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Hi everyone! I don't post often, but read often! I'm 38, have had migraines most of my life. They got to a breaking point when they were everyday. I found a migraine clinic when I had a good PPO insurance. I was on 100 mg topamax as a preventive and sumavel injections as an abortive and that seemed to work. And when it was really bad, I could drive to the clinic and they would give me some shots and let me lay down for a while and work on me until it was aborted. Great! No ER!! Well, lost my PPO and now have an HMO until next year when I get my PPO back and can go back to the clinic. I was fine, thought I was managed with the 100 mg topamax anyways and maxalt worked too. Then of course the topamax stopped working and migraines everyday. I wake up with them. I found I nuerologist. Nice enough guy. Very concerned. Asked alot of questions. Even ordered MRI. NO one had ever ordered an MRI. All clear. So he upped the topamax to 100 mg twice a day. Bam! Did the trick! I was happy. Fast forward to now. Stopped working again. Last two months I have a low grade migrained (about 3 to 4 on pain scale constantly). I have an appt. with the nuerologist Dec. 3. But I was wondering what can I ask for next? I don't want to increase the topamax again. I want a new course of preventative. What are your experiences with another drug? And he doesn't have services to break the cycle sort to speak. So my main question is, has anyone gone to the ER to break the cycle of a low great migraine that is every day for months? I do get break out narly migraines like a 7 on the pain scale and just try to sleep or take a pain pill that I get from someone. I also have arthritis, have had neck surgery but no one will give me pain relief. All I hear is, well you will be in pain, you have had neck surgery and you have arthritis. I have robaxin (muscle relaxer) that I take before bed, but it only helps me sleep, but doesn't help much. I still wake up with a migraine and pain. I also take trazadone for the arthritis to help me sleep. But I can't see a preventative helping at this point unless I somehow break this narly cycle of this migraine that has gone on for months unless I get something strong to bust it out first. Will the ER help me or do I have to be on the floor shaking in pain? When I get at a level 10 on the pain scale and want to go to the ER, I can't move. I'm shaking and can't get off the couch. It's too late. I never know when it's bad enough to go. But I can't take this pain anymore! I have to work full time, so I suffer at work every day taking a maxalt and thinking it may help. But it doesn't.

What are my options. When does someone use the ER? The docor's office doesn't help. My primary care only once gave me shot of something but said to go to my nuerologist next time. Sorry this got so long. My head hurts so bad. Ok so maybe it is more like a 6 and I'm just used to the pain. I know I have to work and provide for my family and can't stay home.

Thanks! Nicole


~Nicole~
 
Posts: 7 | Location: Southern California | Registered: 06-08-2012Report This Post
<Nancy Harris Bonk>
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Hi Nicole,

I'm sorry you are having such a hard time with your Migraines right now. Many times our preventive regime needs to be adjusted, but the real issue here is your prolonged Migraine. What does this neurologist suggest for times when Migraine pain does not stop? Does he have a plan? Can you call him tomorrow and ask?

If not, you may have to go to the ER, which is not a great option for us. But here's the thing, having Migraine pain lasting longer than 72 hours without a 4-hour, pain-free break while awake, should be immediately taken care of by a medical professional. And that may mean the ER. Here is some information on Status Migrainous - The Basicsthat may be helpful.

None of us like to go to the ER, is just isn't the most effective place for Migraine treatment. But there are times when it is a necessity. Teri did an excellent podcast on when to go to the ER that may be helpful for you; When To Go To the Doctor Or ER.

Let me know how you make out,
Nancy
 
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It's good to be mindful of needing to break the cycle you're stuck in.

One other thing to consider is Medication Overuse Headache (MOH), which is also known as rebound. Medication Overuse Headache: When the Remedy Backfires. Taking Maxalt daily can certainly set you up for rebound issues, and rebound coupled with status isn't a great place to land. Studies have shown that medications, including preventative and abortive meds, tend not to work if you're stuck in rebound. They simply can't gain footing and get any real momentum built to take hold and do their job. Getting out of the cycles is the first step toward giving your meds a fighting chance to work.

As for the Topamax, you don't have to settle for simply increasing the dose. Sometimes adding another med along with the Topamax will give it a bit of a "kicker" and the resulting combo will be workable. Or perhaps you might switch to an entirely different med. Maybe it's something in the same class, since you had luck with the Topamax for a while. Or maybe it's something from a different class. We have an extensive list of potential preventative medications HERE. Currently, there are more than 100 different medications and supplements used for migraine prevention, and the possible combinations are virtually endless.

I wish I could give you some pointers for ER visits and migraine from a personal standpoint, but I've never had to resort to that. I know others' experiences are hit and miss with migraine. I will echo Nancy in saying that ERs aren't always the best at dealing with our needs, but there is a chance that they'll be able to break the cycle, and it might come down to your best option, since things have gone on so long.

Group Hug At any rate, I hope that whatever you end up deciding to do works splendidly, and that you're back to feeling consistently better very soon. Group Hug



Dragondrool
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Posts: 6478 | Location: Montana | Registered: 01-11-2007Report This Post
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A little update. Thank you so much for your replies. A huge help and lots of info for me to use. I ended up waiting for my nuero apt. I had on Monday. He ended up adding noratriptalyne (sp?) and continue with the topamax. So I start with 10mg for a week and then add more if I need to. He also gave me a pain medication to try to abort the pain cycle I was in. Which I was happy for. So far it has help somewhat. The pain medication gave me enough relief in the evening to be a Mom and be present better. That's really the only time I can take it since I work during the day. So by the afternoon I'm starting to feel it come back a little. But any relief is better than none! So I will give the medication it's normal course to kick in and work and up the dose if need be. I hate taking so much medication. I also have spondylitis (arthritis in my spine), so I feel like a walking pharmacy sometmes. It sucks. Thank you again for your replies. You gave me the voice I needed to tell the doctor that he needed to give me something to abort the pain cycle and I wasn't going to sit there one more minute in pain and wait for another preventative to kick in. So we will see how long this one works. I just hate when things work for a while and then stop working again.

Nicole


~Nicole~
 
Posts: 7 | Location: Southern California | Registered: 06-08-2012Report This Post
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Group Hug I'm glad to hear you've found some notable relief. Here's hoping for continued momentum! Thumbs Up



Dragondrool
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Posts: 6478 | Location: Montana | Registered: 01-11-2007Report This Post
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