Posted 12/18/2008 5:30 PM (GMT -6)
As we've all found out the hard way, every headache medication has some not so nice side effects. In the end you'll need to weight the benefits of taking the medication versus the difficulties that you experience from its side effects. This can be a VERY hard decision. Looking at Topamax, it's regarded as one of the most effective daily preventative medications for headache. However it has a huge turnover rate of patients that stop taking it due to its frequently very difficult side effects. It actually typically causes weight loss but can have a crippling effect on cognitive ability and mood.
Haven taking Nortriptyline and other tricyclic antidepressants myself, I do think that, for some patients, the problems that you're experiencing can indeed be managed. Like most headache meds, nortriptyline's primary indication is for depressive disorders. In many cases it can help a lot in treating headaches, largely because of the similar brain chemistry mechanisms in headache and depression (or more generally mood), but also because treating mood directly can have a very positive effect on the lives of chronic headache sufferers. With better mood comes an easier time coping with pain, higher energy, better sleep and many other direct and indirect, very interwoven effects. For example, if the medication is helping your mood or energy perhaps you might have an easier time starting and/or maintaining a regular exercise routine. Regular exercise can have a hugely positive effect on your headaches, keep your weight under control and, in general make you healthier.
In the circumstance in which your mood improves and you can exercise, sleep better, cope better, etc. you'll find that those effects reinforce themselves: greater energy helps with regular exercise and vice-versa, better overall health prevents additional health problems that could exacerbate your headaches, better sleep can lead to better mood and high energy, etc. etc. This, if you aren't familiar with the term, is a positive feedback loop.
Conversely, it's very easy to get into a negative feedback loop. For example, no exercise can lead to higher weight gain, then to worse mood, more trouble exercising, worse overall health, lower energy and (perhaps most important in my mind) a more difficult time coing with the pain. And that can become increasingly worse--I actually gained about 90 lbs in about two years because I was stuck in a very strong negative feedback loop--each problem that I had was making every other problem worse.
So the real moral, or the secret to dealing with what your report is to control as many of these factors that you can and, hopefully, it will all lead to a net positive situation. If I had to really narrow it down, I'd say that the most important factors are probably a positive attitude, regular exercise/activity, and good sleep. With bad headaches it can be very hard to stay on top of all of this but even if things aren't perfect, every bit of sustained effort can help more than you might ever imagine.
Sorry for the verbose response...my mind gets very scattered. But giid luck Jeb--you CAN maintain control of your life.
DX: NDPH, Recovered CRPS
RX: Lamictal, Provigil, Clonazepam, Ambien CR, Emsam, Namenda, Oxycontin, Oxycodone
PRN: Haloperidol, Zyprexa, Lodine, Zofran, Skelaxin