
Suggest Treatment For Chronic Migraines And Bad Taste And Dryness In Mouth

I also have a very bad taste in my mouth an hour or so before a severe migraine hits and nothing changes it...I then get really bad dry mouth
Several options. Some more info would be useful.
Detailed Answer:
I read your question and I understand your concern. Of course if you are having frequent attacks it would be useful to try and prevent them.
There are some points in your story I am not so sure I was able to understand, so perhaps you might help me with some more info.
- Your brain hemorrhage:
*when was it,
*what location in the brain (at least the side),
*what did your doctors say was the cause,
*was there some kind of vascular malformation and did you have treatment
(surgery or endovascular treatment) for it?
*Why can't your neurologist give you something else other then botox?
- Your headaches (to make sure that it is indeed migraine headache or perhaps some other kind of headache):
*when did they start,
*location (does it change sides?),
*character (throbbing, pulsating, constant, pressure-like, sharp),
*usual duration, approximately how many attacks a month?
*exacerbating factors,
*other symptoms like nausea, vomiting, increased sensitivity to light and
sounds,
*family history for migraine.
Also you mention Amitriptiline in medications tried. Amitriptiline is a preventive treatment, are you taking it now? If not why, was it not effective or because of side effects?
If I were to give an opinion solely on the present information, I see no reason not to take prophylactic migraine treatment. There are many options apart from Amitriptiline like Propranolol, Valproic acid, Topiramate, Flunnarizine just to name a few. Some work better in certain patients some in others, so the failure of one doesn't mean another won't be more effective. They are all prescription drugs though.
I am looking forward to your answer in order to give a more informed opinion.


I was diagnosed with migraines when I was in my 20 while serving in the military. I stayedwith headachesat anearly age. I have a family history of them.
Migraine, prophylactic treatment needed, consider med overuse
Detailed Answer:
Thank you for that info. It appears the diagnosis of migraine is correct. As for your hemorrhage, although the location is typical for hypertensive hemorrhage, unless you have a long history of uncontrolled high blood pressure it's not that likely at your age, other causes should be considered. I don't see your hemorrhage as an obstacle to preventive treatment.
I don't know whether amitriptiline is the best choice in your case considering you are taking another antidepressive such as cymbalta, apart from not finding it effective it would contribute to the dry mouth sensation you seem to be experiencing as well as other added common side effects.
If you have high blood pressure then logical treatment would be with drugs which prevent migraine attacks as well as lower blood pressure. The most used is propranolol but also calcium channel blockers like verapamil and in some trials ACE inhibitors (lisinopril) or ARBs (candesartan) have shown good effect.
I would try antiepileptics like valproic acid or topiramate only if the above fail, because of the possibility of their added side effects to gabapentine, duloxetine and trazodone.
Some supplements like magnesium, riboflavin, coenzyme Q10 have also shown beneficial effect in some patients.
I would also like to invite you to consider the possibility of medication overuse headache since you seem to be visiting ER so often. Medication overuse criteria include headache for over 15 days a month, overuse (at least for 2 days a week) of drugs for over 3 months and headache worsening during medication. If medication overuse headache is the case, then prophylactic treatment wouldn't be as effective and detoxification is needed first.
I hope to have been of help.


If all alternatives explored wait for botox.
Detailed Answer:
I understand. So it seems it is only this last month that the attacks have increased in frequency, I thought they were even more frequent for a long time.
In that case perhaps therapy with botulinum toxin (botox) has been effective and it's the wearing off period. Usually it should be applied every 12 weeks.
If you have tried all the other options I listed, including valproic acid and topiramate, then it seems your neurologist has explored the recommended alternatives.
So for now I would consider amitriptilyne interruption and the scheduled reinjection of Botox. I wouldn't hurry into taking more drugs as you already are taking several central nervous system acting drugs for fibromyalgia and sleep as well as migraine attacks, at times poly-pharmacy reaches a point where it can be harmful.
Remember that you should have realistic expectations, the efficacy of preventive treatment is not established by making attacks disappear altogether (although desirable), most often they only reduce frequency and intensity. Of course, if on the other hand they are becoming more frequent with amitriptilyne there is no reason to continue it. I imagine it has already been recommended to you that a headache diary would be useful as well in identifying the causes for this exacerbation of the pain, there are many possible external factors (sleep, food, wheather, physical activity etc).
I wish you good health.

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