Menstrual Migraines... Tylenol... Prozac?

Question: Menstrual Migraines... Tylenol... Prozac?

Answer:

Full Question:

I have suffered with headaches for about 10 -12 years. I am 38 now, still with a very regular cycle. My headaches are always on the same side, back of my head and neck on the left side. Never any where else. I do not get auras or any symptoms before I actually get the headache. I am light sensitive and movement of my head or bending over is pretty rough and causes a lot more pain for me. I see my internal medicine (Primary Care regularly for these. I have seen a Neurologist who states that they are perimenstrual headaches and really all you can do for them is treat the symptoms. I have also had an MRI, CT Scan, EEG and x-rays to make sure there was nothing else wrong. All negative.

I take Tylenol #3 about two days before my cycle starts and pretty much for about 4-5 days after trying to prevent the headache from coming. I will also take it a day or so when I ovulate. These are my two bad times of the month. If my medication doesn't help, I go to my doctor's office and get a Nubain/Phenergan shot which usually works. This is the only thing I have found to work VERY WELL. This month I got severe headaches at both times during the month. The headaches are really bad when they hit. This month my doc put me on a new treatment, the Vivelle estrogen patch. It has worked really well until now. I took the patch off last night and already today I can feel the tightness coming in the back of my neck. I have tried many other medications; Imitrex, Amerge, Vicoprofen, Panlor SS - Tylenol seems to work better.

Years ago when I first started with headaches it was when I was on the birth control pill. I would get the headaches when I was on the placebo days, always. So, my OB/GYN took me off of the pill. I was really hoping that would be the cure but, it didn't. I have been off the pill for about 4 years.

Do you have any suggestions? I am really suffering and really don't feel I should have to. At one time another doctor put me on Prozac 20. I did not like that at all, I was like a ZOMBIE. I am really uneasy about being on Prozac also without having depression. I do not have a lot of tension in my life at least that I am aware of. I would love any suggestions that you may have. Great appreciation to you for understanding, Chrissy.

Answer:

Dear Chrissy:

It's not unusual at all for women to have menstrually associated Migraines. Sometimes, hormone therapy such as birth control pills will help; sometimes, not. It all depends on the individual Migraineur. You mention Imitrex and Amerge, but there are now seven medications in the triptan family. It would be well worth it to try some of the others to see if they would help you. Here's information about them:

Triptans: Overview and Profiles
In 1992, the FDA approved the first of a class of medications that many Migraineurs call "miracle drugs." That drug was sumatriptan (Imitrex®, Imigran®), the first triptan. Here are both general information on triptans and detailed profiles of each.

While it's great that Tylenol helps you, there's another problem with taking it as many consecutive days as you describe -- the potential for rebound headaches. One of the newer triptans has been used as a preventive around the time of a woman's cycle with good success:

Frova for Menstrually Associated Migraine
Two studies presented at the annual meeting of the American Headache Society showed that Frova (frovatriptan) is effective as a preventive medication for menstrually Associated Migraine. Frova does not seem to induce rebound headaches. It's efficacy is not affected by the use of oral contraceptives.

Your doctor probably prescribed the Prozac as a Migraine preventive. Some antidepressants work very well as preventives for Migraineurs. It can, however, take some trial and error to find which preventive meds work best for you. One thing to realize is that Migraines aren't exactly headaches. Migraine is a genetic neurological disease that has flare ups or attacks when we encounter triggers. The headache is just one symptom of a Migraine, and not everyone even experiences the headache. With your description of your situation, preventive medications seem a reasonable option. If you and your doctor aren't making progress, you may want to seek the care of an actual Migraine specialist. There's a link to our directory of recommended specialists below.

Good luck,
Teri Robert and John Claude Krusz

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