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Transformed Migraine
You ask. Our headache experts answer.
I am having trouble keeping my migraine headaches under control. I have been a lifelong migraineur. I am 51 years old (my migraines began
when I was age 6), and I am the patient of an
excellent neurologist, who, fortunately for me, also
happens to be a headache specialist.
Three years ago, my migraines changed: they
became more frequent, more painful, and more
difficult to manage. My neurologist diagnosed this
new direction in head pain as a “transformed migraine.” Initially, one daily 25 mg. dose of amitriptyline HCL blissfully relieved all of my transformed
migraine difficulties. Unfortunately, over the past
three years, my transformed migraines have gradually outmaneuvered every attempt to keep them
under control. I have steadily progressed from 1 to
2 to 3 amitriptyline HCL tablets per day. When my
headaches began to break through with greater
frequency and intensity, my neurologist also prescribed two daily 80 mg. doses of propranolol.
During September, 2014, my migraines once
again became very assertive. The preventative
medicines (the daily 3x25mg. amitriptyline, and
2x80mg propranolol) that I am taking became
progressively less effective: I began having weekly
and then daily breakthrough headaches. In December, 2014, my neurologist prescribed a treatment
of Botox in an attempt to alleviate my transformed
migraine symptoms. The Botox seemed to blunt
the breakthrough migraines for a short while, but,
between December, 2014, and January, 17,
2015. I have begun to experience breakthrough
headaches on practically a daily basis.
I am using all of the experience that I have accumulated over a lifetime to keep my headache
pain under control (avoiding all known triggers:
alcohol, chocolate, weariness, stress, but I seem to
be steadily losing ground in my effort to keep my
migraines under control. I fear that, in the not too
distant future, I will wake up one morning with an
incapacitating headache and be unable to reduce,
much less eliminate, the nauseating pain. That is
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HeadW ise ®
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Volume 4, Issue 3 • 2015
not an event that I look forward to, and I would like to
do everything in my power to bring my migraines
under control before that day arrives. – Tim
“Many patients with migraine find they enter cycles of
increased headache activity. In the general population,
the chance of “transforming” from episodic migraine
(<15 days per month) to chronic migraine (15 or more
days per month) is approximately 3% each year. Sometimes, such transformation is triggered by an external
event, such as a major life stressor, or by an internal issue, such as hormonal changes with menopause. Many
tim \