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My official dx is BP NOS, and I've been through the drug roulette. 6 weeks ago I developed severe headaches to the point of cognitive impairment. Got referred to a neurologist from Urgent Care, MRI and EEG done to rule out any real issues. His dx is some  variant of migraines, and since they're constant, triptans probably won't help. UC gave me a small script for fioricet and phenergan, which combined, knocked me out for 12-14h at a time. I have insomnia, so this is unheard of. Not even seroquel doesn't do that.

Neurologist started me on 500mg of depakote er, and I'm already on 75mg of lamictal and 300mg of Wellbutrin. My pdoc is fine with the neurologist managing the AEDs, and he'll handle the rest. Neurologist also ordered 1mg of klonopin at bedtime for 2 weeks. Ok, fine, works for me; also fioricet prn (new formulation).

Since I started the depakote, my sleep schedule is screwed. I take 50mg of lamictal and the 500mg of depakote at night, and I'm fine. As soon as I take the klonopin, I am out for 5-6h cold, and then I wake up and I'm wide awake. I have major insomnia, so usually I'm up until 12-1am and I take lunesta or seroquel depending on when I need to get up. It's been this way for years.

But now, depakote + 1 mg of klonopin = passed the F out hard. 8pm = out. Done for the day. I know barbituates can be sedating, but I stopped taking the fioricet way early in the day, and it doesn't sedate me. 

Has anyone else had depakote cause this kind of change? Without klonopin, no sedation, like normal. I know barbituates are sedating, but I function fine on fioricet. Maybe it's residual butalbital + depakote + klonopin? 

As an aside, the fioricet and phenergan would put me out for 14h, and phenergan only has a mild affinity for H1 receptors. I routinely use 100mg of seroquel for sleep, and it doesn't hit me as hard. 

Is it some combination of everything? Anyone had depakote exacerbate these effects?

Both the neurologist and pdoc think it's a good idea to transition from Wellbutrin to amitriptyline or nortriptyline, because Wellbutrin can cause headaches. That will start soon.

Any insight?

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I have migraines also, and use ice packs, muscle relaxers, and Excedrin.  And all of that will take the edge off.

But I do remember awhile ago my former pdoc put me on tegretol, and the first side effect I had was a good one ... it got rid of the headaches.  I don't remember why I went off of it, but it did get rid of my headaches.

I hope you find something that works for you.

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  • 1 month later...

Actually for me, while on Depakote, benzodiazepines like Klonopin don't really have a noticeable effect. I mean, they do calm me down from panic/mixed episodes, but I don't get tired or sedated from them. Go figure.

For what it's worth, Depakote helped my migraines. Wellbutrin definitely exacerbated them while I was on it. Another med(s) to consider (although nortriptyline/amitriptyline are great ideas for migraines) is clonidine or guanfacine. Both come in extended release formulations (Kapvay and Intuniv, respectively) and act on norepinephrine (like those TCAs you mentioned), giving a boost in that department, but are also wildly effective for migraine and tension headache sufferers. My migraines all but stopped when I went on guanfacine ER (Intuniv) for ADHD and it also helped my anxiety. Surprisingly, of all my meds, Intuniv is one of the most effective and my favorite as far as symptom relief goes. 

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