TBI Headache Medication...

Hi,

I suffered a TBI and ear damage in an explosion in Iraq 4 months ago.  I was knocked out for a couple seconds. Initially, I thought I was OK, I had headaches and tinnitus right afterward, but was told these would go away with time. Then, I developed Eustachian Tube Dysfunction followed by a nasty "staph like" drug resistant infection. I have tubes in both ears.

Although I had headaches from the time of the blast, the headaches became much worse about 2 1/2 months ago. This was troubling because it was about 1 1/2 after the blast injury. Most of the time I have minor head pain...more of discomfort variety. Then they got more severe. I began to get migraine like headaches (2-3 a day)...some so severe it would bring me to my knees. I would have to lie down in total silence. (sensitive to light and sound). Usually, they would last about an hour or two--in which I couldn't do anything. No specific trigger...they might happen as I was sitting calmly reading...you never know.  Also, I got other TBI symptoms...dizziness, I was irritable...even at minor things. I also began to forget things...like shopping lists.

Anyway, I've been seeing neurologist. I was intialkly prescribed Tramadol for the pain, and then Nortriptyline for migraine prevention. I started at 25mg once at night. That decreased the headaches probably about 50% then moved to 50mg at bedtime. That didn't really help the headaches anymore, but I began to notice the side effects. I was REALLY drowsy and I started to have mood swings (I'd be sad or anxious for no reason). So, we decided to go back down to 25mg again. Also...my DR is trying to get me off to use Naproxen instead of Tramadol if I can. That was last Tuesday.

This week has been rough. So far, the moods got worse as i went down. I had a pretty bad anxiety attack Friday for no reason at all. The headaches have come back...worse with the 25mg than before. Still better than nothing, but not as effective as before. Naproxan does nothing for me except upset my stomach, Tramadol works...but it isn't as effective as when I first started taking it (it takes more for the same effect).

So...my question...what migraine preventative medications are peaple using? My Dr mentioned Blood pressure medication and possibly anti seizure. What about side effects? Does anyone take a combo (anti depressant and hiogh blood pressure). Help..this really gets me down. I don't like the way I feel with the Nortriptyline....but I can't stand the pain...that is worse.

Nate

[Bhupinder Kaur, MD]

Hello,

Despite medical advances, migraines can be difficult to treat. Migraines can be treated with 2 approaches: abortive and preventive.
Abortive treatment includes triptans(sumitriptan,naratriptan etc.), Ergotamine tartrate (Cafergot), Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray) and narcotics(butalbital, Acetaminophen and codeine).

Preventive treatment includes medications used to treat high blood pressure(Beta-blockers(propranol),calcium channel blockers (verapamil), Antidepressants(Amitriptyline ,nortriptyline,Antiseizure medications(Gabapentin , valproic acid,topiramate and some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine.Sometimes combinations of medicines are used.
http://www.emedicinehealth.com/migraine_headache/page8_em.htm

Botox toxin has also found to help in migraine. Using a cold compress to the area of pain, resting in a room with little or no sensory stimulation (light, sound, and odors), withdrawing from stressful surroundings and sleeping also helps in headache reduction.

Pls discuss these options with your doctor and start with the treatment.

Hope it helps.If you have any additional queries,then pls post us.
Take care and regards.