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Are you struggling with migraines? Maybe you haven’t tried everything you possibly can…

September 24, 2009

Migraines–wow, my head hurts just saying the word. It’s like a mantel I wear around my neck, and obviously not in a proud way. I have been dealing with headaches for, let’s see–hmmm–not quite 1/2 of my life. (I got a few growing up, but they really started in earnest in my mid-20s and I’m now 45.) For the uninitiated, migraines (for me) are not like a niggling little headache where I can take a few Tylenol and keep on going; this is like a crushing, whole head, throbbing, pulsing, I want to just take off my head and set it on the shelf it hurts so bad kind of pain. I become sensitive to light, sound, noise especially (ask my husband). I do not usually throw up (thank the Lord for small favors) though I can become nauseous. I usually do not experience an aura (seeing black spots, worsening vision in one or both eyes, dizziness), though it has happened–and that usually means I am in for a doozie. They were always worse when flow came to town–sooo much worse. I did not have a single migraine during either of my pregnancies, which was HEAVEN. Though they returned within a few weeks after giving birth, darn it. However, that was clearly a clue that my migraines where hormone-related.

I have seen, oh, at least 6-8 neurologists over the years, many with “headache treatment centers.” I’ve tried many different regimens, including non-traditional and eastern treatments. Nothing worked. I’ve changed my diet. I’ve exercised. I’ve done acupuncture and chiropractic, massage. Nada.

(Note-I feel I should reiterate here that I am a recovering pharmaceutical representative. That gave me entre into many specialty offices that most patients might normally not have access to. That said, I still have migraines.)

So here’s where I’m at today: Through my wonderful, fabulous, incredible endocrinologist, Jannet Huang, M.D., in Irvine, CA, I have found the coolest dude and all-around great doc, Kenneth Martinez, M.D. He has a website if you want to check it out here: After many years of pain, to the point where I was getting EPIDURALS, I now have RELIEF. YES, RELIEF.

I was already taking a few things which I will cover below…Dr. Martinez added two key meds that literally have changed my life.

1–The CLIMARA PATCH (0.025 mg) applied once weekly to my ass. Sooo attractive but you know what? I don’t care–from the minute I put that patch on my body, my headaches were literally gone. A wonderful side effect is that my periods have stopped also–yay me! (Because of taking unopposed estrogen, even at such a low dose, I am seeing my GYN more often due to possible build-up of my endometrial lining–so far so good. As far as I’m concerned, totally worth the risk.) [In a large study published in The Lancet Scarabin et al.[2] compared effects of oral vs. transdermal skin patch estrogen (mainly estradiol-17 beta, the “bioidentical” human estrogen) and found that the oral route was associated with a 3-fold increase in risk of venous clotting disease (thrombophlebitis, pulmonary embolus), whereas the skin patch produced no excess risk. This difference was likely due to the fact that transdermal estrogens are absorbed directly into the bloodstream, while oral estrogens are processed and changed by the liver before release into the blood stream.] So, long story short, even though I’m NOT menopausal, I’m taking this patch to even out my estrogen levels, which can be one of the primary reasons most women get migraines. Taking the pill is a MUCH higher dose and carries much higher risks and side effects for the purposes I need it for.

2–PERIACTIN (4 mg) Now THIS one kind of threw me for a loop. Periactin is an old antihistamine…yea, you heard that right. An antihistamine. Dr. Martinez put me on one 4mg pill at night, then titrated me up to 1 and 1/2 (6mg). He told me to either stop there if I got relief, or go up to 2 pills (8mg) if I still had headaches. Of course you take it at night because it makes you sleepy, which is nice because you have to go to sleep anyway…this just helps you along. But why in the heck does it help with headaches? Well, he tried to explain it to me; like I said, I was a pharma rep; I have some knowledge of PIs (prescribing information–the little white folded up things that come with your meds that you throw away) & stuff, but anything brain? forgeddaboutit. So, for those of you more technical, here’s the explanation about seratonin and you know, stuff:

“Cyproheptadine (PERIACTIN) is an anti-cholinergic that is also competes with serotonin at receptor sites in smooth muscle in the intestines and other locations. Antagonism of serotonin on the appetite center of the hypothalamus may account for cyproheptadine’s ability to stimulate appetite. Cyproheptadine also has been used to counter vascular headaches, which many believe are caused by changes in serotonin activity. It is unclear how cyproheptadine, a serotonin-receptor antagonist, exerts a beneficial effect on this condition, since sumatriptan, a newer agent specifically indicated for treating migraine, acts as an agonist at serotonin receptors.” Phew!

(For the record, I have actually LOST quite a bit of weight on this regimen even though apparently the Periactin stimulates the appetite. I credit this to the fact that I FEEL so much better that I get out and do stuff and therefore burn a lot more calories.)

Now, I have to add that I was already taking TOPAMAX 200mg twice/day and that hasn’t changed (which has the wonderful side effect of suppressing your appetite BTW). In addition to that, Dr. Martinez does clinical BOTOX injections–this is where he injects it directly into my head and neck, which hurts like a mother but helps a heck of a lot. I’ve had the injections done twice–they last about 4-5 months and have given me such AMAZING muscular relief. (I have some involvement in the sub occipital area and lower neck from an accident.) Usually Botox used in this manner will be covered FULLY by insurance if it’s not written up for migraines only which is still considered experimental (don’t even get me started)…but for torticollis (neck pain, muscular movement disorder) most insurance companies will cover it.

For actual migraine episodes, I take RELPAX. I don’t get any of the weird side effects common to Imitrex (tight feeling in my throat, feeling of pressure of tightness, sensitivity to hot temperatures) with it and it’s covered by my insurance. I also take Butterbur (a natural supplement) which has actually been studied in a great study and shown to be effective in preventing migraines. Here’s the link:

Here’s a great link that gives you additional information on how to prevent migraines naturally: For an amazingly well-researched book written by neurologist and migrainer himself, check out “MIGRAINE” by Dr. Oliver Sacks (available at Brilliant.

Obviously I have known diet and lifestyle factors that I think most migrainers already know to avoid: red wine (which I still love and drink anyway!), aged cheese (ditto), stress, meats with nitrates (which I don’t really like anyway). If you are a reader of my blog, you know that I had to cut sugar out of my diet due to insulin resistance, so lots of fresh veges, fruits and fish make up my primary diet.

My final word I guess is this: despite having dealt with headaches for so many years, they don’t DEFINE me. And as one wonderful female endocrinologist told me, unlike other diseases, there are NO known long-term effects of having migraines. You have one, it’s over, you move on.

I love that.

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