When is it Time to Use Migraine Preventive Medication?

When is it time to use Migraine preventive medications?  It has been a difficult decision for me, as it may be for many of you.  There are clear medical guidelines, and recent research that backs them up.  And yet it is not an easy step to take.

3 or more Migraine attacks per month

Headache specialists will generally prescribe Migraine preventives if you have 3 or more Migraine attacks per month.  My HA doctor told me his guideline is one per week, on average (which sounds very much like 3 or more per month).  If you think about it, a Migraine every week, or nearly every week, is a threshold level for having a serious disabling impact on your life.   Every week you will lose hours or a day or more to pain, photophobia, nausea, whatever package of symptoms you tend to have.  You will miss work, family time, social time.  You will waste hours in a darkened room.

Silent Brain Damage

There's more to it than the impact on our daily lives.  Recent research shows that Migraine attacks at a frequency of 3 or more per month, over an extended period of time, leads to brain damage.  The evidence is now very strong that Migraine is a progressive brain disease; it worsens over time.  The more frequent, and longer time since onset of Migraine attacks, the greater risk of damage.  The damage shows up as lesions in the white matter of the brain.  The researchers called it "silent brain damage" because there are no known effects of this damage - yet. 

Teri Robert, author of Living Well with Migraine Disease and Headaches, discussed the implications of this research in her recent article on My Migraine Connection,  "Yes, Migraines can Cause Brain Damage."  Teri gives us an excellent explanation of the research, concluding that:

Migraineurs who experience frequent Migraine attacks and / or have a long history of Migraines are at increased risk of "silent brain damage," brain damage that (so far) does not seem to cause any symptoms. This again shows that reducing the frequency of Migraine attacks (aka Migraine headaches) is critical. 

So why wouldn't you go on preventives?

I have averaged 7 Migraine attacks per month for the last 9 months.  I have been considering preventive medication for the last 8 months.  My hesitation comes from:

• a reluctance to take strong medications that will affect my central nervous system. 
• a history of being sensitive to medications and their side effects.
• a desire to take a natural approach to caring for my health.
• the fact that I had a 50% reduction in Migraines a few years ago from regular relaxation practice.
• the fact that there are no medications that were developed specifically for Migraine prevention, which seems to often lead to the need to try many different medications to find the one (or combination) that works for a particular person.
• the sense that it's easier to deal with the devil I know (Migraine attacks) than the devil I know not of (medications and their side effects).

I suspect that many of you who are reluctant to try preventives have some of the same reasons.  Please do leave a comment to share your thinking.

I will be starting preventive medication in less than two weeks when I next see my headache specialist.  I believe in a holistic approach to dealing with Migraines, including (among other things)  relaxation, meditation, rest, exercise, physical therapy, massage, diet, trigger-avoidance, and appropriate use of medications.   At this point, preventive medication is appropriate!  I need to stop losing 6 - 9 days a month to Migraines. 

I have my hesitations about the "better living by chemistry" theory.  I think there are inherent conflicts involved in our pharmaceutical production being governed by a profit motive.  However, that does not mean that drugs don't save lives and prevent or mitigate disability.  We need drugs available, and we need much better choices in drugs than we have now.  Holistic approaches can reduce Migraine frequency, they can help, but cannot change our inherent neurological make-up.  I use supplements and diet to care for my overall health, but if I got appendicitis you bet I would go willingly to that surgeon.  Knowing that I am at risk of brain damage, you bet I will take the drugs that reduce that risk. 

- Megan Oltman
Embarking on the pharmaceutical unknown.  Wish me luck!

                         Pill image courtesy of [O*] 'BharaT; brain image courtesy of Gaetan Lee.

We’ve moved! For more on managing life with migraine please visit us at www.freemybrain.com

Comments

[Christy]

Hi Megan, I always enjoy reading your very informative blog. Since you asked for comments: I have 3 to 10 migraines a month. There seems to be a long-term cycle to them that is not related to the seasons or anything that I can identify. When I'm in the bad part of the cycle, I start thinking I need a preventative, but then the migraines gradually become less frequent by themselves and, for all the reasons you listed, I have no desire to start experimenting with pills. I did try Topamax for one week, but it was disastrous and I became suicidally depressed within a few days, and also too confused mentally to pick up the phone and tell the doctor what was happening. This experience reinforced my reluctance to give anything else a try. I mean it frightened me so badly I refuse to try anything! And, after 45 years of migraines my brain is probably already one big lesion. If I were younger it would be a more difficult decision.

[Megan Oltman]

Hi Christy - Thanks for sharing your experiences. I get the impression that most people can find a preventive regimen that works for them, but it may take a lot of tries. I certainly understand your reluctance! I hope at least you have effective abortive options. Wishing you more pain-free days than not!
- Megan

[Laura]

Hi Megan - I just came across your blog today and am glad I found it. I'm 49 years old and somewhat new to the whole migraine world (about 2 1/2 years)- they seem to definitely be related to my ever fluctuating hormones. I started Topamax about 10 days ago and have a couple of small side effects so far (tingling fingers, coke taste flat, etc) but so far none of the horrible side effects some people report and most importantly NO migraines. I've read both the horror stories and the success stories with the preventives (especially Topamax) and will be interested to see what you think when and if you try them. Good luck!

[Megan Oltman]

Hi Laura - I'm glad you found the blog, and glad to hear your experience with Topamax. 10 days without Migraines is good news! I do suspect that more people write about their bad experiences than their good ones, so the on line consensus may be a little slanted that way. I'll be sure to come back and share my experience, good, bad or indifferent.