Hemiplegic Migraine

[PG59]

After being hospitalized for "TIA" symtoms in March, the doctor placed me on Amitriptylene (25mg) ,to prevent any future hemiplegic migraines, which he contended could produce a full blown stroke. Three months later, I had two back to back full blown seizures that the hospital said was caused by the Amitriptylene, have lost my driver's license, and been placed on Topamax.  I am trying to rationalize why this doctor selected a drug that clearly lists potential serious side effects as STROKES AND SEIZURES as the best possible choice to alleviate these types of migraines and the risk of stroke?

[Vanessa Lacuesta]

Hi

In managing certain diseases, the physician would usually weigh the risk and benefits involved with the treatment of choice. In your case, was it ascertained that the diagnosis was a hemiplegic migraine? Other disease conditions such as seizures and stroke may also present similarly. The abortive medications commonly used for migraine headaches are contraindicated in cases of hemiplegic migraines as their mechanism of action involves narrowing of blood vessels thus, preventive migraine therapy especially calcium channel blockers may be the drug of choice especially if the hemiplegic migraine is of the familial type.

As with the prescription of an antidepressant, the risk of seizures is minimal for amytriptyline however, your physician may have weighed the risk and benefit that you may get from taking the drug. Preventive migraine therapy has been used for hemiplegic migraines and amytriptyline is one of the most commonly use antidepressant for migraine prophylaxis.