Topamax and poly-drug use.. questions!?

Wow, she's really throwing out the scripts! To be fair 7 years of constant pressure is a long time, so she's treating it aggressively.

It sounds like she is hitting it from every possible angle. Anti-inflammatory (steroid), muscle relaxant, a first line preventative and an abortive.

Compazine is an interesting choice. Do you get extremely nauseous, aside from car sickness?

You're right, starting three meds at once is a lot. The topamax probably won't work as a preventative until you get up to effective does (ie after you have finished with your steroid and muscle relaxant).

What's your titration schedule for topamax? It has a reputation as being one of those few drugs that people either really love or hate. Either way, I've heard that it usually involves some getting used to. It takes time for your body to adjust.

The grainy vision sounds like a minor case of Visual Snow. It can be migraine related. I used to get it when I took zoloft. Maybe a side effect of the paxil?

Whenever I'm concerned about potential interactions I go to drugs.com and use the interaction checker. It's free. I find that whoever created the site is very cautious. I.e. if there is ANY potential for an interaction, they list it. As a result I will use it as a resource, but rely more heavily on my physician and pharmacist for a more realistic appraisal.

That's exactly it. The skelaxin and medrol are being used to accomplish the same goal, just via different mechanisms. The skelaxin or medrol may or may not work on their own. She is probably thinking that combined, there is a better chance that the additive effects will make the difference and provide relief.

Migraine is difficult to design a preventative medication for (because you can't use animal models). You really can't ask a mouse if it is having a migraine and their is no way to quantify the pain it is experiencing. As a result, many of the medications used for migraine were originally designed to be used for other conditions. Over time people have found these meds to be helpful at preventing migraines. Topamax is one such example. It was designed to be an anti-epilepsy drug.

When you take it your body adjusts. If you withdrawl to quickly, your body doesn't have time to readjust and so you risk having a seizure. If you decide to come off of the med, follow your doctors advice and come off slowly. If you taper down slowly enough, there is very little chance of having a seizure. The same is true of SSRI's (eg paxil). If you suddenly stopped taking it, within a few days you will be in for a world of anxiety (I've been there... not fun).

Increasing 25mg/week is the standard titration schedule that most neurologists use. I wouldn't recommend going any faster than that. I'm going to start this med very soon and may even go slower... we'll see. FYI be sure to stay VERY well hydrated (this helps to avoid kidney stones). I'm planning on drinking water at least every two hours (i'll set my cell phone alarm to remind me).

Best of luck!

Post Edited (EvilFluorescents) : 2/17/2011 12:35:17 PM (GMT-7)

Hi Batman,

I wouldn't think that there would be interactions per se, but caffeine is a diaretic and so ingesting large amounts of it along with something that has the potential to cause kidney stones is probably not the best idea.

How much caffeine do you ingest (how much coffee, tea, etc.) per day? How long have you been doing this? Taken occasionally caffeine can help to abort a mild migraine/headache. But just like OTC and prescription pain pills, when taken long term, caffeine can cause rebound headaches. If you are experiencing rebound headaches, you won't be able to successfully treat the migraines until you've withdrawn from the caffeine. It's not a fun process, but it has to be done. I would talk to your neuro and see if she thinks you may be having caffeine induced rebound headaches.

Best of luck!

Post Edited (EvilFluorescents) : 2/17/2011 11:55:14 PM (GMT-7)

Hi Batman,

Nope, caffeine can cause rebound headache. That mild thumping headache you feel is the beginning of caffeine withdrawl (it gets worse... then it gets better). If your doctor hasn't mentioned it, I would look into going to a headache specialist. Get on their waitlist now.

Us migraineurs/headache-y individuals are different than the rest of caffeine addicted america. We have "migraine brain." Unfortunately, this makes us susceptible to rebound headache.

Can the rebound headache last 24/7 for seven years? I don't know... I'm phobic about taking loads of things that can cause rebound headache and so haven't gone down that path myself. For an answer you will have to talk to a headache specialist. At the very least rebound headache will make your condition worse and more treatment resistant. BUT I am not a doctor and am not saying you have rebound headache. I'm only saying the conditions are there that could lead to it. Talk to a headache specialist.

