. One advantage to beta blockers is that they are usually VERY inexpensive (last time I got atenolol for husband's blood pressure it was under $3 for a month).</p><p></p><p>The next class that is usually tried is calcium channel blockers. Verapamil is the only one of these I know off the top of my head. These are also usually avail in generic form.</p><p></p><p>After that the tricyclic antidepressants like elavil are usually tried. There are a number of these. Liquid elavil or doxepine can actually be titrated to a very small amount, or with small adjustments in amount taken daily. They are also used for fibromyalgia the same way, with the dose changed a bit each day depending on how you feel.</p><p></p><p>After these medications have been tried, then anti-seizure medications like topomax, neurontin and lyrica are tried. Even depakote is sometimes tried. </p><p></p><p>Most of the people I know with chronic severe migraines do NOT get sufficient help from SSRI's and SNRI's for migraine prevention. Effexor was marketed as a migraine preventative for a while and was NOT successful for anyone I know who tried it. </p><p></p><p>I would encourage the doctor to start with beta blockers and to let your daughter try several different ones if she has problems with one. It truly is the safest class of medications for prevention, propranolol (Inderal is the brand name) was considered the gold standard for migraine prevention for years. Then I would work through the medication classes in the order I listed them, unless there is a compelling reason to not try a certain type of medication.</p><p></p><p>Going for topomax right out is maybe not the best way to handle it. It truly has some amazing side effects. And it is rare for teh cognitive dulling to go away, though it does for some people. But if you can take a medication with less side effects, one that has been in use for decades, so more is known about it, it seems safer to me. And it is what we have done with each of my children.</p><p></p><p>Docs want to go ahead with topomax or neurontin or depakote because they hear more about these. The drug makers put $$ into advertising these medications, esp for new uses, because they make more $$ off of them. But it surely doesn't help you or your daughter to trial her on a medication that will cost several hundred dollars a month and can have very serious side effects like weight loss, seizures, etc.... (neurontin, topomax and lyrica are antiseizure medications and if you skip a dose you run the risk of a seizure).</p><p></p><p>That is what my neuros have always told me, I hope it can help you. You might look at the list of medications that Walmart has on their $4/month or $10/3 months list before you go to the doctor. Then you can ask if you can try one of those medications first to see if it works. Otherwise, check your insurance co formulary. They may have limitations or forms that have to be filled out for topomax or lyrica or other medications.</p></blockquote><p></p>
[QUOTE="susiestar, post: 237283, member: 1233"] I have had migraines since I was 4 years old, Wiz since he was 2 and Jessie since she was 3. There are several classes of medications that are used to prevent migraines. Some are older drugs with side effect profiles that are better known, some are newer medications that we are just learning about. These are NOT medications to take to get rid of a migraine when it hits, but medications to take daily to keep from getting migraines. The first class of drugs are beta blockers. These are blood pressure medications and they DO lower your blood pressure. It is often helpful to remember to sit up and stand up slowly, esp the first few weeks on the medication. Propranolol, metoprolol, atenolol are all some examples of beta blockers. One advantage to beta blockers is that they are usually VERY inexpensive (last time I got atenolol for husband's blood pressure it was under $3 for a month). The next class that is usually tried is calcium channel blockers. Verapamil is the only one of these I know off the top of my head. These are also usually avail in generic form. After that the tricyclic antidepressants like elavil are usually tried. There are a number of these. Liquid elavil or doxepine can actually be titrated to a very small amount, or with small adjustments in amount taken daily. They are also used for fibromyalgia the same way, with the dose changed a bit each day depending on how you feel. After these medications have been tried, then anti-seizure medications like topomax, neurontin and lyrica are tried. Even depakote is sometimes tried. Most of the people I know with chronic severe migraines do NOT get sufficient help from SSRI's and SNRI's for migraine prevention. Effexor was marketed as a migraine preventative for a while and was NOT successful for anyone I know who tried it. I would encourage the doctor to start with beta blockers and to let your daughter try several different ones if she has problems with one. It truly is the safest class of medications for prevention, propranolol (Inderal is the brand name) was considered the gold standard for migraine prevention for years. Then I would work through the medication classes in the order I listed them, unless there is a compelling reason to not try a certain type of medication. Going for topomax right out is maybe not the best way to handle it. It truly has some amazing side effects. And it is rare for teh cognitive dulling to go away, though it does for some people. But if you can take a medication with less side effects, one that has been in use for decades, so more is known about it, it seems safer to me. And it is what we have done with each of my children. Docs want to go ahead with topomax or neurontin or depakote because they hear more about these. The drug makers put $$ into advertising these medications, esp for new uses, because they make more $$ off of them. But it surely doesn't help you or your daughter to trial her on a medication that will cost several hundred dollars a month and can have very serious side effects like weight loss, seizures, etc.... (neurontin, topomax and lyrica are antiseizure medications and if you skip a dose you run the risk of a seizure). That is what my neuros have always told me, I hope it can help you. You might look at the list of medications that Walmart has on their $4/month or $10/3 months list before you go to the doctor. Then you can ask if you can try one of those medications first to see if it works. Otherwise, check your insurance co formulary. They may have limitations or forms that have to be filled out for topomax or lyrica or other medications. [/QUOTE]
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