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I have been struggling with migraines for several years. I…

Hello, I have been...

Hello, I have been struggling with migraines for several years. I was taking Topirmate 75mg for them. I had started at 25mg but the doctor would just increase the dosage each time i went back due to the medication not helping. What do you think i should do next?

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

I would say it is episodic. But occasionally it can be daily. Last week i was at softball practice and threw up 3 times due to the migraine. I usually feel nauseous with them.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

When i was younger, i would see different colors. I saw my little cousin with a bright pink face and my grandmother minutes after with a deep blue face. My pediatrician had done some tests but could not find anything. I had an MRI done when i was younger due to my headaches and being nauseous with them. They also could not find anything. They have gotten extremely worse over the years. I mostly get them in the spring, summer, and fall. i get them in the winter also but those ones are tolerable.

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Answered in 29 minutes by:
4/20/2018
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,839
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer. This is Dr. Love.

The next step is to increase the dose of topiramate to 100 mg daily. The recommended dosing when using topiramate is to start at 25 mg per day and if necessary, increase in increments of 25 mg until 100 mg daily is reached.

However, if the 100 mg daily dose of topiramate is not effective, there are also a number of other medicines that can be used for prevention of migraines (also called prophylaxis of migraines). Have you been tried on any other migraine preventive medicines in the past?

Do you have any other medical problems?

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Customer reply replied 4 months ago
I was prescribed 600mg Ibuprofen before. I have been taking topiramate for almost 2 years and i do not feel like that it would help upping the dosage. I was kinda trying to find something else to try since none of the dosages have been effective. For being a 16 year old teenager, these migraines really take a tole on my school work, being social able, and just doing simple activities.
Customer reply replied 4 months ago
My sister also has very hard times with her migraines since she was little also. She has been prescribed several different medications, botox injections, and needle injections in the base of the neck. they have yet to find what causes it still and shes 24. They did mention that it is genetic. I kinda worry that i may have gotten the gene.
Customer reply replied 4 months ago
i have found myself snapping at people and having very bad attitudes with these. I know they are from the migraines because that is mostly when i feel the need to do it. I apologize for sending multiples messages at a time.

If you have not yet been tried on any other medicines and you do not have any other medical problems, the usual next medicine that I would try as a preventive medicine would be a beta-blocker, such as metoprolol. Metoprolol (and other beta-blockers) is primarily manufactured for heart disease and high blood pressure, but it also helps prevent migraines.

There are several other beta-blockers that have been shown to help prevent migraines, such as propranolol and timolol. There also are some medicines that are on the market for depression, such as amitriptyline, that may prevent migraines in many people. In addition to the topiramate, there are other seizure medicines that can help prevent migraines, such as valproic acid.

There is no preventive medicine that works for everybody with migraines, so the usual approach is to try different medicines until the medicine that works for you is found. If someone has another medical problem, and we can treat two problems with one medicine, that may guide medicine selection, but if there are no other medical problems, then the various medicines are about equivalent in which to try first, so you may get a different choice from different doctors.

Botox is usually not considered until several different oral preventive medicines have been tried and not been sufficiently effective.

We cannot find what causes migraine headaches in most people, although yes, there is an increased risk in someone with a positive family history.

If I can provide any additional information, please let me know.

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,839
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer reply replied 4 months ago
Thank you so much, i will take this into consideration. I will let you know if i have any additional questions.

You are very welcome.

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