Migraines & PMDD???

Hi, what you read about mixing certain antidepressants and triptans is true. I take a tricyclic antidepressant to help prevent my migraines, and several other medications to prevent and abort them. I just started on it and it takes awhile to build up in the system so I don't know how well it is working yet...Unfortunately, I can't help any with the PMDD. Do you only take the topomax one week before your period and then go off it again after your period (I'm sorry I may just be misreading your post)? Take care.

Dear Zimmy -- I have heard this too but my docs know that I take 2 anti-depressants and triptans. My worst most STUBBORN migraines are pre/present menses. I also believe that I may be hitting perimenopause. This can happen up to 10 years before menopause and that my migaines are increasing in frequency each year. Their are a few threads in the past about "hormones and migraines." Happy reading.

Gosh, I never heard about the "overdosing on serotonin" but I have heard that taking anti-depressants and triptans together is a heart risk. I wouldn't worry about overdosing on serotonin. What dosage of Prozac are you taking? A psychiatrist is the best person to dispense meds. I'm getting off of my Wellbutrin which has no serotonin, it has neophenefrine (sp?) instead. I hate taking meds but I was severely depressed and chronic migraine is a depressant too. Did you know that their are PMS clinics out there? Maybe do a google search.

hopefulmigrainer--I recently started doing research on triptans and anti depressants and I did not mean to scare you or anyone else. I started posting here to get some input from others. I am glad that you have done your own research. I have a doctors appt coming up to discuss the anti-depressant meds so we'll see what he gives me. Thanks for the info on the pms clinics, very helpful. Take care and again, did not mean to scare anyone

mommyto3-I was not told about tapering off issues with topomax, just to take it for one week and then stop, I have a doctor's appt so I will ask again about this, to make sure. Thanks for your input. Take care

hi brea, thanks so much for your input, i am no longer going to take topomax because of the side effects and because i am now on an anti-depressant. the doctor informed me to work on one issue at a time so we'll see what happens, i wish you the best of luck and you're right, it's nice to have people understand what we go through, take good care

The best remedy for menstrually related migraines is called butalbital. It is quite old (I am a neuroscientist specializing in PMDD). It sometimes takes an hour or more to work, but it has the best success rate of any anti-migraine drug. Why don't you get it prescribed more often? 1) It is a barbiturate, so there is a potential for abuse 2) marketing companies are going nuts to prescribe women topiramate (topomax) because it was not effective as an anti-epileptic and they don't know what to do with it. 3) It is off patent, so no one makes money off it like they do from Imitrex etc. 4) Premenstrual migraines (most of them are) are completely under-researched and the majority of the solid research is not picked up by the medical community.

Butalbital does not prevent migraines (unless you get warning signs, like aura etc and take them when you have warning signs) but it makes the pain go away. It should not directly interact with antidepressants of any type, though they can make you sleepy and you should not drive etc till you know how they will affect you. These drugs actually address the most likely direct causes of the migraine.

Most antidepressants do not help with migraines, especially menstrually related mirgaines. Some can in fact cause headaches. Although most doctors will tell you otherwise, the actual studies do not support the fact that antidepressants (or any class) reduce or prevent menstrual migraines, or certainly not by much. If you have some conditions, (poly cystic ovaries, irregular periods, are perimenopausal or menopausal) you may have migraines that do not seem to be premenstrual, but are actually caused by the same hormones that are just being secreted at an irregular time.

You should not take antimigraine drugs like Imitrex with any antidepressant (celexa, lexapro, prozac, paxil, zoloft) and a lot of others. You should also not abruptly stop taking either topomax or antidepressants, unless a doctor tells you to because there is an emergency.


If you are getting migraines 3-4 times a week there are a few things you should check out.
1) anemia (very common, very underdiagnosed)
2) thyroid (also very common, very underdiagnosed)
3) your sleep pattern
4) diet - some things are notorious and reliable causes of migraines (but only in specific people). You should do the brown rice, turkey and pears diet for a few weeks and slowly add things back to see if it is diet related. Also keep a detailed diary of what you ate and when. Red wine, MSG etc can all be culprits
5) Don't fad diet and don't skip meals - dehydration and low blood sugar are not good for migraines either
6) a screaming hot bath with some epsom salts and 1-2 aspirin (this will dissolve and be absorbed by the skin, helped if you use a little bath oil) may also help reduce inflammation that comes with migraines and "reset" the blood vessels. It doesn't always work for me, but a lot of times it does.

