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Lamictal Headaches


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#1 jessica

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Posted 24 August 2007 - 12:45 PM

The topic really says it all.

As someone titrating up on lamotrigine, I'm having a helluva time dealing with the headaches. It feels like my head is about to split open. My pdoc and I (during one of my twice weekly appointments) figured out it's not migraines, and it's likely just the lamotrigine — we both have strong feelings on ever ever ever starting two meds at the same time. (N.B.: Yes, I know I'm lucky to be working with this guy, rather than one of those notorious doctors who throw eight new scripts at you at the same time.)

Now, other than headache, nothing about the lamotrigine is bothering me, and it's all about suicidal depression and paralyzing anxiety vs. side effects, so the headache is going to stay for the time being. I did switch to divided doses, so that may help even it out, but then again it may not. My doc suggested a lamotrigine blood level to figure out what's going on but I pointed out that even if we know, that doesn't tell me anything about symptoms, and it only tells me how my body chose to metabolize it today which, with lamotrigine, may as well change tomorrow, the day after, or possibly with the passing of comets. So while it may be interesting from a How Do I Metabolize Today? perspective, it's probably not going to be terribly relevant.

What I can't find in the PI sheets or, for that matter, on PubMed, what actually causes the headache. I'd like to know the cause because I'd like to know the best way to find relief. Acetaminophen isn't touching this bastard, and with peptic ulcers, the NSAIDs are totally off the table. Codeine isn't helping either.

I am not keen on adding another psychiatric drug to my personal pharmacopœia, and would prefer to deal with something that relieves the lamotrigine problems straight up, rather than through some random manipulative side effect that comes with the price of what a medication is actually meant to do as well. I don't like taking meds based on the hope of one side effect hitting, because it's too much of a shot in the dark.

Ideas? How did you kill your lamotrigine headaches?
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Dx: agoraphobia w/ panic disorder (300.21 / F40.0), recurrent depressive disorder, current episode severe w/o psychotic symptoms (296.3 / F33.2), generalised anxiety disorder (300.02 / F41.1), non-organic insomnia (307.42 / F51.0), schizoid personality disorder (301.2 / F60.1), Asperger's syndrome (299.8 / F84.5), post-traumatic stress disorder (309.81 / F43.1)
Rx: lamotrigine
Previous Rx: alprazolam, amitryptyline, amphetamine salts, buspirone, bupropion, clonidine, diazepam, diphenhydramine, duloxetine, escitalopram, eszopiclone, fluvoxamine, lamotrigine, lorazepam, olanzapine, prazosin, propranolol, quetiapine, ramelteon, sodium oxybate, trazodone, zaleplon, zolpidem, zopiclone




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#2 dymphna

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Posted 24 August 2007 - 01:03 PM

Ideas? How did you kill your lamotrigine headaches?


I am rapidly discovering that the cure-all to many things is effing Gatorade.

Seriously.

The powder has less 'crap' than the liquid, but doesn't taste as good, and isn't as convenient.

Barring that, dropping a Lamictal dose by 12.5 or 25mg for a few days will normally do wonders for headache modulation (i.e. slide you through the 'break-in' period).


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#3 Bipolar Bear

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Posted 24 August 2007 - 01:04 PM

Ice packs and a tough will.

I had headaches starting up, and I did use NSAIDS, but ice packs on my eyes, forhead and base of skull helped a lot too.

I spent a lot of evenings on the couch in the dark during titration. But it was worth it. I loved Lamictal.

