Case Summary  |  30 year history of migraines

I have suffered migraine headaches from the age of 7. They occur two to three times per week at their worst and one to two times per month at their best.

The migraines have always started with an over all felling a fatigue followed shortly (within 30 min) by an aura in the form of “shooting stars” in my peripheral vision. Within 30 seconds to 10 minutes after the visual aura an intense, throbbing and tearing pain with advice from the back of my skull in the area of the occipital lobe of the brain and advance like a wave through my entire head. The pain throbs and undulates; it causes photophobia (painful aversion to even dim light), phonophobia (sensitivity to sounds) as well as nausea.

I discovered by accident as a child (around age 8) that baby aspirin and caffeinated soft drinks eased the pain. PLEASE NOTE CHILDREN UNDER 18 YEARS SHOULD NEVER TAKE ASPRIN DUE TO THE RISK OF REYE SYNDROME.

From the age of 14 to 25 I used Excedrin - a combination over the counter pain reliever containing aspirin, acetaminophen (active ingredient in Tylenol) and caffeine.

I first spoke to a family doctor about the headaches at age 25. He was the first person to take me seriously and use the word “migraine”. He prescribed amitriptyline (a tricyclic antidepressant) as a once daily preventative. I would still use Excedrin as a rescue for my “break though” migraines. I used the daily amitriptyline and Excedrin rescue treatment plan until I married at age 29. I discovered the amitriptyline, as a tricyclic antidepressant was causing a mild sexual dysfunction. I stopped taking the tricyclic antidepressant under the care of my family doctor.

After a successful discontinuation of the amitriptyline I started taking a beta blocker for my daily migraine preventative treatment with Excedrin still as a break though rescue medication. I am a very fit runner with a blood pressure that runs about 100 over 68 to 110 0ver 70. The beta blocker caused a drop in my already low blood pressure (80 over 50) thus, the beta blockers where discontinued by the family doctor and I went the next 6 years without a daily preventive migraine treatment and suffered migraines three to four times per week.

At age 36 I saw my first migraine specialist. I was restarted on the amitriptyline but a much lower dose and replaced the Excedrin with a triptain class migraine rescue medication called Inmatrix. I did not tolerate the Inmatrix well and it did not help the migraine pain at all. The migraine specialist then recommended tramadol (Ultram) a non-narcotic pain reliever as my break though rescue medication.

The current treatment goal with the migraine specialist is to reduce my migraines to one per week. While I have not had several weeks in a row with only one migraine; I have had weeks where I have had only one migraine and I was able to treat it with the tramadol. I am 5 weeks into my new treatment plan and I see the migraine specialist next week for a 6 week follow-up.