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Questions on MOH, 'break the cycle' and preventatives

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Posted

Hi Everyone,

 

I know I've posted a few times recently regarding my experience/questions about amitriptyline and my newly acquired daily headaches.

 

Today marks the one month anniversary of the start of my 24/7/never-leaves-me-alone headache pain. Before this, I used to get headaches/migraines every now and then, but it always responded to ibuprofen and sleep.

 

I am in need of some of your expert experiences/input since I'm still fairly new to this...

 

My doctor is not very explanatory so I've been trying to do a lot of research on my own. Though he did tell me to stop googling, cause it increases my anxiety. He keeps making me come back every 5 days or so for updates, but just keeps telling me to continue taking the amitriptyline (20mg).

 

So I have a few questions:

1. What is the possibility that this is medication overuse headache? The first week of the headaches, I took various painkillers, mostly Ibuprofen but never exceeding the daily amount. I was at the hospital one day, all I got was a muscle relaxant and anti-nausea med (which didn't work). And one day I tried Imitrex, with no luck. The last 3 weeks, I've only taken pain meds on one day, the rest of the time ice pack to the head, sleep and moan in pain when it gets bad.

 

2. The headache pain for me usually shoots up from the back of my head (from the base) and sometimes spasms, sometimes throbs. I wake up with the pain, go to sleep with the pain. Some days its more bearable than others. I'm wondering, do I need to take something to 'break the cycle' of pain? It feels like the blood vessels are throbbing daily without having a chance to go back to normal. I'm only on a preventative (amitriptyline) will this be enough to break the cycle?

 

Sorry for the long post!! I look forward to hearing your input. I need help. :(

 

Sidenote: referral to neuro sent 3 weeks ago, they replied 2 days ago saying yes they got the referral but they are scheduling appointments by order of importance. So I am on a waitlist to have an appointment scheduled.

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Posted

Well, Amitriptyline can cause headaches and other symptoms of migraines like stomach pain and sensitivity to light (weird, right?). All pain meds like Tylenol,  aspirin, vicodin and ibuprofen run the risk of rebound headaches, which you seem to experience as you are taking a lot of pain meds everyday. 

 

 

You need to give your anti-depressant a few more weeks to see if it will work, but there are other types of meds (preventatives) that can help with your month long migraines. You can take meds like topamax, depakote, verapamil...or triptans like imitrex or frova...and then like a few of us on this board, you might have to migrate to botox, nerve blocking and, DHE drips, and other stuff our ndocs wanna do. I personally take four pills to control my migraines: topamax, verapamil, depakote and vicodin. But I have to move on to nerve blocking soon.

 

Hope this helps.

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Posted

I get migraines and they are a lot like what you described. I take a triptan (amerge) for them and that gets rid of them. For prevention I've found that the birth control pill prevents them almost all together.

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Posted

Thank you both for your replies. :)

 

cfranco92- It is weird that meds can cause the same symptoms its trying to address. Aside from taking birth control pills, I don't have much experience with taking daily meds. Though just to clarify, I took the pain meds the first week, the last 3 weeks I have not taken any pain meds aside from one day. I could most definitely benefit from pain relieve from pain meds, but I was afraid of having a rebound headache so I stopped. My doc says he doesn't think I have a rebound headache though... Imitrex didn't work for me, gave me bad chest pains and my doc said no more triptans than.

 

You're right, I have to give the ami a few more weeks (currently finished 3 weeks), but will it work on its own to break my current cycle of non-stop pain? Or do I need something to break the cycle before the preventative can work?

 

I was doing research, trying not to 'self-diagnose' but in reading about the symptoms of different types of headaches, occipital neuralgia descibes my symptoms spot on. Also, when I went for a massage, the message therapist was quite perplexed by a bunch of muscle that was 'sticking' to the base of my skull (and which he was unable to work out). I really hope its not ON and just tension/migraines....

 

Genevieve- you're lucky BCP helped your migraines :) I'm currently on a low-dose of a combine BCP but was supposed to switch to a progesterone-only pill (due to a estrogen/liver condition) last month. However, a SE of the progesterone only pill (and the most complained about SE from users) were.... headaches. :(

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Posted

Hmm... imitrex gave me weird chest pain / indigestion feelings. My neurologist switched me to amerge instead and I no longer have any side effects. Aside from the chest pain, did the imitrex get rid of your headache? If so, I'd push to try a different triptan. Imitrex is pretty hardcore for side effects -- there are a lot of other ones that cause less discomfort.