Good luck.
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#4 firedancer

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Posted 24 August 2007 - 01:31 PM

i second gatorade and ice packs. my problem when titrating up was i was having migraines and those horrible lamictal headaches so i was in pain 24/7 or that is what it felt like. i had a prescription pain med but only used it for those bad migraines and not the headaches, for that - ice packs and gatorade - my new favorite is the a.m. formula (which i laughed at when i first saw the commercial until i tasted it), mango something - yummy!
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Dx: Bipolar, Intractable Migraines, Social & General Anxiety, Idiopathic Seizures

Current Rx: Lamictal, Xanax, Seroquel XR, Nuvigil, Ambien

Past Rx: Prozac, Paxil/CR, Lexapro, Cymbalta, Ambien/CR, Wellbutrin XL, Effexor/XR, Depakote/ER, Keppra, Topamax, Neurontin, Zonegran, Trazadone, Klonopin, Seroquel, Zyprexa, Lyrica, Trileptal, Risperal, Ablify, Geodon, Lunesta, Skelaxin, Doxepin, Flexiril, Zanaflex, Verapamil, Lithium Carb, amitiptylin, triptans (can't take 'em), pain meds

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#5 Sasha

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Posted 24 August 2007 - 04:32 PM

Yoga, cat and cow poses, helped some. Ibuprofen, if you don't have any interaction issues, helped a little. But mostly you just have to stay hydrated and wait it out. I think the last time I titrated up on lamictal it started getting better about day 4, if that's any help at all?
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#6 In_Remission_crickets

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Posted 25 August 2007 - 06:02 AM

Hi Jessica, I am having the headaches too. I am taking ibuprofin/Advil for some relief but i wanted to note that in the course of my reading/research I found that you shouldn't take acetaminopehn/Tylenol with lamictal. Don't know if this is hard core truth but thought it was worthy of a mention. Tracey

#7 jessica

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Posted 25 August 2007 - 06:35 AM

I am having the headaches too. I am taking ibuprofin/Advil for some relief but i wanted to note that in the course of my reading/research I found that you shouldn't take acetaminopehn/Tylenol with lamictal.


Really? As someone with a peptic ulcer, I absolutely cannot take ibuprofen or any of the NSAIDs in any form. Can I have a cite on the no-acetaminophen stance? I'd like to look into this further.
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Dx: agoraphobia w/ panic disorder (300.21 / F40.0), recurrent depressive disorder, current episode severe w/o psychotic symptoms (296.3 / F33.2), generalised anxiety disorder (300.02 / F41.1), non-organic insomnia (307.42 / F51.0), schizoid personality disorder (301.2 / F60.1), Asperger's syndrome (299.8 / F84.5), post-traumatic stress disorder (309.81 / F43.1)
Rx: lamotrigine
Previous Rx: alprazolam, amitryptyline, amphetamine salts, buspirone, bupropion, clonidine, diazepam, diphenhydramine, duloxetine, escitalopram, eszopiclone, fluvoxamine, lamotrigine, lorazepam, olanzapine, prazosin, propranolol, quetiapine, ramelteon, sodium oxybate, trazodone, zaleplon, zolpidem, zopiclone


#8 firedancer

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Posted 25 August 2007 - 08:16 AM

i would love a link to that too. i'm currently on lamictal and lithium so ibuprofen is out for me and i take lorcet plus for migraines which is acetaminophen/hydrocodone.
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Please be nice to me, I'm a blood donor (conquering my fear of needles one pint at a time).

Dx: Bipolar, Intractable Migraines, Social & General Anxiety, Idiopathic Seizures

Current Rx: Lamictal, Xanax, Seroquel XR, Nuvigil, Ambien

Past Rx: Prozac, Paxil/CR, Lexapro, Cymbalta, Ambien/CR, Wellbutrin XL, Effexor/XR, Depakote/ER, Keppra, Topamax, Neurontin, Zonegran, Trazadone, Klonopin, Seroquel, Zyprexa, Lyrica, Trileptal, Risperal, Ablify, Geodon, Lunesta, Skelaxin, Doxepin, Flexiril, Zanaflex, Verapamil, Lithium Carb, amitiptylin, triptans (can't take 'em), pain meds

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#9 Sasha

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Posted 25 August 2007 - 10:58 AM

For interaction stuff, the best thing to do is really always to check with your pdoc, rather than checking links online. Safer and more reliable...
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#10 jessica

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Posted 25 August 2007 - 11:28 AM

For interaction stuff, the best thing to do is really always to check with your pdoc, rather than checking links online.