I just posted my experience as a new topic.  Here it is again for good measure:

I have never posted anything before, but want to get the word out about my recent experience Cymbalta.  I had never had migraine, but started suffering from Vertigo in Jan 2007.  I had MRI of my head/ear, two Sinus CT scans, and a full allergy workup.  Nothing wrong.  FIRST DIAGNOSIS- Meniere's disease - so I followed a salt-free diet (prescribed for Meniere's disease), but no improvement.  SECOND DIAGNOSIS - Vertigo-associated migraine, and I was sent to a headache specialist.  Although my mother, her father, and two brothers are migraine suffers, I had never had a migraine.   This was april, 2008.  Thinking the vertigo might be caused from the antidepressant medication I had been taking for several years, my doctor switched me to a newer drug - Cymbalta.  Concidentally, this is when the vertigo started to be followed by intense Migraine.  I was up to the working dose of 60 mg per day of cymbalta, but cut back to 40 mg/day, (probably a sub-therapeutic dose) because I thought it was making the migraine worse.  The Psychiatrist thought that was impossible, and told me that Cymbalta is even prescribed for headache.   The migraines became a daily event- now coming with classic auras, as well as vestibular (vertigo) auras.  I took a Stress Reduction class, went through 10 sessions of expensive biofeedback, and was put on Topomax.  As my headaches were worse during the second half of my cycle, the headache doctor also but me in an Estrogen patch, hoping higher estrogen levels would reduce the severity of the migraine.  Still no improvement.  Seven months later, the migraines were no better, and I wanted to quit the Topomax - I hated the way it made my food taste, and I was definately suffering cognitive impairment from it.  I decided something wasn't right, and I wanted to get off everything.  Unfortunately, I was now entering a depression.  Unwilling to increase the dose of Cymbalta, I switched back to Zoloft.  And here's the point to the story:  ITS BEEN 3 WEEKS AND I HAVEN'T HAD A SINGLE HEADACHE.  I still have the vertigo - and its probably more noticible now that I don't have the headaches.  I think its important to know that Cymbalta may worsen your headaches.  This might be because of its dual mechanism of action as a seratonin AND norepinephrine reuptake inhibitor.  Similar compounds might have similar effects - I know Wellbutrin gave me headaches.  If you have migraine - STAY AWAY from this DRUG.

Wow thanks - It didn't occur to me that Tomopax could have brought on the depression, but it doesn't surprise me, given all the side effects this drug has.  THe main reason I stayed at 75 mg instead of going up to what my Doctor considered a therapeutic dose of 100 mg is that it made me feel extremely anxious.  I think you're probably smart to use Exedrin - please be careful: Its VERY hard on the digestive system - my mother was using it for her migraines and wound up in the hospital with internal bleeding.  Interestingly, her migraines totally disappeared when she started taking Beta Blockers for hypertension. 

Hi. My first post. I have pmdd and I also get menstrual migraines. I am premenopausal. 48 and still have regular cycle. I have dealt with this for a while. I agree with the neurologists post. I take Zoloft for pmdd and barbitol/caffeine/Tylenol? . I do not take much. Typically 2 or 3 pills a month. I catch it during predrome phase. Also, diet is huge and will trigger inflammation and migraine. I get the knots in back of my neck (pain) and use ice and massage to relieve. And aromatherapy like peppermint oil l. There is something with the vagal nerve too(rubbing this nerve helps). Anyways, it is debilitating and I try to stay away from stress (work meetings) etc. I also have a smell aura and get naseaus by smells such as cigarette smoke and Cologne. I used to vomit almost uncontrollably during a migraine and it would relieve but have not had one like this for a few months. Also, the pmdd is tough. It lasts two weeks before period and it is hard to manage. I cannot smoke marijuana due to job so I take Zoloft. Some weight gain but trying to manage that too. Anyways, I feel for anyone going through this. It sucks.