 

As for daily preventatives, I've also tried propranolol and it didn't do anything other than give me a stomachache. :/

 

Oh, and one last thing! I've had endless headaches that I thought were treatment resistant migraines (lasted for weeks, didn't respond to triptans). They turned out to be sinus infections. Something to keep in mind.

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Posted

Thank you both for your replies. :)

 

cfranco92- It is weird that meds can cause the same symptoms its trying to address. Aside from taking birth control pills, I don't have much experience with taking daily meds. Though just to clarify, I took the pain meds the first week, the last 3 weeks I have not taken any pain meds aside from one day. I could most definitely benefit from pain relieve from pain meds, but I was afraid of having a rebound headache so I stopped. My doc says he doesn't think I have a rebound headache though... Imitrex didn't work for me, gave me bad chest pains and my doc said no more triptans than.

 

You're right, I have to give the ami a few more weeks (currently finished 3 weeks), but will it work on its own to break my current cycle of non-stop pain? Or do I need something to break the cycle before the preventative can work?

 

I was doing research, trying not to 'self-diagnose' but in reading about the symptoms of different types of headaches, occipital neuralgia descibes my symptoms spot on. Also, when I went for a massage, the message therapist was quite perplexed by a bunch of muscle that was 'sticking' to the base of my skull (and which he was unable to work out). I really hope its not ON and just tension/migraines....

 

No, you do not have to take anything to kickstart the anti-depressant. It should just start to work on its own. If you are no longer getting rebound headaches or if your ndoc (or general doc?) says you aren't, maybe you can go back to pain meds. 

 

Hmm... imitrex gave me weird chest pain / indigestion feelings. My neurologist switched me to amerge instead and I no longer have any side effects. Aside from the chest pain, did the imitrex get rid of your headache? If so, I'd push to try a different triptan. Imitrex is pretty hardcore for side effects -- there are a lot of other ones that cause less discomfort.

 

As for daily preventatives, I've also tried propranolol and it didn't do anything other than give me a stomachache. :/

 

Oh, and one last thing! I've had endless headaches that I thought were treatment resistant migraines (lasted for weeks, didn't respond to triptans). They turned out to be sinus infections. Something to keep in mind.

 

Imitrex also gave me weird side effects but it worked wonders for my migraines so I continued to use them. I also took propranolol, and my ndoc had a sample he had me try in the office and I passed out. :(

 

And YES about the sinus headache/infections. See an ENT or your general doctor to rule out other things before you settle on a migraine diagnosis. 

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Posted

My experience with Imitrex- head pain was on the left side, I took 50mg, waited... nothing happened (in terms of the headache). Two hours later I took another 50mg, head pain dulled. Two hours after that, it returned on the opposite side just as severe. Because of the chest pain, I got a bit scared about triptans. When my doc said no more triptans, I just agreed. Though I may ask him again when I see him next. It may be months before I see a neuro (I live in Canada, the wait is forever for most specialists unless you have an urgent case) so I'm just seeing my regular doctor for now.

 

I was considering propranolol as my next preventative if the amitriptyline don't work because I read that it may help with anxiety?

 

cfranco92- Oh no, did you pass out because of low blood pressure? I generally have low blood pressure these days so I don't know if propranolol may be right for me.

 

I never asked about sinus infection specifically, but when I mentioned that sometimes the spot between my eye and nose hurts (sinus) my doc just said migraines can aggravate the sinuses too.

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Posted

Yeah I passed out due to low blood pressure--I always have low blood pressure so that just made it worse. Sinus infections are very painful and can have similar symptoms to certain kind of headaches and migraines. Hopefully you can have another appt with an ndoc and they can steer you in the right direction.