Depends on the source. There are some good drug interaction checkers based on what the researchers found in the clinical trials, and there are many sources for peer reviewed journals indexed online. I don't take anything based on Anecdotes seriously, because the plural of Anecdote is, despite the joke, not Data. Individual field reports are interesting but individual field reports of interactions need to get written up. Personally, I'm skeptical about any interaction between lamotrigine and acetaminophen, which is why I asked for a citation.

In other words, as xkcd put it, Stand back, I'm going to try science.
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Dx: agoraphobia w/ panic disorder (300.21 / F40.0), recurrent depressive disorder, current episode severe w/o psychotic symptoms (296.3 / F33.2), generalised anxiety disorder (300.02 / F41.1), non-organic insomnia (307.42 / F51.0), schizoid personality disorder (301.2 / F60.1), Asperger's syndrome (299.8 / F84.5), post-traumatic stress disorder (309.81 / F43.1)
Rx: lamotrigine
Previous Rx: alprazolam, amitryptyline, amphetamine salts, buspirone, bupropion, clonidine, diazepam, diphenhydramine, duloxetine, escitalopram, eszopiclone, fluvoxamine, lamotrigine, lorazepam, olanzapine, prazosin, propranolol, quetiapine, ramelteon, sodium oxybate, trazodone, zaleplon, zolpidem, zopiclone


#11 romancandle

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Posted 25 August 2007 - 12:34 PM

I know this doesn't answer all your questions, but my experience was that once I hit my stable dose [200mg], my headaches diminished almost completely. I still get one once in a blue moon.

But yeah, ice packs help. Tylenol, stuff like that.
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#12 In_Remission_Reflections

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Posted 25 August 2007 - 10:14 PM

so do the headaches ever go away, like after you've been on it for a while?

#13 firedancer

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Posted 26 August 2007 - 10:34 AM

so do the headaches ever go away, like after you've been on it for a while?


mine did, eventually. just one day, they stopped.
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Please be nice to me, I'm a blood donor (conquering my fear of needles one pint at a time).

Dx: Bipolar, Intractable Migraines, Social & General Anxiety, Idiopathic Seizures

Current Rx: Lamictal, Xanax, Seroquel XR, Nuvigil, Ambien

Past Rx: Prozac, Paxil/CR, Lexapro, Cymbalta, Ambien/CR, Wellbutrin XL, Effexor/XR, Depakote/ER, Keppra, Topamax, Neurontin, Zonegran, Trazadone, Klonopin, Seroquel, Zyprexa, Lyrica, Trileptal, Risperal, Ablify, Geodon, Lunesta, Skelaxin, Doxepin, Flexiril, Zanaflex, Verapamil, Lithium Carb, amitiptylin, triptans (can't take 'em), pain meds

be yourself because the people that mind don't matter and the people that matter don't mind - dr. seuss

#14 Jerod Poore

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Posted 26 August 2007 - 02:52 PM

so do the headaches ever go away, like after you've been on it for a while?


A shitload of reports from the field are pretty much the same:

The Lamictal Headache is usually consistent. People have it all the time, or it is around only with dosage increases, or it just strikes at random. Of course at some point when you reach a particular dosage threshold the consistency can change from "strikes randomly" to "all the time," but a new consistency is still consistent.

Hence, I guess, the current mystery as to the nature of what causes it. Many side effects are easy to pin down and easy to group people into why said side effects won't effect them, or if so to what extent.

With something like this, it's a target moving within a black box. The black box is moving, too.

Can a constant headache go away? It has. Given enough people that falls under a new category of consistency of, "eventually goes away," subset of, "around only with dosage increases."
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa

#15 jessica

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Posted 27 August 2007 - 09:10 AM

Follow-up.