I really feel for you. It would be incredibly hard to come off of something that you absolutely depend on. Especially so if it is so helpful for your anhedonia.

A lot of us migraineurs are VERY sensitive to medications... much more so than the general population. I wonder if you would find doing a very SLOW titration onto stimulant based ADD drugs to be helpful (just make sure it doesn't make the migraines worse).

I'm not too well versed in ADD drugs and I do not mean to sound like an ignoramous or insensitive (so please don't take it this way), but have you tried some of the non-stimulant drugs like strattera (sometimes used to treat migraine)? There are also some second and third line drugs out there like tricyclics (also used for migraine and at higher doses anxiety/depression) and intuvin (also used to treat high blood pressure).

Lyrica is used for pain (including migraine), general anxiety disorder, and can help some with ADD (though not anywhere near as effective as a true ADD drug, it does provide a little extra concentration help). The only draw back is that it can be a little activating (maybe taking it in the morning and late afternoon would be a good option).

Lots of food for thought I know. Best of luck!

Post Edited (EvilFluorescents) : 2/18/2011 10:58:00 PM (GMT-7)

Well EvilF you've certainly provided far more information than I could have expected.  Kudos to you.

What really strikes me is the idea that migraine-prone people are sensitive to drugs.  I know I've always been sensitive to drugs, whether my headache is a migraine or not.  I did have a period of drug addiction a while ago--amphetamines used for ADD in fact, highly addictive--and that's exactly what set-off this "head pressure" to begin with.  However, during that time, there was a lot of other possible aggravating factors: excessive sleep deprivation, multiple panic attacks, poor posture, and an all-around unhealthy lifestyle.

I've been sober and healthy for six straight years, however, and the head pressure hasn't decreased, in fact it's only gotten worse gradually.

I *did* hide this information about addiction from my neurologist.  However--and this is an important fact--I never hid it from my psychiatrist.  My psychiatrist once suggested the same drug the neuro is prescribing--Topamax--and I take that as a sign that the treatment would probably be the same.

I'm surprised no one else besides you has anything to add here, though...?

I just picked up the prescriptions today.  Looking at the package inserts for all 3 of them, it really hit me how scary all of this is.  It's just too many pills to take for the first six days.

Do you think it would be okay if I slightly modified the plan.. instead of taking 3 different meds for six days.. just to take two?  Just Medrol and Topamax... and I'll try the Skelaxin later on?  If I was to follow her plan to the letter, I'd have 3 drugs that cause drowsiness in my system (Paxil, Topamax, Skelaxin), who knows what that would do to me.  Probably I wouldn't be able to stay awake for more than 7 hours of the day, and I'd be useless from all that "zombification."  That doesn't even factor in additional side effects.

Do neurologists even consider the well-being of their patients when prescribing drugs?

I know no one here is qualified to give me advice.. but I just want your thoughts about this?

Hope it's okay to jump in here. I'm new to this forum and had been hanging out in the Lupus forum because of my best friend Kait. But wanted to come over here given I've been having migraines and wanted to see about anything on Topamax. I've been taking topamax a good while here. Don't remember how long now, I'm up to 400 mg. I can take Maxalt 10 mg as needed. I haven't seen my neurologist in a while, but I do need to make an appointment to go back soon and with the weather as it has been, I have had to postpone. Hopefully I will be able to go back soon. I have had my classic MRI, X-Ray's, and basic check up with bloodwork done. I haven't had the lights or color tests done. I wish she would, so we could get to the bottom of what types of migraines I have for sure. I do take Topamax and Maxalt for sure. The only other medicine I am on is Wellbutrin. Since I am not able to see my neuro right now, my pysch doctor has taken over the medicine prescriptions because she said the Topamax is also used for mental illness in some cases and she says it can help with balancing out my system in conjunction with the Wellbutrin. Score!!

