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Finding the Right Migraine Preventive Medication is Complicated, Frustrating
August 11th, 2011 - Posted by Diana Lee
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When you live with chronic migraine finding the appropriate preventive medication for your unique situation and characteristics can be incredibly complicated.
Almost no one knows better than me how frustrating it can be to try what feels like a zillion medications and fail every single one. But what can be even more difficult are the unexpected, rare side effects that take an otherwise helpful medication completely out of the running.
In the eight years I’ve been dealing with chronic migraine I have taken somewhere in the neighborhood of 25-30 preventive medications. Until recently, not a single one of these medications did anything to reduce the frequency or intensity of my migraine attacks. Luckily, most of them didn’t have any serious or intolerable side effects for me, either. Unfortunately that wasn’t the case with a medication called Topamax. It made me constantly nauseated, stupid, slow, tired and depressed. I stayed on it way longer than I should have because I didn’t realize the medication was responsible for those symptoms and because my doctor at the time was a big fan of treating side effects with additional medications. The decision to go off it was easy because it wasn’t doing anything to help my migraines, but the decision isn’t always that straightforward. Knowing what I do now I’d never let things go on that long again, but I think I had to go through it to learn more about what to expect, what to tolerate and when to question the experts.
In the time since I stopped taking Topamax I’ve tried a bunch of other preventive options, and though none of them improved the frequency or intensity of my migraine attacks, none of them caused any side effects either. Nothing serious or even mildly annoying. I’d been very lucky until this spring.
In April I started a new medication for migraine prevention called Savella. This medication is not FDA approved for migraine prevention, but has been FDA approved for fibromyalgia, so some doctors theorize it might help with migraine prevention, too. As I began slowly, steadily increasing my dose of Savella I noticed I was feeling more energetic and less moody. I wasn’t needing as many naps to make it through the day and even though I was in a similar amount of pain, I was able to do a bit more around the house, such as cooking dinner more often. Unfortunately Savella turned out to be a less than ideal for for other reasons. It turns out Savella has been making my otherwise healthy blood pressure sky high. Like, in danger of having a stroke, high.
I was so bummed out when I realized I’d have to back way off the Savella dose and maybe even stop taking it altogether. It has been so rare for me to find any preventive medication that offers me even a slightly better quality of life or increased stamina. And now because of some rare side effect I have to go off it and lose all the gains I was enjoying so much. It’s frustrating. It’s also a really good reminder of how many factors come into play in trying to find the right preventive medication for your particular body, symptoms and needs. Once again it’s back to the drawing board for me.
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"I had my first migraine when I was 12. I thought I was going blind, the spots in my vision all grouped together and everything went black. The pain was intense and felt like my head would crack open above my right eye." 
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I have been put on a calcium blocker, diltiazem 30mg at night and nortriptyline 50mg, which is a depression medication used a lot by doctors for migraines. I have been happily surprised with the results. Will have very dull pain I wouldn’t even call it pain, just a feeling quite doesn’t take over as usual. I had to call the doctor and ask if I could start off with 1/4 pill of the 30mg diltiazem am then pm and increased it weekly by 1/4 until I get to whole pill. She said anyway you can do it without sleepy results, which at 1 pill made me sleep all day next day, it worked for me increasing like this. No other side effects from either medications. Loving them both. I had for past 2 years had very bad vertigo, nausea, ear-pain, eye pain, sinus pain, you name it in the head I had it. So glad with these results. Hopefully all will calm down eventually and can be taken off later in maybe year or so. Or I may be dreaming. I am the type that hates taking any medications, and past two years I have had much more than I wanted to use. I have always been a believer in natural healing but nothing natural has helped with this ailment, migraines are the pits!
That’s not a silly question at all, Abby! We tried putting me on a medication for the high blood pressure and backing off the Savella, but even at the lowest dose of Savella and a higher dose of a blood pressure med, my blood pressure stayed dangerously high. It was really disappointing.
I feel you. I’m up to about 20 different preventative meds I’ve tried. Still with no luck. Savella sounds really interesting and I’ve read a little bit about it. My doc won’t prescribe it because “you don’t have fibromyalgia.”
Silly question, but would taking a blood pressure medication to lower your numbers be an option? If Savella is giving you relief, it’s such a bummer you can’t continue it.