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Migraine Headache


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In the News...

July 19, 2006
FDA Issues Public Health Advisory on Mixing Antidepressants with Migraine Drugs

Recently the FDA has warned against mixing common migraine drugs, called triptans, with antidepressants categorized as either SSRIs or SNRIs. Combining these drugs together can trigger a life-threatening condition called serotonin-syndrome which is characterized by rapid heart beat, sudden changes in blood pressure, and increased body temperature. Other symptoms include restlessness, hallucinations, loss of coordination, overactive reflexes, nausea, vomiting, and diarrhea. Patients with these symptoms when taking these drugs should seek immediate medical care, the FDA said.

SSRIs, for depression, included in the warning are Celexa (citalopram), Fluvoxamine (generic), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine) Symbyax (olanzapine/fluoxetine) and Zoloft (sertraline). SNRIs are Cymbalta (duloxetine) and Effexor (venlafaxine).

Triptans, for migraine, are Amerge (naratriptan), Axert (almotriptan), Frova (frovatriptan), Imitrex (sumatriptan) Maxalt and Maxalt-MLT (rizatriptan), Relpax (eletriptan), and Zomig and Zomig ZMT (zolmitriptan).

The FDA issued the warning after receiving reports of serotonin syndrome among patients mixing triptans and SSRIs or SNRIs. The FDA said patients who are taking a triptan along with an SSRI or SNRI should talk to their doctor before stopping their medications. FDA, MedPage Today

What is a migraine? from the  Nat'l Institute of Neurological Disorders & Stroke
The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. It is often accompanied by extreme sensitivity to light and sound, nausea, and vomiting. Migraine is three times more common in women than in men. Some individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a lack of food or sleep, exposure to light, or hormonal irregularities (only in women). Anxiety, stress, or relaxation after stress can also be triggers. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine is caused by inherited abnormalities in genes that control the activities of certain cell populations in the brain.(1)
Migraine Triggers from the  Nat'l Institute of Neurological Disorders & Stroke,(1) and
The most common migraine triggers are:  from the  Nat'l Institute of Neurological Disorders & Stroke, and
  • Stress (either during a stressful time or right after stress subsides. Scientists report that people can develop migraine not only during a period of stress but also afterwards when their vascular systems are still reacting. For example, migraines that wake people up in the middle of the night are believed to result from a delayed reaction to stress.)
  • Menstrual cycle in women.
  • Changes in sleep. Either getting too much or too little sleep.
  • Fasting or skipping meals.
  • Changes in barometric pressure and weather.
  • Bright light or reflected sunlight.
  • Foods such as chocolate.
  • Excessive caffeine or caffeine withdrawal.
  • Smoking or being around someone who smokes.

Other migraine triggers include:

  • Strong emotions, such as depression or anxiety.
  • Physical exercise.
  • Alcohol, such as red wine and port.
  • Aspartame, found in diet sodas, light yogurts, and other sugar-free foods.
  • Monosodium glutamate (MSG), found often in Chinese food and as a seasoning for meats and other foods.
  • Nitrates, which are found in cured meats such as hot dogs, bacon, or cold cuts.
  • Tyramines, which are found in pickled or marinated foods, aged cheeses, or yeast.
  • Birth control pills and hormone therapy.
  • Certain medications, especially those that dilate blood vessels.
  • Overuse of headache pain medications, leading to rebound headaches.
  • Bright lights, glare, reflected sunlight, or other intense visual stimuli.
  • Odors such as perfume, paint, dust, and certain flowers.

While a food-triggered migraine usually occurs soon after eating, other triggers may not cause immediate pain.

Keep a diary and show it to your doctor...
Keep track of your migraines print this form from Merck
References and Educational Video Tutorials about Migraine Headaches
1) Video: Migraine Headache at Medline Plus and click on the "Interactive Tutorials" Tab in the Upper Right Column.  Scroll down & click on "Migraine Headache", then follow the instructions to view the video. 
2) Video: Migraine from 1on1  View this excellent video:  Scroll down to "Look" "See how changes in the brain and its nerve endings can lead to migraine pain. video from Glaxo-Smith Klein & WebMD
Common Triggers and more from The American Council for Headache Education;
Migraine from Medline Plus, A Service of the National Library of Medicine and the National Institute of Health.
5) Migraine fromthe Nat'l Institute of Neurological Disorders & Stroke, The Nat'l Institute of Health

Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Jan 2005

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