Mental Fatigue / persistent drowsiness / hypersomnolence
Last September, I started using low dose Adderall (5 mg BID) for migraine associated hypersomnolence. I have found it helpful, but not yet optimized.
It allows me to mostly function at a basic level which is better than feeling sleepy all the time.
I have seen others express an opinion that Migraine may cause mental fatigue and drowsiness, and I believe that this is true. I have a recent anecdote to share in support of this idea.
I have been using a 5 mg dose of Adderall to help me wake up to a state of mostly full alertness. I have observed that it requires about an hour to take effect and wears off about 6 hours after dosing. The way that I have been using the initial dose is to take it when I initially awaken, then go back to bed and sleep until the Adderall wakes me up about an hour later. Then I am good for about 5+ hours after which I take a second dose which carries me mostly through the rest of the day.
I had a migraine episode recently that came on about an hour after reawakening. It was part of a several day long episode. This time, I noticed that, while the Adderall initially awakened me as usual, the migraine caused noticeable drowsiness, and I immediately took a dose of Imitrex, which is my preferred treatment. The migraine abated after about 2 hours, which is typical for me. I noticed that the drowsiness lifted and my mental state returned to where it was before the migraine onset. Interesting. My conclusion is that migraine *itself* causes a suppression of CNS activity directly resulting in drowsiness which can overwhelm the effects of low dose stimulants. (Possible RAS effects?)
So far, the Adderall seems to be the most effective treatment for me for migraine associated hypersomnolence. I cannot tolerate caffeine in more than small trace amounts, I get hideously intolerable multiple side effects from it at doses of much more than 10 mg/day. I have tried Provigil; It is no good. It is a "dirty" drug with poor effectiveness and several undesirable side effects including stimulation of painful bruxing. Adderall, at my low dose level has almost no noticeable side effects, but has some short term variability in its pharmachokinetics that need to be worked out with possible dosing adjustments and maybe a time-release formulation.
I decided to try the Adderall because I came to the conclusion after many years of observation that I was not having a *sleep* problem, but a *Wake* problem. It was not that I was not sleeping adequately, but that I was not able to awaken fully and maintain a normal waking state throughout the day.
I am retired. I do not have any externally imposed schedules, so I can experiment.
That is so interesting,
, about the Adderall helping with some of your migraine symptoms. We have had another member mention having this same (or similar) experience. I'll link their story here, in case you're interested, https://migraine.com/stories/triggers-migraines-and-solutions-for-resolution. We appreciate you sharing your experience with this! It can be so helpful to hear from others who have been through it firsthand. Wishing you continued success with this particular migraine symptom and treatment! -- Warmly, Christine (Team Member)
I have a couple of comments related to the article that you linked, plus additional observations:
"2) Determine sleep regimen: 1) Go to bed & arise same time everyday, 2) Determine # of hrs required to get a good night's sleep"
**No, not for me. ** This does not work.** NO amount of willpower can overcome a hormonal disregulation, which appears to be a big part of the migraine problem.
"5) Breakthrough Medication: ... My neurologist started me on Adderall XR."
Oh, yeah... I think here lies the solution for my type of migraine. When my doc gave me the script for Adderall, he suggested that the Adderall might make my migraines worse; this did not happen; in fact, just the opposite.
I started with a single dose of 5 mg/day. I soon found that this helped me wake up and remain fully alert for about 5 hours starting about 1 hour after dosing, then when the stimulant effect wore off, a crash into sleep for about an hour, then the brain fog returned at its previous level for the rest of the day. Interestingly, the migraines that I still got seemed to be less intense, less troublesome. So, I asked my doc for 2 tablets per day. This worked better; I took the second dose 5 hours after the first one to allow for the ~ 1 hour induction period to make a seamless overlap. This was successful in extending my wakeful (and functional) period to a total of 10 hours followed by a crash as before, plus brain fog.
Now, I had a bit of a buffer of unused tablets from starting my initial dosing a bit erratically, so I decided to try 3 spaced doses of 5 mg each, taken at 9am, 2pm, and 7pm.
SUCCESS!! This schedule regulates my sleep cycle with no willpower or discipline required at all. I have been trying this schedule for about a week. The only thing I need to do is be careful to take each of the three doses close to on time, and not more than 90 minutes late for the second and third doses. (More than an hour late and I will start to feel drowsy, so I have a warning.) This is mostly pretty easy, I just set a timer for the next dose. Now, I wake up naturally between about 8 and 9 am, usually without the need for an alarm, and I get sleepy-drowsy between 1 and 2am, falling to sleep effortlessly, and awakening naturally after about 7 hours.
One more interesting thing that I noticed. The Adderall does not seem to work during the active pain phase of a migraine attack. I had a migraine attack that started about 2 hours after I took an initial dose of Adderall, where the stimulant effect had started to be noticeable. I noticed a significant onset of drowsiness with the migraine, and took a dose of sumatriptan at the first signs of the migraine. This took effect as typical, and the migraine symptoms cleared after about 2 hours, after which the stimulant effect of the Adderall returned. I took the second dose of Adderall on schedule and the effects continued as expected. ... Interesting.
I think the extended release version of Adderall would be easier to use than my TID schedule, and I am going to discuss this with my doc at my next visit, which will be soon. I ran into a retired migraine researcher, who is also a migraine sufferer, who recommended the extended release version of Adderall as being effective for some patients who get excessive drowsiness symptoms, so there is some research basis supporting its use.
IMO, the sleep disregulation problem is *hormonal* (and not related to melatonin, which I have tried without success) and *absolutely NOT* a matter of "sleep hygeine" like some clueless practitioners want to put the blame on the victims of this disease.
Hi. Just wanted to say sorry if you were looking for this post -- it got flagged as spam in our system. This can happen sometimes, especially if it's about medication. As you can see, you're good to go now. Thanks for sharing! -Melissa, team member