I have been on Skelaxin before and I didn't find it worked, but I do have arthritis in my upper neck and back, which was found in the x-rays. So who knows how long I have had the arthritis. I can understand the car sickness. I can't answer about the SSRI's because I am allergic to SSRI's, no joke. Paxil - I am very allergic too. Made me so suicidal it's not funny. I told the docs within 48 hrs but they didn't listen. They said it wasn't in my system enough to work, despite tremors, and no appetite. To make a four month story short, it ended me scratching my legs till I bled, paranoid, married, and hubby didn't want me to be committed. I checked in anyway and checked out AMA the next day. Within a few weeks I was sweaty burning with fever, in a manic state, hubby finally took me to ER, and doc took one look at me and I told him I believe paxil allergic reaction he said no kidding hee hee. He gave me a shot of vistaril and it didn't do anything and an hour later gave me another one which finally knocked me out flat. Best sleep I ever got finally ha ha. I regained my senses about a year and a half later and divorced hubby since I did marry under paxil induced haze and wasn't in my right mind. Oh and when I was told to stop paxil, I did have side effects like mad, but believe me - it was NOT seizures at all. It was more joint pain and headaches than anything and I just upped my caffeine and took excederine migraine meds. I just subsituted one addiction for another, if you will. I'd rather have joint pain than the nightmare I went through with paxil.

Zoloft left me flat, but I didn't mind, but I wasn't my cheerful self so that had to go. Lexapro was like a marijuana and made me high and I was eating like a pothead. It would have been comical and it was until a real pothead cornered me and asked what I was taking because they know I was not a pothead ha ha. I took it for a week ha ha - that had to go, but hey.. if I want to be high again, I know what to take right? My psych doc and I agreed no more SSRI's for me ha ha. But if it works for you all - that is great. It just didn't work for me that is all. My current fiance does great with Paxil, so I'm happy for him. I just have to be careful handling his paxil and I watch him for side effects like a hawk ha ha. Oh and yes, he was there when I had my paxil nightmare, what's even more embarrassing is he was the best man at the wedding. Say it with me... ohhhh. But in his defense, he tried to talk common sense into the ex hubby and talk him out of marrying me since he knew I wasn't in my right mind to get married. I joked with him that he should have talked to ME about not getting married hee hee. He says he didn't know he liked me back then until about a year and a half after I got married. Now say it with me... awww.

My neurologist didn't say anything about drinking tons of water to prevent kidney stones. I must do that immediately. I did notice that once I started Topamax I didn't crave sweets as much and I didn't crave as much caffeine drinks. I tend to go for diet drinks since they are not as sweet. I tell you, I notice the sweet stuff in foods and tend to not want them. If you give me a super sugary food - I will gag. I will tell you it is so sugary, sweet, or too rich. If it's salty - I'm liable to tell you it is too salty. Blah. Oh Topamax has helped lower my blood pressure, I think. Of course, since my migraines and headaches has been more controlled now - my blood pressure is lowered too. And I've lost tons of weight too.

I do agree, migraine sufferers are more sensitive to meds than most people because I have to be careful about medicines that I take. I am even sensitive about what lotions or soaps that I use on my body. It's like my body says nope - you can't use this or that. It's a nightmare sometimes. I usually hate taking any drugs because I never know how I will react.

Topamax didn't make me sleepy at all, but how have you faired on it?

Last week I got the "okay" from my neurologist to skip Topamax during the initial 6 day course of Medrol dosepak and Skelaxin.  (All my meds are generic, btw, if that matters.)

I'm very apprehensive about taking new medications so I only got around to starting today.  At this point I've taken 4 of the 6 medrol pills, and one Skelaxin (I'm supposed to take two but I decided just taking one to gauge the effects.)  I would say there has been no change in the head pressure at all, if anything it has been worse.  I also noticed an "actual headache" after I took the first 2 Medrol pills.  Also, unusual stomach upset and nausea throughout the day--I don't know if it's more from the steroid or the muscle relaxant.

Maybe I need the second dose of Skelaxin to notice benefits, but I just didn't detect anything positive about it.  An hour after taking it I noticed mild drowsiness and "just feeling weird and unpleasant" for a few hours, and little else.  There was also a very demotivating feeling of just wanting to sit there and stare at the wall, as if nothing was worth doing.  My conclusion is that taking another one of these would ruin my day, and I just can't tolerate that.  What am I supposed to notice from a muscle relaxant, anyway?

So, day one is a letdown.  When can I expect some of the beneficial effects to kick in?  The neurologist said I would to go through the entire Medrol dosepak before I can notice one day of improvement, but even then that improvement won't last, which is why I'm then supposed to start Topamax as the core drug.