During this morning's psychiatric appointment, we discussed lamotrigine headaches at length. We considered a range of alternatives for headache relief, including barbituates, other anticonvulsants, triptans, beta blockers, calcium channel blockers and the ergot derivatives. (I asked, "You want me to take 'shrooms?" And yes, my doctor is very open about what we can try and do and where we should go with any medication decisions.)

I said I didn't want to discontinue the lamotrigine because it's helping with many other issues, for instance, bad eating habits, bad sleep, & c., issues I'd thought meds couldn't affect in the slightest, yet it's definitely helping on those as well as acting as an anxiolytic. It's just taking forever to taper up to a dose that means significant depressive relief, which is pissing me off.

I argued that I'd prefer to stick with opiates on several bases — for one thing, they work on this and I know they work, so the experimental factor is taken out. Secondly, they don't interact with most medications the way that, say, a beta blocker or another anticonvulsant would, so they don't affect my titration of lamotrigine as much as other medications. Thirdly, they don't have really sucky side effects like another anti-convulsant or a beta blocker would.

So, that's what we're doing for symptomatic relief, taking p.r.n. and waiting until I no longer need them, and then bumping up the dosage and starting again. (Opiates don't generally knock me out, my experience with hydromorphone intravenously in hospitalisation for an abdominal infection being a major exception.) So that's what I'll be doing, so I can actually deal and go on with life.

I hate taking anything that's addictive for its recreational qualities — benzodiazepenes, barbituates, opiates, & c. — but I was reminded today that when you're in pain, you're in pain, and no amount of being Catonian is going to help.

Besides, Cato died by disembowelling himself with his hands. I am so not that bad-assed.
  • 0

Dx: agoraphobia w/ panic disorder (300.21 / F40.0), recurrent depressive disorder, current episode severe w/o psychotic symptoms (296.3 / F33.2), generalised anxiety disorder (300.02 / F41.1), non-organic insomnia (307.42 / F51.0), schizoid personality disorder (301.2 / F60.1), Asperger's syndrome (299.8 / F84.5), post-traumatic stress disorder (309.81 / F43.1)
Rx: lamotrigine
Previous Rx: alprazolam, amitryptyline, amphetamine salts, buspirone, bupropion, clonidine, diazepam, diphenhydramine, duloxetine, escitalopram, eszopiclone, fluvoxamine, lamotrigine, lorazepam, olanzapine, prazosin, propranolol, quetiapine, ramelteon, sodium oxybate, trazodone, zaleplon, zolpidem, zopiclone


#16 Jerod Poore

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Posted 27 August 2007 - 11:44 AM

Jessica,

the ergot derivatives. (I asked, "You want me to take 'shrooms?"


The psychedelic components of mushrooms are psylocibin and/or psilocin.

Ergot derivatives are common, old-school migraine drugs. Dr. Hofmann was working on a migraine drug for Sandoz when he stumbled across something else entirely. Ergot itself is a fungus that grows on rye.

Please see my adventures in collecting edible mushrooms when a little bit of another psychoactive compound gets mixed into an otherwise edible one, and thus my guess as to why Zyprexa is so good at stomping out ultradian rapid cycling.

Otherwise I do know some of my mycology from the old days.


I argued that I'd prefer to stick with opiates on several bases — for one thing, they work on this and I know they work, so the experimental factor is taken out. Secondly, they don't interact with most medications the way that, say, a beta blocker or another anticonvulsant would, so they don't affect my titration of lamotrigine as much as other medications. Thirdly, they don't have really sucky side effects like another anti-convulsant or a beta blocker would.

So, that's what we're doing for symptomatic relief, taking p.r.n. and waiting until I no longer need them, and then bumping up the dosage and starting again. (Opiates don't generally knock me out, my experience with hydromorphone intravenously in hospitalisation for an abdominal infection being a major exception.) So that's what I'll be doing, so I can actually deal and go on with life.

I hate taking anything that's addictive for its recreational qualities — benzodiazepenes, barbituates, opiates, & c. — but I was reminded today that when you're in pain, you're in pain, and no amount of being Catonian is going to help.


