....drug out yet that can control this pain, and not constrict blood vessels?

Question: ....drug out yet that can control this pain, and not constrict blood vessels?

Answer:

Full Question:

My life before trigeminal neuralgia in 1993 was great, but the pain from this terrible neuralgia was truly unbearable and almost lead to my suicide. Micro vascular decompression surgery on the trigeminal nerve gave almost complete relief, but left me with an extremely sensitive nerve and an occasional headache (which I had never had before and my family has not). Around the time when I turned fifty, and entered perimenopause and started having hot flashes, my bad migraines started. Most are a direct result of the hot flashes enlarging the blood vessels in my head, and setting off the pain peptides from this sensitive nerve (my research diagnosis). Our local neurologist is not a migraine expert, but he did a MRI about five years ago and found no real cause for the migraines. They can not understand the tie between the hot flashes and the migraines. All preventatives (anti-seizure, etc.) cause a worsening of the migraines, as does estrogen to stop the hot flashes. My only salvation has been the triptan drug Zomig, but I have to take it daily as a preventative (2.5 mg broken in half 2 times a day). I have high blood pressure that is controlled by metoprolol, but I always feel a tightness in my head probably from the Zomig. Is there a drug out yet that can control this pain, and not constrict the blood vessels in my brain? Is there an expert out there whose specialty is this sensitive nerve? Thanks for any help! Linda.

Answer:

Dear Linda;

Sometimes, 2 bad things co-exist at the same time. One of my professors used to say, "You can have fleas and you can have lice...." My guess is that you probably have not tried EVERY neuronal stabilizing agent that exists, and more are about to arrive. The latest ones are Keppra, Zonegran and Trileptal, as well as the forthcoming pregabalin. Perhaps seeking out a headache specialist who also is a pain management physician would be fruitful.

Good luck,
John Claude Krusz

Linda,

There is also a class of Migraine abortive in development that doesn't constrict the blood vessels as triptans do, but it's probably going to be several years before it's available. Personally, I'm quite anxious for it to come out since I can no longer take triptans because of heart disease. Here's an article with the latest info I have on this:

A New Class of Abortive Is in Development
Researchers in Europe and the United States are at work studying a new abortive medication for Migraine treatment. The drug, labeled BIBN4096 BS is a calcitonin gene-related peptide (CGRP) antagonist. Serum levels of CGRP are elevated in patients with cluster headaches and Migraine. Results of a first clinical trial are promising. Of special note is that this medication may be safe for patients with heart disease.

In the meantime, Dr. Krusz offered you great advice about prevention. Getting to a Migraine specialist made all the difference in the world to me. I'm actually getting nearly two months between Migraines now.

Best wishes,
Teri Robert

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