Prophylactics or daily preventatives are where we wander into medication for other conditions on a just- in-case or you-never-know-it-might-work basis. And you can be lucky.
The most commonly used are beta blockers: propranolol, metoprolol and timolol, more normally used to treat angina and lower blood pressure. What they do for migraines is not clear, although it must involve troublesome blood vessels. Unfortunately, the first time I took propranolol my blood pressure plummeted, I felt as though I had weights in my legs and was constantly on the point of fainting. It was quite frightening and clearly not an option. At the time Lismore had a resident nurse (or indeed several) willing to help, even when off duty, and she quickly reassured me. My blood pressure was normally low anyway.
Then along came SSRIs, or selective serotonin reuptake inhibitors, the latest antidepressant being offered at a time. As triptans are described as working like the brain chemical serotonin, i.e. reversing the changes in the brain that cause migraines, it was no great leap to consider them when it was suggested. So, along with the rest of the world, I took citalopram on the basis that my migraines maybe something to do with serotonin reuptake problems.
I have no idea whether or not I was better with them, but I certainly smiled more and I already smiled a lot. I also felt as though I were seeing life through a window, not a glass darkly, but at one remove. So, after some time and with no obvious improvement, I decided to come off them. That’s when the fun started. Neurological fireworks is the only way I can describe the strange and alarming electrical storm in my head that went on for days, even though I cut them down painstakingly slowly as advised, halving them, then halving the halves and so on. Eventually the fireworks stopped. Everything stops in the end, which is the most consoling part of the human condition.
Despite this I was persuaded to try a much older antidepressant, amitriptyline, a tricyclic said to help chemicals in the brain that may have become unbalanced. Clearly mine are not just unbalanced but often haywire. This is a commonly prescribed drug and everyone knows someone who has had it at some point. It had the effect of giving me good sleeps, which means I am always likely to get fewer migraines. After years of waking up and concerned husband asking: ‘How’s your head?’ it seemed helpful. Unfortunately I had to stop it when I experienced unacceptable facial spasms which went away once I was off it. However, I had tolerated it for a few years and for that I was grateful. I briefly tried dosulepin, another tricyclic, but the tics returned.
I may have an inconvenient condition, but my reactive body often rescues me. I know I could never be poisoned via my stomach, as antiperistalsis easily kicks in.
Then there was Sandomigran (pizotifen). This has been around for a while but I had avoided it because it was said to make a body fat and sleepy. It’s one thing having a three-day week, quite another becoming large and sleepy even when ‘well’. However, in a moment of active desperation, I was persuaded to give it a go and certainly, to start with, I did not gain weight or feel sleepy. Neither did I have fewer migraines but, because eventually I did gain weight and develop facial tics, I abandoned it. Tics to the rescue again.
Some researchers believe epilepsy and migraine share some of the same traits, although it’s not entirely understood why or how that’s the case. Topiramate is a synthetic anticonvulsant most commonly prescribed for the treatment of epilepsy, bipolar disorder and sometimes migraine. It works by reducing bursts of electrical activity in your brain and restoring the normal balance of nerve activity.
Sodium valproate has also been thought to help prevent migraine. However it is not as commonly offered, as it can cause problems for a baby’s development, including birth defects and long-term learning difficulties. For this reason, it is not recommended for those of child-bearing age.
I was never tempted by either of these anticonvulsants.