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Migraine Preventives & Weight Gain

The threat of weight gain as a side effect of migraine preventive is a major concern for many migraineurs. Though I’ve been sympathetic to their worries, I never really understood. If something reduces the migraine severity and/or frequency, I thought I’d be willing to gain even 70 pounds. Then I started gaining weight on cyproheptadine and was rewarded with a massive infusion of empathy. Read about it in The Emotional Turbulence of Gaining Weight on a Migraine Preventive on Migraine.com.

Upon finishing that post a few weeks ago, I wasn’t sure if the weight gain was worth the trade off. Then I asked this hypothetical question: Would I stop cyproheptadine tomorrow if it meant I’d lose the weight within a week and my daily pain would return to a level 7? No freaking way! Ten or 20 pounds is an absolutely fair price to pay for level 5 pain.

Avoiding and Coping With Migraine Medication-Related Weight Gain by Diana Lee has some excellent tips if you’re struggling with weight gain from a preventive or inactivity due to migraine.

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Searching for Fatigue Source Reveals Overlooked Midrin Overuse

As you’ve likely noticed, fatigue, both physical and mental, ranks high on my list of migraine complaints. Since finding some effective preventive medications in the last year, fatigue has probably become my most debilitating — and annoying — symptom.

Though my doctors and I think the fatigue is a migraine symptom (it is far worse during a migraine attack) I’ve searched for other causes. My thyroid’s been scanned an biopsied, I’ve taken supplements after tests indicated low vitamin D and B12 levels, my internist has probed a variety of possible causes… and yet the fatigue lingers.

Then, a bright light bulb suddenly switched on. I’ve taken an average of two Midrin each day (some days none, other days four or five) for the last three years. The drug is a combination of acetaminophen (Tylenol’s active ingredient), a vasoconstrictor, and a mild sedative. Though I don’t feel sleepy when I take it, I wonder if the sedative could have an additive effect that’s left me worn out after three years of a continuous dose. (Not to mention I could have medication overuse headache, a.k.a. rebound, from daily acetaminophen.)

I am so careful with the medications that I take. I research them well and track whenever I take an abortive, but somehow the frequency with which I was taking Midrin didn’t register. I’ve been off it two weeks and both my fatigue and migraine frequency have lessened (though the roof debacle has muddied my results). I’ve taken plain acetaminophen three times each of the past two weeks, but am going to try to go without it completely this week.

The number of different migraine triggers, the possible effects of medications on migraine frequency and severity, and the variety of symptoms that can be present during a migraine make for a complicated juggling act. I never intended to join this circus.

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Migraine Preventive Wins & Losses

When I write, the words often flow from my fingertips before I consciously assemble them in my mind. I type and suddenly thoughts I didn’t know I had are splayed across the computer screen. This can be an exciting, almost magical experience. It can also force me to face truths I don’t want to acknowledge.

Even though I felt pretty good migraine-wise last week, something else always seemed more important than writing. It wasn’t until Saturday when I read a novel in which a teenager who was taking a creative writing class was continually surprised by what her writing revealed that I realized I was avoiding something. That truth I didn’t want to see? Ritalin is not the amazing get-your-life-back pill that it was the first week I was on it.

My migraine brain is not impervious to cloudy days. The mental fog has returned. I still have a migraine attack nearly every day. Sometimes I’m so fatigued it feels like sandbags are weighing down my body. I do not pop out of bed raring to go after seven or eight hours of sleep, nor do I go nonstop all day like the Energizer bunny.

While I mourn that lost energy and mental clarity, I also feel like an ungrateful brat. After a month on Ritalin, the pain tops out at a level 4 and I’m fairly productive even though I have to push myself hard to get going. Reducing my highest pain level by a full point and being able to get out of the house more? That’s a migraine preventive triumph.

Except that the losses continue to obscure the wins.

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Ritalin Three Weeks In: A Turbulent Relationship

Like so often happens with love at first sight, the spark I initially felt with Ritalin has faded. That first week, I had energy and a clear head even when I had a migraine. Week two began with a five-day migraine full of fatigue and head fog. Since that attack let up, I’ve had intermittent bursts of vigor and mental wherewithal, but also daily migraine attacks, during which I’m back to physical and mental blah.