Pain is pain, quality of life is quality of life. You're dealing with what is, in its purest form, neuropathic pain. One thing provides symptomatic relief - an opiate. You don't take it every day and at some point you hope the pain goes away and you can stop taking it. Or you're going to take it on an as-needed basis for an indeterminate time.

What's the big deal?
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa

#17 jessica

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Posted 27 August 2007 - 11:56 AM

Pain is pain, quality of life is quality of life. You're dealing with what is, in its purest form, neuropathic pain. One thing provides symptomatic relief - an opiate. You don't take it every day and at some point you hope the pain goes away and you can stop taking it. Or you're going to take it on an as-needed basis for an indeterminate time. What's the big deal?


I was married to an addict once and have lots of emotional issues around addictive substances.

What else do people do for neuropathic pain? I feel like a lot of people are looking for non-opiate substances kind of desperately because of the big taboo on opiods generally, but very little else seems to work for most people. I'm leery of adding on a drug because it might work when there is something we know works.
  • 0

Dx: agoraphobia w/ panic disorder (300.21 / F40.0), recurrent depressive disorder, current episode severe w/o psychotic symptoms (296.3 / F33.2), generalised anxiety disorder (300.02 / F41.1), non-organic insomnia (307.42 / F51.0), schizoid personality disorder (301.2 / F60.1), Asperger's syndrome (299.8 / F84.5), post-traumatic stress disorder (309.81 / F43.1)
Rx: lamotrigine
Previous Rx: alprazolam, amitryptyline, amphetamine salts, buspirone, bupropion, clonidine, diazepam, diphenhydramine, duloxetine, escitalopram, eszopiclone, fluvoxamine, lamotrigine, lorazepam, olanzapine, prazosin, propranolol, quetiapine, ramelteon, sodium oxybate, trazodone, zaleplon, zolpidem, zopiclone


#18 Silver

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Posted 27 August 2007 - 09:26 PM

What else do people do for neuropathic pain? I feel like a lot of people are looking for non-opiate substances kind of desperately because of the big taboo on opiods generally, but very little else seems to work for most people. I'm leery of adding on a drug because it might work when there is something we know works.


They often use... anticonvulsants. And Tylenol. And icepacks. And massage. And tricyclics, calcium-channel blockers, and beta-blockers. And for migraine and chronic daily headache, everything under the sun, from magnesium to supplemental oxygen to DHE injections. Makes one want to go bonk one's head on the wall, perhaps? At least you guys covered it all this morning.

Opioids might well be worth a trial. You're respectful of them, you know all too well the damage they can cause, you know what to look for. Remember, sometimes tiny doses will do the trick. Or they might not work at all, and you'll try them and write them on the 'failed' list after a few days.
And there is the possibility that if you break the cycle of the headaches, you'll be out of the cycle for the time being. Does happen with other, non-drug headaches; not out of the realm of possibility here. Or, as previously stated, you'll take them as needed, in a rational fashion.
The caveat: As you know, they're strong psychoactive substances, both in their presence and in their absence / your withdrawal. So, if you have any exacerbation of your depression while taking opioids, or if you notice an exacerbation after discontinuing use, remember that it might be the opioids, rather than an affective shift. Sometimes this factor gets overlooked and I just feel compelled to throw it in here.

I may have missed it in my reading, but - did the Gatorade work?

Alt suggestion, if you are not a Gatorade fan - V8, although VERY high in sodium - seems to offer the same 'lytes, according to my officemate, a long-time Lamictal-taker. She also said that caffeine was the worst thing ever, as it would relieve the headache for a bit and then it would rebound, much as in frequent migraine (even though it was a non-migrainous HA.)

I'm not finding an acetaminophen/Lamictal drug warning on any of my usual checkers, including MicroMedex (the full-on inpatient version), by the way, and the pharmacist at the state psychiatric facility was unaware of any problems combining them in rational quantities in an otherwise healthy non-elderly person.
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#19 In_Remission_Christian82

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Posted 28 August 2007 - 12:12 AM

I had mild Lamictal headaches while titrating up, which went away around 100mg ... and that took about a month to get there. My headaches were not unbearable, and taking some all natural ibuprofen that I got at Trader Joe's pretty much made them go away. I think my headaches may have been milder than most, they were more of an annoyance than anything serious.

