HeadWise Volume 4, Issue 3 | Page 10

reader mail 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 10 HeadW ise ® | 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 \