Despite my freakout, I don’t think Ritalin is directly making the migraines worse. I’m pretty sure the five-day migraine was the result of unwittingly (or half-wittingly) reintroducing salicylates to my body. Since then, the weather has been erratic. My sleep is off, too, which could definitely be a Ritalin side effect.

On top of those issues, whenever one migraine dissipates, I have enough oomph to do something that triggers another migraine. That energy is a positive effect of the Ritalin that I have yet to figure out how to manage. I unintentionally over-exert during yoga or on the treadmill as I try to find the balance point of good exercise without triggering a migraine. Or I go to a place that I don’t know will be perfumed. Or I have sex (damn those orgasm-triggered migraines!).

Could it be that if I went two days in a row without a migraine, the next attack would be less debilitating? As if I need to recharge between migraines to get back that lovin’ feeling even when I have an attack. I also wonder if my body is acclimating to the medication and it is becoming less effective.

Ever a romantic, I still believe Ritalin and I can work through these difficulties and create a loving, supportive long-term relationship. Maybe we’re not meant to see each other every day, but would be better off having fun together a few times a week. I’m sticking with daily for now as I try to manage all the other triggers. That’s always hard work, but not as exhausting as it was before Ritalin came into the picture. Every relationship has its tradeoffs, but the good ones are worth the effort.

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Ritalin Side Effects

With my lighthearted approach toward Ritalin, I fear I’ve diminished the fact that it is a a real drug with potentially serious side effects. Sorting through information on the medication was surprisingly complicated. On one hand, it seems like a relatively mild, safe medication; on the other, there are dire warnings about its risks. I assume this is because it is often prescribed to children (many believe it and similar medications are overprescribed) and has a potential for abuse.

The most common side effects, compiled from the FDA-approved medication insert (PDF), WebMD, Drugs.com and RxList, are:

  • nervousness
  • agitation
  • anxiety
  • insomnia
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dizziness
  • heart palpitations
  • headache
  • increased heart rate
  • increased blood pressure
  • dry mouth

Serious side effects, according to MedlinePlus (from the National Institutes of Health), are:

  • fast, pounding, or irregular heartbeat
  • chest pain
  • shortness of breath
  • excessive tiredness
  • slow or difficult speech
  • fainting
  • weakness or numbness of an arm or leg
  • seizures
  • changes in vision or blurred vision
  • agitation
  • believing things that are not true
  • feeling unusually suspicious of others
  • hallucinating (seeing things or hearing voices that do not exist)
  • motor tics or verbal tics
  • depression
  • abnormally excited mood
  • mood changes
  • fever
  • hives
  • rash
  • blistering or peeling skin
  • itching
  • difficulty breathing or swallowing

For a complete list of potential side effects and their severity, see this thorough list of side effects of 10 mg of Ritalin from Great Britain’s National Health Service or WebMD’s Ritalin side effects.

Personally, I was a little shaky the first couple days I took it, but less than I would be if I had a cup of coffee. Since then, I’ve been careful to eat 30 minutes after taking it, as the label recommends. My feet also seem excessively sweaty and I’ve lost a couple pounds. Having gained 13 pounds on cyproheptadine, I haven’t minded the weight loss and hope that the weight-related side effects of the two medications ultimately cancel each other out. In case you’re concerned, be assured that my casual approach to the drug is not out of a sense of euphoria, but because I’m so happy to feel like my normal self again. The absence of serious side effects makes this even easier, of course.

The possibility that the drug with disrupt sleep is a big one for migraineurs, many of who already have trouble sleeping. I take it first thing in the morning and haven’t had a problem. Because I don’t use it to manage ADD or ADHD symptoms, I don’t need multiple doses in a day. I’m not sure why, but my energy and mental clarity last all day with only one dose.

Beyond the immediate side effects of the drug, there are concerns of its potential for abuse and the effects of long-term use. You’ll have no trouble finding alarming article on either topic. I’m not worrying about either one right now. By taking only 5 mg a day and using it for a legitimate medical condition, I don’t think I’m at much risk for abuse. If I’m still on it in a year, I’ll look into the long-term effects. For now, I’m just enjoying having the mental wherewithal to write long, research-intensive posts like this one.