#20 firedancer

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Posted 28 August 2007 - 10:48 AM

i know that this goes off point from the original question but, i have intractable migraines so i know pain. since jan '05 i have been on percocet, vicoprofen and now lorcet plus (i've tried others, but most just don't give me any relief). at this point i could very well be an addict, but i am very respectable of these meds and take them only when necessary (they don't make me sleepy at all, just relaxed and they numb the pain enough that i don't want to do anything desperate).

not every migraine requires that i take them. i may very much want too sometimes, but i don't. i use ice packs, ear plugs and my eye cover/mask and lay as still as possible in a dark room. but when i need them, i know they are there.

my neuro only prescribes pain meds to 3 of his patients, and i am one of them. he was a hard sell, but he knows it keeps me out of the ER (although i do have a form that my neuro has filled out informing the ER that i am not a drug seeker and recommends what they should give me via IV - dilaudid, ativan, reglan and thorazine if needed). not to mention that i am unable to take triptans or ergotamines because of bad reactions to them in the past. so until we find something that works, this is my life.
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Dx: Bipolar, Intractable Migraines, Social & General Anxiety, Idiopathic Seizures

Current Rx: Lamictal, Xanax, Seroquel XR, Nuvigil, Ambien

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#21 Bipolar Bear

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Posted 28 August 2007 - 04:53 PM

Follow-up.

I hate taking anything that's addictive for its recreational qualities — benzodiazepenes, barbituates, opiates, & c. — but I was reminded today that when you're in pain, you're in pain, and no amount of being Catonian is going to help.


I understand your hesitation, I really do. Right now I'm on a pretty steady stream of benzos to help me ride out the waves of rage and insomnia effexor is giving me. As long as we remember to take the meds for what they are for, it can be okay. Sometimes I think it takes more bravery to take the treatment and be responsible than to be stoic and take the pain.
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#22 Jerod Poore

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Posted 29 August 2007 - 10:12 AM

Jessica,

Pain is pain, quality of life is quality of life. You're dealing with what is, in its purest form, neuropathic pain. One thing provides symptomatic relief - an opiate. You don't take it every day and at some point you hope the pain goes away and you can stop taking it. Or you're going to take it on an as-needed basis for an indeterminate time. What's the big deal?


I was married to an addict once and have lots of emotional issues around addictive substances.



OK. There's no dealing with that without getting into the realm of support group land.


What else do people do for neuropathic pain? I feel like a lot of people are looking for non-opiate substances kind of desperately because of the big taboo on opiods generally, but very little else seems to work for most people. I'm leery of adding on a drug because it might work when there is something we know works.


Well, as written you're already taking it. Or what you could take would mess up what Lamictal does.

Now calcium channel blockers could have some truly unpredictable effects, positive or negative.

Lamictal doesn't do that much with the calcium channels, but there is a connection between some of the calcium channels to glutamate, and Lamictal does a lot with glutamate.1

So depending on the particular channels being affected by the drug in question, who the hell knows what will happen. The headaches go away, or they get worse, or nothing happens with them. Meanwhile, regardless of what happens with the headaches, the benefits of Lamictal decrease, or increase, or stay the same.

My vote is for keeping that one low on the list of things to try.

Silver writes:

And for migraine and chronic daily headache, everything under the sun, from magnesium to supplemental oxygen to DHE injections.


Magnesium, oxygen. Yes! Those are things worth trying. By themselves, with each other, and/or along with the traditional migraine cures of the ergot derivatives and triptans.

Once again aconymania strikes, so I have no clue as to what DHE is.