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Posted

I haven't seen an ndoc yet and probably wouldn't for a few more months. In Canada, appointments for a specialist (unless you have an immediate life threatening illness) can take 6 months to a year. Knowing my doctor, he just wrote 'headache' and nothing else on the referral, so they are not even scheduling an appointment for me yet. I'm really frustrated, but I can see my family doctor on a weekly basis and he's pretty amendable when it comes to medication suggestions. He's not switching me off amitriptyline yet and I'm still waiting for the meds to kick in, do something. He wouldn't diagnose me with the type of headache I am having, but seems to blame all of my symptoms on anxiety.

 

I had a CT scan without contrast done (came back normal), would it be advisable to insist on a MRI? I asked my doctor 2 weeks ago and he said no.

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Posted

Hi Trixx - I have suffered from MOH headache for several months, and wanted to clarify for you that it takes several months of overtaking an over the counter medication or prescription med to cause MOH or rebound headaches.  So if prior to your headache beginning, you had overtaken medications like excedrin migraine or some other OTC medication usually taking them more than twice per week, for any type of pain say back pain or a mild headache, then this could be MOH or a rebound headache.  In my case, I didnt believe at first that I could have MOH headache, but as soon as I quit taking the OTC's, the headaches worsened and I had to believe the dr's were correct in their diagnosis and I just did not realize how much I had taken.  If you are rebounding, it can take several months to get these under control.  For me it took 5 months and a combination of two preventives to finally find some relief!  Good luck on your journey... Let us know how it goes.

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Posted

HI migrainegirl68- Thank you for the clarification on rebound headaches. I don't think I took any OTC painkillers more than twice a week prior to the start of this 24/7 headache. Though in the past, especially during my period, I would take OTC painkillers for a week straight for pelvic pain and no rebound headache. I still have a long long way to go in terms of a diagnoses for this headache, my doctor sent a referral to a different neuro, since the first one wouldn't book me an appointment anytme soon. Though an appt. with the new neuro will probably still be months away. I'm really glad to have found forums where I can learn more about meds, headaches, treatments etc., so I can see what I can do in the meantime.

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Posted

I'm so sorry you've been in so much pain.

 

Has the migraine gotten any better?

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Posted

You have about a zillion medications to try, so don't give up; it is hard work to break a cycle sometimes, but you have loads of stuff to try.

 

Just curious, does anyone know, are more doctors trying amytriptilyine as a first line treatment for migraine prophylaxis? Because I feel like I have heard a couple of people on the boards say that tricyclics were the first their doctor tried. Pamelor was the *last* med (other than Botox) I tried, and I have tried every class of meds, sometimes more than one in each. I mean, I know it works for some people, but I think using it as a go to choice is weird.

 

Anyway, usually there is no rush to get an MRI. Your neurologist may order one, just to have a baseline. But if they know it is migraine, it is unlikely to show them anything.

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Posted

I have been having the daily headache for over a year now.  It started on March 3, 2012.  I finally, after being poked, prodded, scanned, searched, accused of drug seeking, waiting over 14 hours in the emergency room and many other doctors, office visits and strange looks, got a diagnosis from a neurologist and headache specialist.  It is called New Daily Persistent Headache.  The best way to describe it is like a dimmer switch.  It can move up and down but never turn all the way off.  It is unaffected by most "pain relieving" medications (from OTC meds to prescribed ones)...Meds like Lortab and Vicodine don't help the pain as much as make you not really care that you are in the pain.  Although I do seem to get some relief (and by some, I mean, it dulls the throb) from taking 2 of the green BC powders.  The NEURO Dr. put me on Topamax and Tizanidine (as needed when the headache is intolerable).  It (Topamax) can take up to 3 weeks to take effect.  I now have more good days than bad days, but again, the headache never truly goes away.  The only one of the listed side effects that I have is the carbonated drinks taste like metal.  Unluckily, I don't have the weight loss...(Why would the depressed fat girl with huge self esteem issues related to her body get to be that lucky?)  There is no known cure or no known trigger for this headache.  It can last anywhere from 3 months to more than 25 years. I researched and googled my headache and never came across this until my Dr. told me about it.  But once I Googled it, I was able to find info on it and realized I am not the only one.  Just thought I would throw my 2 cents in...Hope it helps.....at any rate, I hope you find out what is causing your headache, I definitely sympathize with you.  I wish nothing but fast relief for you.

 

Ashley  

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