Brief Answer:
treat stress and headache together, test tsh & B12

Detailed Answer:
Hello,

I think your basic problem can be anxiety / depression and from that creeps these headaches. Do you feel stressed again?? Due to any reason?

. Sibellium is a good old medicine for migraine but you can try something which can handle both anxiety depression and migraine as well.

There are medicines like dothipin or sertraline or venalafaxine which have good results in all the above mentioned problems.

Your problem is basically related to psychiatry and not neurology as CT head is normal. Stalopram is alos an anti depressant but not very effective in headache.

For acute attacks of migraine you should ideally take a pain killer like - naxdom 500mg within 5-10 min of its onset...delaying and tolerating these headaches only make it worse and chronic. Taking medicine soon helps in aborting the attack and also reducing further attacks.

You can discuss these meds with your treating team and can start them in low dose.
It helps to get serum B 12 level and tsh.

Hope the reply is useful.

Wish you good health.
Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
can try dothiapin (prothiaden) & lifestyle change

Detailed Answer:
Hello,

Thaks for answering back.

Whenever I have a patient similar to your case I usualy prefer dothiapin for treating both anxiety and depression and various major headaches (the ptients should not have high blood pressure).
I advise to start the medicine with a dosage strength of 25mg at night and raise it by 25mg every one to two weeks by monitoring the response. Usually the patients show adequte results in about 100-150mg.

For acute pain attacks - naproxen sodium with domperidone combination 500mg can be taken. It is wise to take this as and when needed medicine in the begining of the new headache episode --as it stops it completely.
The medicine dothiapin can be taken for 6-12 months and then can be tapered slowly and stopped under supervision.

It is good to get routine blood tests every 3-6months while on medicines.

Every person with headcahes and stress should make lifestyle changes for wholesome relief and attain good quality of life.

There are bening visual disturbances usually seen associated with severe headaches but they become completely ok after the attack subsides. You may however get vision checked.

Wish you good luck.
please feel free to ask more questions for clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
raise stalopam by 5mg or dothiapin by 25mg

Detailed Answer:
Hello,

I think stalopam will not be a good option as you are also having headaches presently.
If you still prefer this medicine--we can do one thing- take stalopam for depresison or anxiety and take naxdom for headaches on SOS basis. Try it for few days to two weeks. If the frequency if headaches reduces then you can continue with stalopam ..and if it dosent help headaches them shift to dothiapin.

Stalopam can be started at 5mg and raised to 15-20mg by increasing 5 mg at a tiem after monitoring the response for 2-3 weeks on first dose. You can check it with your treating team.

In case of dothiapin- starting dose is usually 25mg and then increase by 25mg each time after waiting for 2-3 weeks on first dose to show effect.

take the dose which gives maximum benefit with minimum issues and continue with that for 6-12months. Later we start reducing it in cases which keep almost completely well- by 25mg at a time. The reduction should also be done under doctors supervision as it can be troublesome at times.

I hope the reply helps you.

please feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry

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