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"Stuck" on starting doses of preventatives

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Posted 10/18/2005 12:42 PM (GMT -8)
Does anyone have any experience with a problem I've been having with my neurologists that can only be described as becoming "stuck" on starting doses of preventative meds?

For instance, my first neurologist put me on a starting dose of Depakote. When I came for a follow up visit and was still having problems, he added Topamax, but did not increase the Depakote. He didn't even suggest it. My PCP finally got so fed up with that that she took me off the Depakote after a year on it and referred me to a second neurologist who is, admittedly, much better at treating migraines. But the new one has done that a little bit too. For instance, she put me on 25 mg of Nortriptyline about 1 year ago and has just held it there ever since, even though I was not getting good migraine management out of my current combo of meds.

So I guess this is my real question . . . I'm *finally* starting to get some good results from my preventative meds. But how do I know if that starting dose of Nortriptyline is actually contributing?

Here is what I'm currently on:

Topamax 100 mg 2 /day
Neurontin (this is new to me, so I can't remember the dosage off the top of my head) 1/day
Nortriptyline 25 mg/day
Skelaxin 800 mg 4/day
Magnesium 500 mg/day
Lexapro 40 mg /day
Toprol 100 mg/day


I'm going back to my current neuro tomorrow. She mentioned taking me off the Nortriptyline when I was there last time, but I get the feeling she wants me to take the lead on that decision. I don't know what to think. I'm fine with taking it if it is actually doing something, but I'm skeptical that it is. confused

Does anyone have any thoughts? Thanks. :)
Posted 10/18/2005 6:47 PM (GMT -8)

Go to a Headache Specialist...Headache Clinic and stick with one doctor, not a bunch of "monkeys" who don't have the expertise and are going to be changing your meds and not know what the other doctors are doing. I went through the same thing and ended up taking 19 different things at once, NO JOKE...and didn't know what was working and what wasn't...

I felt so out of it all the time and couldn't deal with all that confusion and lack of interest from the doctors etc.  I felt like there were too many hands in the cookie jar so to speak...

I found one doctor who managed everything and my PCP only managed things that had nothing to do with the migraines/headaches...(examples, sinus infection...allergy shots, birth control)

How does that sound???

I can't believe you are on all that medication...its hard to know what is working and what's not? My doc wouldn't allow combinations of Topamax, Neurontin, Depakote and Nortriptyline?

Sara

Posted 10/18/2005 6:56 PM (GMT -8)
I do go to a headache clinic, and I see a neurologist there.
Posted 10/20/2005 7:51 AM (GMT -8)

What was the explanation you were given for putting you on the Nortriptyline, when you were already taking a migraine preventative?  Also, what on earth has you taking such a high dosage of muscle relaxer( Skelaxin )? Does your doctor think your migraines are somehow muscle related?

Just curious,

Leigh Ann cool

Posted 10/20/2005 8:08 AM (GMT -8)
Yeah, I have really bad neck problems that seem to have been a big contributing factor to my increased migraines. And her idea with the Nortriptyline was that adding it to what I was alreading taking might provide relief. I didn't get on all those meds at once. That has come about over time.

I had my appointment yesterday, and we decided that I'll stop taking it. If I get along OK, great. If not, she asked me to start it again and double the dose. So I guess I'll see what happens.

Thanks for responding. :)
Posted 10/21/2005 8:10 PM (GMT -8)

Wow, that is a lot of medications. Neurontin and Topamax together surprises me as well, though I have heard it works well for muscles.

Do you keep track of your headaches and medications in a headache diary? That will help you determine if medications are working.

I've found the best way to work with the doctors is to educate myself and then ask lots of questions. Find out as much as possible about the medications you are taking, side effects and the reasons for prescribing them. If your headaches aren't subsiding then I would suggest none of them are working or one or more are triggering headaches.

My neurologist lives by the rule - only change one thing at a time. That way you can identify the cause and effect relationship.

You mentioned that you have a problem with your neck muscles. Has your neurologist mentioned Botox? Mine injects it in my forehead but will inject it in neck muscles if they're involved as well.

Good luck.

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