I'm 26... been suffering from tension headaches for 10 years!

[informeduser]

I am a 26 year old male. I have been suffering from tension headaches for the past 8-10 years. I have taken numerous drugs: Tylenol, Aleve, Ibuprofen (up to 800 mgs), etc., and was even diagnosed with a case of rebound headache ultimately due to ergotamine toxicity (due to taking too much Migril). I was put on Pamelor and after a while things got better. I now get headaches a few times a week. Sometimes I get none, sometimes I get them 3-4 times a week at the most. I have been taking Fiorinal for my headaches for at least the last 5-6 years and find that it works best for me.

I moved from the US to Hong Kong sometime ago and canceled my medical insurance there so now obtaining Fiorinal is a bit more difficult. I cannot seem to locate this drug in Hong Kong. I visited a private hospital and after briefly explaining my history to the doctor, he immediately prescribed the following drugs:

- Tryptanol (amitriptyline) – 10MG / 1 Tablet twice daily
- Arcoxia (etoricoxib) – 60MG / 1 Tablet twice daily, if needed

I notice amitriptyline (what the doctor prescribed) is the same class of drug as nortriptyline (what I was prescribed in the States previously). I have read online that nortriptyline is more effective and that it poses less side effects than amitriptyline. Can anyone provide me with more information? Is amitriptyline safe to take? It seems like it has many side effects. Also, it seemed like the other drug I was given is actually for arthritis. Has anyone been given this drug for tension headaches?

If anyone has any advice or suggestions – please let me know. I am also interested in knowing if Fiorinal is available in Hong Kong or outside the USA. If I get my new doctors in HK to write up a prescription, would I be able to fill it legally in the US or other markets?

[informeduser]

Thank you for taking the time to reply.

Can you say whether amitriptyline is more effective than nortriptyline (or vice-versa) or does it generally depend on the individual? I tried the etoricoxib and almost felt as if it caused the duration and level of pain to increase somewhat. With Fiorinal, I can almost feel it working. It is quite effective but yes I have read that if taken regularly it can lead to dependency.

I was actually born three months premature with an extremely mild case of cerebral palsy. I'm perfectly healthy and appear "normal" (my daily life is not affected at all) but my muscles are naturally tense due to my condition and I suspect that when under stress it would cause me to get headaches much more easily. I was previously prescribed Zanaflex. Do you think this medication or other muscle relaxers would be beneficial to take or at least look into?

Do you also recommend that I get tests done to rule out any underlying causes? My previous doctors just listened to what I had to say but did not order any tests. I have been told by others to get x-rays of both my head and neck and possibly an MRI, CT, and EEG.

Please let me know your thoughts -
    
Thanks for your Reply!

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I can not make specific recommendations about the medications you have been prescribed. However, you are correct in stating that nortriptyline and amitriptyline are the same class of drugs, what is termed tricyclic antidepressants. They share common side effects, but just based on the strength of their activity at different receptors, notriptyline causes less side effects than amitriptyline, but the difference is generally somewhat minor in most people. Amitriptyline can cause more dry mouth, GI side effects, and weight gain, etc but in general, they are both equally effective in chronic headaches. At low doses (10-25 mg, even up to 50 mg) there are minimal side effects usually. With toxic doses (significant overdose) fatal side effects can occur.

It is important to know that fiorinal is notorious for causing severe rebound headaches that are very difficult to treat, because withdrawal from each of the components of fiorinal can occur. Its use in headaches should be avoided when possible. NSAIDs, such as those used for arthritis, are effective for tension type headaches, and are a good alternative, though it is also important to note that use more than even a few times a month can lead to rebound.

Continued followup with your neurologist is recommended; finding a medication regimen that is effective enough to prevent the use of as-needed medications such as fiorinal or arcoxia except infrequently should be the goal.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.