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[CrispyChick]

Hi guys.

As I try to sort my hellish peri symptoms I can trigger migraines quite easily.

I use triptans.

But as I'm exploring different hormonal tools, I know I'll trigger migraines.

I believe there are some meds out there that work as prevention???  What is best?

I'm on a ssri so don't want amitriptyline. I already take high dose magnesium. It's just not enough.

Thanks

[CLKD]

I believe that earlier this year a new drug was approved for migraine treatments.  That as well as nose bleeds are two issues that I dread 

[CrispyChick]

Yes. I believe so. But as always, you need to have tried traditional treatments first. £££ I guess.

So I need to hear what more common treatments folks have success with.

[Mary G]

Crispy, if the migraines are hormone related then hormone manipulation is the first line of defence but if that stops working or is not possible, propranolol is next on the list but a high dose is usually needed - I take 200mg every day but you can go as high as 320mg.

After that a TCA antidepressant but if you don't want to switch ADs, the next step is to add in a calcium channel blocker.  After that you would need to look at anticonvulsant medication but hopefully the propranolol will work on its own.

[CrispyChick]

Thank you Mary.

Unfortunately it's hormonal manipulation that causes them.  But I need to try stuff fur the other hell.

So propranolol. You get on fine with it? Works well? I do have quite low blood pressure - so a bit concerned there...

What is a calcium channel blocker?? X

[Mary G]

Crispy, you might need to consult a hormonal migraine specialist because I'm not sure the average GP is clued up on migraine medication.

High dose propranolol works very well for me in combination with the calcium channel blocker (5mg) but they are both blood pressure lowering medications and might not be suitable for you.  How low is your blood pressure? 

You will probably have to go straight to anticonvulsant medication like topiramate but it does work well and is high up on the preventatives list. 

I found hormone manipulation alone worked for years but it suddenly stopped working a couple of years ago and the migraines returned, probably because of my slightly raised blood pressure. 

PS. I forgot to mention that untreated subclinical hypothyroidism can also cause hormonal migraines and it's important to take thyroxide (?) even if you are a borderline case.