1 Lamotrigine mechanisms of action. Leach, Michael J., PhD, et al. Antiepileptic Drugs Fifth Edition
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
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#23 Maddy

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Posted 29 August 2007 - 10:51 AM

Once again aconymania strikes, so I have no clue as to what DHE is.

I'm not sure this is correct for DHE, but this is what I found:
http://www.headaches...ets/DHE_45.html

"DHE-45®

There is a form of ergotamine available for Injectable use under the trade name of D.H.E. 45, and by inhalation under the trade name of Migranal®. It is useful in the acute treatment of migraine and other vascular headaches such as cluster headache."
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#24 dymphna

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Posted 29 August 2007 - 11:26 AM

With something like this, it's a target moving within a black box. The black box is moving, too.

Can a constant headache go away? It has. Given enough people that falls under a new category of consistency of, "eventually goes away," subset of, "around only with dosage increases."



It's Schroedinger's anti-convulsant.





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#25 StrungOutOnLife

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Posted 29 August 2007 - 05:52 PM

Because this is a very common issue, I'm pinning it.
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#26 Silver

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Posted 29 August 2007 - 09:07 PM

DHE is, well, just what the link says it is. Thanks, Maddy!
It is a nasty, unpredictable little drug, with many contraindications, and (hey, it's ergot-derived) weird-ass serotonergic effects. Also, it's third-fourth line treatment for migraine and CDH, so I doubt Jessica would be visiting DHE-land any time soon.

Magnesium oxide, though, and supplemental O2... well, they're just, so, elemental.

Magnesium oxide on a daily basis is the one I've heard of most often, 1 neuro around here gives it for chronic daily HA and then additional prn dose for migraine; mag citrate is a dandy laxative, so not such a big hit for headache use. Some controversy re: which type of magnesium supplements to use. Much of that controversy... seems to be stirred up by supplement manufacturers; magnesium oxide appears well-enough absorbed, but some people like mag sulf, . It seems to have grade 'C-' evidence in migraine.

The supplemental O2 can be fantastic for acute flares of migraine superimposed on chronic daily headache. Some migraineurs love it.

Of course... Lamictal headache doesn't seem to be migrainous.

One other thought: Indocin.
Indomethacin works on some very specific types of headaches when nothing else does, including the other NSAIDs (even Toradol) in high and low doses.
Particularly hemicrania continua, which this isn't, but... argh. Long long discussion, the indo-headache thing, and I have to go impersonate a productive employee.
This is a yes-no drug. You know within 1-2 days (or doses) if it will work for headache.
If it is used long-term, 1) it's a NSAID, a burly big mean one, with all the attendant GI/cardio effects; 2) rebound headache can/will result.
But short term, it's gorgeous when it works.


And, after all that, there's still no answer to your question re: what is the etiology of lamotrigine-related headache. An astonishing paucity of information out there.

Older case report of felbamate-associated headache (in 1996) - our uni collection doesn't go back that far. Ettinger AB. Jandorf L. Berdia A. Andriola MR. Krupp LB. Weisbrot DM. Felbamate-induced headache. Epilepsia. 37(5):503-5, 1996 May.

I did find one case report of oxcarbazepine-associated headache - they just stopped the drug. [A Palmieri (2007) Oxcarbazepine-induced headache, Cephalalgia 27 (1), 91–93. ]
Borderline hyponatremia in that case, which is kinda the first thing I'd think if I heard "Trileptal" and "new headache," so not ground-breaking. (Gatorade again...)
So then I thought...
Hyponatremia isn't the most common ADR with lamotrigine. But, check it out:
Hyponatraemia associated with lamotrigine in cranial diabetes insipidus
L Mewasingh, S Aylett, F Kirkham, R Stanhope. The Lancet. London: Aug 19, 2000. Vol. 356, Iss. 9230; pg. 656
Note that these were kids who already had DI. So that is a big, huge, hairy confounding variable here. (Also, in neither case was the presenting symptom headache. Their parents were monitoring their desmopressin use, so they caught this very early.)
"We report the cases of two children with cranial diabetes insipidus who were treated with lamotrigine for seizures and who had accompanying changes in desmopressin requirements. Lamotrigine is a new anticonvulsant chemically unrelated to other existing antiepileptic drugs. Studies suggest it acts at voltage-sensitive sodium channels and also decreases calcium conductance. Both of these mechanisms of action are shared by carbamazepine, which can cause hyponatraemia secondary to inappropriate secretion of antidiuretic hormone. It is possible that the effect of lamotrigine on fluid balance in the cases described is also centrally mediated."