Any thoughts?

Hi batman, ok...I've been exactly where yÓu are...first -do not take the paxil and topamax together. Look up sertonin storm/toxicity/syndrome-i am presently undergoing hopefully the last month of 8 months of it due to 2 neuro's giving them to me together-takes 30 full days to detox your system-i can't walk/talk/think many times during the day...paxil itself can cause daily headache/aura/foggy- ask them to switch it first to another same type of med (that way no weaning process and/or time without antisepressant in you system). Try that for a week or two-see if aura/headaches/foggy improves. I took paxil for 11 yrs with no side effects and then boom! Sigh, ok-next the steroid dose pack-t'll make you nausea/flushed/moonfaced/hungry-it's to relieve some muscle pressure-it really can't hurt you to take it as prescribed-just be sure to eat with every pill -even something light. The skelaxin-muscle relaxer-again, not gonna hurt you-may give you hang over effect-if you are a light weight with alcohol/meds, only take it at night for a few days and if need be break pill in half...one skelaxin makes me feel wonderful! But, it snows me for 12 hours and fog for about 15. The "as needed" are truely as neededs-only for a moderate to severe migraine, they may make you drowsy/foggy-so try to take once you are somewhere to stay put with your first dose to see how you do. Also, have you had a cervical(neck) mri? You could have an underlying bulging disc/pinched nerve...that has caused these. Before you invest anymore of your life in pain, see if you can get one ordered-can't hurt-if yÓu've been in a car accident/are very physically strenuous to yÓur spine/have any numbness/weakness of hands/arms-have them order one. Again, I've been there - I just found out I have "stenosis" or narrowing of 2 my cervical verterbrae that are causing pressure/closing on the posterior part of my spinal cord. I have to now get nerve conduction studies because my arm/leg weakness/tremors are so severe and if there is nerve damage, I will require surgery to open that space up-if NOT- a simple steroid injection until it does become a problem may help and then maybe no migraine meds needs at all! Sigh, ok...sorry-i ramble and am on bedrest at present due to my whirlwind of dr drama's. (And I'm a nurse too boot-lol!) Ok, so neck mri, take the solumedrol/skelaxin/change the paxil to new drug/ hold off for 1-2 weeks to see effect of new drug before you want to add more to the mix, then if mri ok and still have migraines, add topamax-be very careful of the side effects of it and the new antidepressant. The topamax caused my paxil to give me all the severe side effects-report all side effects to your doctor. Look up serotonin storm and if you start to have those after adding topamax, then notify your dr. My dr's said "keep taking it , it will go away" 8 months later, it's not gone but worse and now I have to wait another month before it's "out of my system". Some people love topamax, others don't -everybodies chemistry is different. Also have they tried a blood pressure pill as a daily preventative before they go the strong route? A daily low dose beta blocker or calcium channel blocker will open the blood vessels of your brain so that when the "spasms" occur that give you migraines occur you don't feel them so much and no more migraines-also clearer definitive side effects, less likely to counter act with other. Antidepressant med as well as the as needed and present ones....just a suggestion. The bp pill may cause yÓu to feel lightheaded with sudden up/down position until you adjust. It may give yÓu a mild fatigue by lowering your heart rate, probably milder fatigue than the topamax. Sigh, ok did I miss anything?? Lol! I wish you the best and any questions, look me up and send a message-hang in there, you're on the good side of this! YÓu can take the time/different routes to figure it out..also, I loved loved acupuncture, when I could afford it..not so hot on the chiropractor touching my neck, but just my preference...again-take care and good luck!! Amy jo

Dear Amy,

I appreciate your time, but what you've said is very hard for me to process.  In addition, I find myself fogged and drowsy from Skelaxin, and it sucks.  I'm the type that if I'm just thrown off slightly, my performance in any given task is reduced by at least 50%, that goes for all things.  I already want to quit the Skelaxin and this is just the second day.

