Expert Answer: Are there therapies for migraine patients who have Mitral Valve Prolapse & can't tolerate triptans?

Mitral valve prolapse (MVP) is a relatively common condition which affects about 2% to 3% of the population. Most people have a mild degree of prolapse with few symptoms. When symptoms, such as palpitations and chest pain do occur and are bothersome, treatment with a beta blocker can help. Beta blockers can also help prevent migraine headaches, although the dose for migraines is usually higher. Triptans (medications such as Imitrex, also known as sumatriptan, Maxalt, Relpax, Zomig, and other) are contraindicated when certain types of heart disease are present, but they are safe to use in people who have MVP.

Patients who should not take triptans include those who have had a heart attack, suffer from angina, or have many risk factors for coronary artery disease. The alternatives for those who cannot take or do not tolerate triptans include traditional pain medications, although many of those can cause worsening of headaches, or so called rebound headaches (the official name for this type of headaches is “medication overuse headaches” or MOH). The drugs proven to worsen headaches, if taken frequently, include narcotic or opioid drugs, such as codeine, Percocet, Vicodin, Demerol, and other. Taking as few as 5 tablets of such drugs each month can cause rebound headaches. Caffeine is another major culprit which makes headaches better in the short run but can make them more frequent and severe if taken frequently. Both dietary caffeine and caffeine in drugs, such as Excedrin, Fioricet, Fiorinal, and Esgic can not only worsen headaches, but make them unresponsive to other treatments. Anti-inflammatory drugs, such as ibuprofen, naproxen, and aspirin do not cause worsening of headaches, while aspirin actually prevents headaches from worsening. Migralex is a product I developed after years of research into possible causes of headaches. This is a rapidly dissolving combination of an extra-strength dose of aspirin (1,000 mg in two tablets) with magnesium oxide (150 mg in two tablets). A recent Cochrane review (an independent organization) showed that 1,000 mg of aspirin is as effective as 100 mg of sumatriptan (Imitrex) with aspirin causing fewer side effects. Magnesium provides a buffering effect which reduces stomach upset from aspirin. If none of these alternatives to triptans help, preventive treatment may be indicated.

Our philosophy at the New York Headache Center is to try to avoid medications, especially prescription drugs. Fortunately, very often we can help without resorting to drugs. The usual list of our treatment approaches includes avoidance of caffeine, regular sleep, regular meals, avoidance of food triggers, regular aerobic exercise, biofeedback and relaxation training, magnesium, CoQ10, and other supplements, acupuncture, Botox injections, and as the last resort, preventive and acute medications.

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