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A Morning Person After All? A Return to Normal With Ritalin

When I was teaching public speaking in graduate school, I had a student I called Lawyer Boy who argued about everything. I told the class, which began at 7:40 a.m., that I was not a morning person. He responded, “You’re a morning person, you just don’t want to be.” This was about a year into the migraine attacks disrupting my life significantly (it was actually the last class I was able to teach).

I’ve wondered since if I really am the morning person I remember being as a kid, but the migraine attacks and fatigue were causing me to sleep more than usual. Now, on my seventh day of Ritalin, I have to admit that Lawyer Boy was probably right. I fall asleep at 10:30 or 11 p.m. and wake at 7:40 without an alarm clock. Before Ritalin, I’d sleep until 10:30 a.m. on a good day. On a night I had a migraine (which was most of them), I’d sleep until at least 11, often noon or even 1 p.m. Then I’d lie in bed for an hour or two, mucking about on my phone and gathering the energy to get up.

It doesn’t feel like Ritalin is amping me up, but is restoring my rightful self. This morning, when my head was throbbing at a level 4, I was still up at 7:40. I popped out of bed and started writing immediately. Even better, the head pain decreased to a 3 within 30 minutes. Reduced fatigue, a clear mind, less head pain, minimal side effects*. . . . I hope this lasts.

*For me at least. I’m working on a post about side effects and potential problems of Ritalin.

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Cyproheptadine for Migraine Prevention

The entire time I’ve been on cyproheptadine (about seven weeks), I’ve alternated between wanting to gush to you about it and feeling an immense need to keep quiet, lest I put its effect in jeopardy. I’m more superstitious about this medication and its efficacy than a starting pitcher in the seventh game of the World Series. I fret over the strangest things, afraid that any change in my symptoms or dose could mean an end to the relief.

Cyproheptadine is not new or novel; in fact, the brand name version, Periactin, is no longer made. It is an old antihistamine often used to children with migraine. I tried it a couple years ago and, although it is known for causing drowsiness and is sometimes used as a sleep aid, it made me jittery and unable to sleep. That first trial lasted only a couple days. This past summer I was so fatigued (turns out I was deficient in vitamins D and B12) that I decided maybe the side effects I experienced on cyproheptadine the first time would be welcome.

This time I had the more typical side effects of drowsiness and increased appetite, but also had an immediate reduction in the severity of migraine pain. The side effects were the strongest the first week I started the medication. I’ve increased the dose twice and each time have noticed the side effects for two or three days before they disappear. So far, I’m two pounds heavier than when I started.

Cyproheptadine’s maximum dose is 36 mg; I’m on 12, where I plan to stay for at least another month to see if I get any further benefit the longer I’m on the dose. For now, I’m enjoying many days where the pain ranges between a level 2 and 4. Only twice in the last month has the pain reached level 6 and I’ve even had a couple hours at level 1. At least, I think it was — I have no memory of what level 1 feels like.

This is the land of rainbows and unicorns!

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Why I’m Doing Better, Part 1: Climate & Medication

After my recent glowing posts, many people have inquired why I’m feeling better. I’d like to give you a clear, definitive answer, but migraine is never that simple. There are a number of factors, from climate and medication to exercise, meditation and forgiving myself for being sick. I’ll talk about the first two today and the others, which have probably had a greater impact on my health and suffering than medication, later this week.

Climate
Moving to Phoenix, away from the clouds and rain of Seattle and the ever-changing weather of Boston, has had the biggest influence on my migraine frequency, duration and severity. Storms and clouds have been rolling through Phoenix the last week and I’m on migraine day six. Though migraines aren’t always present when there’s weather, particularly if I’m on vacation, the correlation holds about 90% of the time. I wonder if the issue is barometric pressure changes, though Seattle’s barometric pressure is relatively steady, so parts of my hypothesis fail there.

Indomethacin
I began taking this nonsteroidal anti-inflammatory drug in June because the sand-in-my-eye symptom pointed to the slight possibility that I had an abnormal presentation of hemicrania continua. This rare headache disorder is completely responsive to indomethacin. Though my headache pain lessened, it did not cease, which means my diagnosis is still migraine. My doctor kept me on a daily dose of 225 mg of the medication, though he warned that it is not recommended for long-term use as it is hard on the stomach. I’m sticking with it for now because it is the only medication on which I’ve noticed a decrease in the frequency and severity of my migraines.

Discontinuing Wellbutrin and Lamictal
In 2005, I was prescribed Cymbalta, Wellbutrin and Lamictal for depression. I stayed on them far longer than I intended, especially considering that I was still majorly depressed while taking them. I finally went off of them this summer after determining that my dizziness, tremor, hot flashes, fatigue, cold hands and feet, mental fogginess, nausea, and increased pulse were not migraine symptoms, but medication side effects. I believe Wellbutrin was the culprit, but I wanted to stay off all three if I could. When my depression symptoms returned, I went back on Cymbalta. I’m happy to say that the depression is at bay and I’m not experiencing any other side effects.

Namenda
I’m in love with this medication, which is an Alzheimer’s treatment that is used off-label for migraine. I don’t know if it has had an effect on the migraine severity or duration, but it has cleared the mental blah that has plagued me as the migraines worsened. I credit Namenda with returning the mental wherewithal necessary for me to resume blogging and restoring my sense of intelligence. The feeling dumb aspect of migraine, which is not addressed frequently enough, has been one of my most limiting symptoms and has caused the greatest loss of my sense of identity and purpose. Did I mention that I love this drug?

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Trouble Thinking on Topamax? Study Finds “Language Disturbances”

Migraine preventive Topamax (topiramate) has long been associated with trouble thinking, hence the widely used nickname of Dopamax. A recent study indicates that some people have trouble with language while taking Topamax. Some “language disturbances,” as the authors call it, include:

  • Finding words
  • Substituting a word with another unrelated word
  • Taking forever to get a thought out
  • Meshing words
  • Naming objects

According the Reuters article, “Language disturbances generally occurred within the first month of treatment, were of mild severity, and did not require further adjustment of dosages or discontinuation of topiramate.” I’m not sure what that means. Did the language disturbances subside after a month? Does “mild severity” mean that participants chose to stay on the drug even with the side effects?

The abstract of the original article in the journal Headache, Language Disturbances as a Side Effect of Prophylactic Treatment of Migraine, doesn’t answer these questions, but does raise others:

Conclusion.—It can be hypothesized that a disorder such as migraine, which involves numerous cortical and subcortical circuits implicated in the transmission and behavioral and emotional processing of pain, represents a facilitated substrate for the occurrence of language disturbances due to topiramate. This could be the expression of a more generalized impairment of cognitive processing. These aspects should be investigated in prospective studies involving larger migraine patient samples.

My interpretation: The make up of a migraineur’s brain is such that Topamax’s language side effects can flourish. Language problems could be only one part of overall impaired thinking. I believe this means that Topamax impairs thinking, but most migrainuers will attest that our minds are fuzzy even without Topamax. That’s the research I want to see.

Do these findings fit with your experience of Topamax? Take The Daily Headache’s Topamax & migraine survey.

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Strong Warnings of Zyprexa’s Side Effects

Not sure how often — if ever — Zyprexa is used for headache, but just in case. . .

Zyprexa, an antipsychotic, has a tendency to cause weight gain, high blood sugar, high cholesterol and other metabolic problems. The side effects have long been know, but the drug’s maker, Eli Lilly, has now added them to prescribing information.