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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64704
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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There I get severe migraine which lasts two weeks

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Hi there I get severe migraine which lasts for around two weeks and was having them every month. I am having Botox which has slowed it down to once every two months but unfortunately I had them in quick succession so my migraine lasts a month. I'm on 125mg dosulepin. I've had flunarazine sumitriptan but I'm still having them. Any advice would be welcome. Thank you
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Phil, MD replied 1 year ago.
I would try topamax daily as a preventative.It works very wellStart at 50 mg and increase by 25 mg per week until controlled
Expert:  DrRussMD replied 1 year ago.
HelloI have a different answer for you.In fact, dosulepin is a tri cyclic anti-depressant.It would have major and potentially very dangerous interactions with topamax.Selection of a preventative medication must be individualized.For example, there are newer antidepressant type medications that prevent migraine [effexor, as opposed to most SSRIs which have not been so helpful].A beta blocker is more indicated in some people.Sometimes a calcium channel blocker.Sometimes a drug like topamax.Here is a mayo clinic rundown on these drugs:http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358 This must be based on the selection by a migraine expert, who knows your entire history and the nature of your migraines.Treatment is not one size fits all.There are also preventative measures:See this mayo page:http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/prevention/con-20026358In addition, studies have indicated a magnesium deficiency problem in those with migraines. 50% of patients will respond to magnesium replacement. In those who have mitral valve prolapse, 90%. Nutritional considerations are therefore also important. Including diet, avoiding foods that trigger the migraine. IN alternative medicine, acupuncture has helped a lot of migraine patients acutely.Biofeedback has also been shown to be effective in clinical trials. OK, so that is an initial answer….Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, I was suggesting that you use topamax instead of your current medication
This would obviously need to be discussed with your doctor
A CAT scan or MRI might be needed to rule out other issues given that your headaches have changed
Expert:  DrRussMD replied 1 year ago.
HelloThis is the expert who gave you the extensive answer above.Topamax is an anti-seizure medication that can help with migraines.It is one of many.I see no indication for an MRI, as you have no exam findings you state that indicate this need. That is something to discuss with your doctor.That would not simply be done because you have a few more migraines.See also these lifestyle interventions.http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/lifestyle-home-remedies/con-20026358 Find me in medical any day, by request.Please click a positive rating on my answer page [see the top] if you appreciate my extensive answer above, and my follow up.I would be glad to go more into integrative medicine on another post.Good luck.dt