Migraine Treatment Choices – Sophie’s Choice
Today’s prompt/topic for the Migraine and Headache Awareness Month Blog Challenge is: Sophie’s Choice: What are the toughest treatment choices you face when balancing Migraine/Headache Disorders with other health conditions?
Yikes! This topic really hits home for me. . .
The toughest treatment choice is one that I’m forced to make every time I have a Migraine. I’ve had a heart attack and have coronary artery disease, occasional angina, and a heart murmur. Technically, triptans are contraindicated for me. Going by all the “rules,” I shouldn’t take them at all. BUT, when I have a Migraine, my blood pressure shoots up into stroke range. So, which is more dangerous – the stroke-range blood pressure, or the risks presented by the triptans? I discussed this with my Migraine specialist and told him that I think the blood pressure presents a bigger risk, and I want to take triptans. Once he was sure I fully understood the risk, he was willing to prescribe triptans for me. I no longer use sumatriptan (Imitrex) injections because I feel the risk of that form is too high, but I do use the tablet form of Zomig. A note here: I would never say that someone else should make the same choice. This is a very serious and difficult choice that must be made by the physician and patient, working together.
Another treatment choice was regarding my Migraine preventives. For over 10 years, I took a large dose of time-release verapamil before I went to bed. It was great because it served two purposes – controlling my hypertension AND helping prevent Migraines. A couple of years ago, I was working hard at controlling diabetes and lost quite a bit of weight, checking in with my doctor at regular intervals. I suddenly began feeling unwell – not hungry or thirsty and always sleepy. When I went to my doctor, my diastolic blood pressure was only 35. This made no sense since it had only been two weeks since I’d had a check-up. He sent me to the hospital for tests. In the end, it turned out that rather than adjusting gradually to the weight loss, my body had suddenly reacted, and I could no longer tolerate the large dose of verapamil. That meant that my primary Migraine preventive and all antihypertensive medications are now out for Migraine prevention. When the choice was using those medications for Migraine prevention and risking passing out or looking for new preventives, there really wasn’t much choice,
There are other choices such as how severe an asthma attack has to be before I’ll use my rescue inhaler because it always triggers a Migraine. There’s also an issue with my taking steroids because I have diabetes, and steroids tend to make blood glucose levels rise. That means if I have a long Migraine or a cycle for which steroids would normally be prescribed, there’s a conflict.
Overall, the issue with triptans is the biggest choice I’ve had to make. I have to say that choice makes me angry with the FDA because there’s a transcranial magnetic stimulation device designed to abort a Migraine with a single magnetic pulse to the back of the head, but the FDA has yet to act on the application for approval. This device has been approved and in use in the United Kingdom for two years, but without FDA approval, it’s not yet available in the United States.
What tough choices have you had to make? Please leave a comment and share with us.
Learn more about the 2013 MHAM Blog Challenge and other MHAM events by visiting: 2013 Migraine & Headache Awareness Month Information Page
June, Migraine and Headache Awareness Month, is dedicated to Unmasking the Mystery of Chronic Headache Disorders. The Migraine and Headache Awareness Month Blog Challenge is issued by FightingHeadacheDisorders.com
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