A Forced Switch in My Migraine Meds

For the last six months, I've been in a really good groove with my migraine treatment. It feels like magic to be able to say that. It's the first time in my life that my head has felt this good, and my gratitude is off the charts.

How did I find the right treatment regimen?

How did I get here? I switched doctors more than once. I switched from a neurologist to a migraine specialty neurologist to a headache clinic. I asked a LOT of questions. I participated in medication trial and error. I shared what was working and what wasn't.

And for a while, I was managing an ideal situation.

What does my migraine treatment consist of?

Since the late fall, my migraine daily regimen has included a supplement called EBH4, nebivolol - a beta-blocker that aids in the preventive treatment of migraines, and taking Nurtec every other day as a preventative. I receive Botox for migraines every 3 months (although I'm only two treatments in) and I also have a small arsenal of abortive migraine medications should they be needed, but I'm so grateful and lucky to say that they've hardly been needed as of late.

Unfortunately, migraines are not the only health challenge I struggle with.

Complicating comorbidities

In January, I was hospitalized for a Crohn's flare and placed on high-dose steroids. I also underwent anesthesia for a fertility-related procedure. Days later, I was struggling with nearly passing out every time I sat or stood up. I spoke to several of my doctors via telehealth, on the phone, and finally, was sent to the emergency room for dehydration and assessment. There, my blood pressure read extremely low - averaging around 75/45.

It took three weeks after this event to undergo the testing required to correctly be diagnosed with adrenal insufficiency. During that time, each of my providers made tweaks in my medication regimen to try to help with my low blood pressure and the resulting side effects I was struggling with.

A change in my medications

My doctor at the headache clinic very quickly noted that while nebivolol was not likely the cause for low blood pressure (or the associated symptoms), it was also probably not helping that factor. He suggested I stop taking it immediately - no need for a taper. I felt really anxious about this - I had finally found a regimen that worked, and that had enabled me to function and work full-time while living with migraine disorder and had prevented me from visiting the emergency room or infusion clinic for IV abortive medications.

I met with my headache doctor again, after my adrenal insufficiency diagnosis.

Can I still balance my treatment plan?

I had started treatment to raise my cortisol and aldosterone (hormone) levels, and I was worried that not being on the daily nebivolol was going to disrupt my migraine prevention strategy. I shared with him my concerns, and I asked for recommendations on how to balance out the support from Nurtec, EBH4, and Botox.

He suggested another medication shift - this time stopping the Nurtec and switching to daily Qulipta.

Finding my baseline

I recently made this change, and I'm still getting used to it. My body underwent several medication changes and major stressors in a short period of time, and I'm still trying to find out what my new baseline is for each of my health conditions. Having to change something that was working for me, for an external (non-migraine-related) reason, felt really frustrating, but I am grateful for an educated specialist who has proven he will listen to me and adjust things accordingly.

Have you ever experienced this frustrating need to switch or change migraine treatments based on other health conditions or medications? I'd love to hear about it below.