Still and all, if it persists and if you're getting a BMP drawn anyway, would be interesting to see what the sodium was (low or borderline low.)




Sorry. Headache is sort of an interest for me. Other people collect stamps. I'm intrigued by odd headache syndromes.
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#27 Jerod Poore

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Posted 30 August 2007 - 11:11 AM

Silver,

Magnesium oxide, though, and supplemental O2... well, they're just, so, elemental.


I should send you to the doghouse for that one.



One other thought: Indocin.
Indomethacin works on some very specific types of headaches when nothing else does, including the other NSAIDs (even Toradol) in high and low doses.
Particularly hemicrania continua, which this isn't, but... argh. Long long discussion, the indo-headache thing, and I have to go impersonate a productive employee.
This is a yes-no drug. You know within 1-2 days (or doses) if it will work for headache.
If it is used long-term, 1) it's a NSAID, a burly big mean one, with all the attendant GI/cardio effects; 2) rebound headache can/will result.
But short term, it's gorgeous when it works.


Ahem....

and with peptic ulcers, the NSAIDs are totally off the table.


I can tell you from close, second-hand experience that indomethacin practically eats through the stomach lining of anyone who doesn't follow the protocol of eating plenty before taking it, staying vertical for at least 30 minutes, and having a cast-iron stomach to start with.

And that rebound headache is a bitch. One has to be on top of its half-life with a stopwatch.

Other than all that it's a fantastic, often overlooked medication that will do wonders to relieve inflammations when nothing else works. Including headaches caused by inflammation.

Again I'd put this one way down on the list of things to try. Grasping at straws entries.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
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#28 Silver

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Posted 30 August 2007 - 08:09 PM

Ahem....

and with peptic ulcers, the NSAIDs are totally off the table.


I can tell you from close, second-hand experience that indomethacin practically eats through the stomach lining of anyone who doesn't follow the protocol of eating plenty before taking it, staying vertical for at least 30 minutes, and having a cast-iron stomach to start with.


Dammit, I knew I saw a CI in there somewhere, and I couldn't find it on reread. This is why I should not read and post at work. A thousand apologies. Can I plead Topamax?
But I love the stuff, nasty GI-phage that it is.
However, it's also way not cool with even medium (1.0) serum levels of lithium. So no indomethacin for me, either... although it is the only thing that worked for me for evil persistent post-lumbar-puncture headache. I had to ask for it specifically. 2 days of Indocin after 9 days of serious discomfort. I loved it as much as I loved Toradol for renal colic.

In my (weak) defense, I'll add - it can be used very short term for the management of hemicrania continua. Breaking out of the HC is the trick.
I'm reading and hearing variable things about LTG headache, as far as whether or not it returns once it's been relieved.
Haven't found any anecdata yet on mag ox or O2 for AED-associated headache. I'll keep asking.
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#29 In_Remission_anita

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Posted 19 September 2007 - 12:57 PM

About the Gatorade recommendation...I did try it for about a week. Found that it screwed with my blood sugar levels so much that I had to stop. And it didn't seem to relieve the issue. That was when I was titrating though, so since then my headaches/migraines are manageable. If it's a bad migraine I take Fiorinal and 1/2 Vicodin. Otherwise, an ice pack on my eyes does wonders.

Anita

#30 Bipolar Bear

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Posted 22 September 2007 - 11:15 PM

I was just put back on Lamictal and am dealing with this all over again. And it sucks big time. The Starter Pack should come with a row or two of painkillers.
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