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Dr. Krusz is a recognized expert in the fields of
headache and Migraine treatment and pain treatment
To read more about Dr. Krusz, click HERE.

Please Note: We receive far more questions than can be answered in this format. In many cases, our Guide, Teri Robert, has already researched the topic of the question and may have information already published on this site. Some questions answered here will be answered by Teri. Dr. Krusz will be reviewing her answers before they're posted to see if he can offer additional input.
I am forty-eight with no children. I've had chronic migraines my entire life as well as chronic fatigue. At this point I just started Provigil 20 mg a day which greatly helps my fatigue. I take Maxalt 10 mg sublingual with 2 Advil every 12-18 hours which is when I begin to feel I'm going to get ill with pain if I don't. This really works!!! But, I'm concerned that I am in this pattern now for about the last 3 weeks with the Maxalt and Advil and am afraid I'm in rebound but don't know how to stop without provoking a physical reality that makes me want to not be living in this body. I've been seeing a neurologist to try to find a prophylactic treatment for the migraines. So far I have tried Botox injections, and Depakote and Topamax none of which helped. My doctor has not tried me on beta blockers as he fears it will make me more tired with my chronic fatigue, so he gave me a prescription for Amitriptyline. I just had a psychiatric consult and the psychiatrist thought I'd be better off trying the beta blocker. He is not keen on amitriptyline side effects. Being that I am doing well on the Provigil, which do you think might be a better choice, amitriptyline or Inderal? Also, if I am in a rebound cycle with the Maxalt and Advil, will they still be able to work as prophylactics? Bless you for your input.

Dear Sandra:
I'm somewhat confused. You describe good results with Maxalt and Advil. There may be some downsides to the latter and I prefer Vioxx or Bextra as they don't have harmful effects on your stomach lining like Advil can. There are many more agents in the anticonvulsant family that can have good effects on a migraine pattern. I don't like beta blockers or amitriptyline for primary headache management. ProVigil is neutral in this whole equation. What is your sleep pattern like? If not satisfactory, making a better sleep pattern can go a long way to helping a headache pattern. My guess is you might need to consult a headache expert in your area.
John Claude Krusz


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