Moving on... If I'm to follow your advice to the letter, then I'm going to have to scrap the entire plan this neurologist gave me, and I'll just be back to square one: in other words, chronic head pressure every single day, with no idea how to stop it.  I can think for myself, but as you can see with SEVEN YEARS of 24/7 "head pressure", trying to tackle this problem on my own hasn't worked out so well.  I think maybe following orders for once is the way to go, for a problem that now controls my entire life, on top of other things like ADD and learning problems.  Long ago I also decided I don't have the discipline for the migraine diet or yoga--how many people do?--nor the patience to wait years to see if they work.

The idea of switching Paxil for something else, or else not taking Topamax, is just not going to be compatible with the current plan.  Yes, I *am* concerned about this combination of drugs.  I know about serotonin syndrome.  I'd rather not take Topamax at all.  But what are the options?  I cannot afford another MRI--my insurance isn't great--and as for a second opinion, I consider myself lucky enough to already have a neurologist that won't tell me "it's all in your head."

As someone with horrible ADD, I don't have the flexibility most people have, I can only stick to *one plan* at a time, or no plans at a time.  Perhaps if I could get rid of the head pressure or so-called "migraine", I might be able to tackle other issues like ADD and executive dysfunction, but all I can do right now is one small step at a time in a very linear and predictable fashion.  Otherwise I'll just have to swear off doctors altogether, and lose 100% of the progress and the money I paid to get to this point.

(BTW, I hope you won't be offended by the overall "abrasive tone" of this post, realize that it's not directed at you, but just the frustration I have for my scenario...)

Post Edited (Batman55) : 3/17/2011 11:29:05 PM (GMT-6)

Hi, mayo clinic put me on topomax started at 25 mg at night worked up to 200 mg at night. it definately decreased the number of headaches and the severity.
the medrol pack is for inflammation it works differently than Skelatin sorry about my spelling. skelatin is more of a muscle relaxer. all of these are non addictive physically. The medrol pack will give you a burst of energy. the skelatin will loosen the neck muscles. you probably do not even realize how much tension you hold in your epicranias and shoulders and neck. the topomax is a preventative. I wouldn't recommend being on medrol packs often, but i have several issues. I believe your doctor is trying to give you the best overall care possible for this chronic headache. If the skelatin makes you drowsy only take a 1/2 it may be to strong for you people have all different tolerances to meds. another med in that family would be like a flexeril. I go to physical therapy for Arthritis and Lupus when i have a migraine we work onmy neck and head and shoulders, I also get a massage one time a week. Very beneficial for chronic headaches. All types of headaches can be very painful and it sounds like you get combination headaches,migraines with tension. and if the migraine starts to go away the tension brings it back. I am not a dr. just a professional migraine sufferer....lol...
Big things that helped...find out what your triggers are: i am photosensitive (very sensitive to sunlight), almost any preservative esp sodium nitrate, basically any lunch meat or processed anything, BIG ONE ASPARTAME or sugar substitutes like anything diet. even sugar free gum can give me a headache... and hormonal.
I found if i keep a regular schedule like go to sleep at ___ and get up at ___ helps. i know people that have had allergy testing done to help eliminate triggers caffine for some people is a trigger for others it helps, bananas trigger for some people.

well... just wanted to share .. I hope you find some or any of this helpful... I wish you non headache days!!! also try ice packs on back of neck or warm compresses on back of neck. for the tension ones. Good luck.. i really feelfor you ... i have a baby migraine a brewing so i amgoing to get off the computer. take some meds and close my eyes with an ice pack. best wishes

panther fern,

thanks a lot for your response.  you've given me some food for thought.

as for finding out my triggers, it's a difficult issue.  i use caffeine to give me extra focus and if that's my trigger, that's a problem.  as in, natural consciousness doesn't get the job done when your brain is naturally sluggish and inefficient.  too much computer use is also a trigger for some people.. but computers are a hobby for me.  not to sound like a complainer, but i'm not known for flexibility.  if anyone here has executive function problems--it seems like most of you don't--you would know what i'm talking about.  instead, i tend to sometimes receive blank looks, or critics claiming i'm just lazy, stubborn, and irresponsible.  some of the criticism is valid, some isn't.  regardless, i don't want to change very much, and yet i badly want the head pressure gone.  i'm not embarrassed to say so.

best case scenario: the topamax eventually works, the side effects are not unbearable, i can taper off the drug and find that my headaches are greatly reduced, and i can then get off all the meds.  is it possible?