Guest blog by Yvonne Wabai: The Winding Road Of Migraine Treatment.

Yvonne Wabai

Migraine: The primary headache disorder that still baffles the scientific world. I was formally diagnosed with chronic migraine with aura at the close of 2017. I had been living with the condition for years. A battery of blood tests and an MRI were performed to rule out other conditions. The neurologist then concluded that I did indeed have migraines. Then began the battle of formulating a treatment plan.

Treating migraines.

Migraines are still not well understood by  scientists and doctors. This means that they are incredibly difficult to treat. This is terrible news for migraine patients because migraine is the most common disabling headache disorder. There is no one-size-fits-all when it comes to migraine treatment. The neurologist liaises with the patient to find out which treatment plan works for them. To give you a glimpse into what this is like, here is my journey.

Trial 1

The neurologist diagnoses me with chronic migraine with aura. He stops me from taking paracetamols which I had been taking to manage my headaches. He explains that overusing paracetamols adds to the gives you medication overuse headache. He also stops my birth control that I had been using to manage PCOS (polycystic ovarian syndrome). This is because estrogen-based birth control pills trigger headaches. In addition, they increase the risk of stroke in people with migraine with aura. However, a recent analysis demonstrated that birth control pills are not only safe for women without migraines, but also safe for those with migraines, with or without aura. The issue of migraines and birth control is best explained in this article on Tonic.

He puts me on Gabapentin twice daily and a single dose of 400mg of Riboflavin (Vitamin B₂). Gabapentin is an anticonvulsant. It is used off-label for migraine prevention. A high dose of riboflavin has been shown to be efficacious in migraine prophylaxis. Unfortunately, this combination fails to work for me. After a month, it’s back to the drawing board.

Trial 2

The neurologist puts me on 50mg Topiramate twice daily. I have to start from a lower dose, so I follow a complicated set of instructions that see me get to 50mg twice daily within three weeks. Topiramate is also an anticonvulsant. This doesn’t work out as well as expected. Therefore, two months later, the neurologist changes my medication again.

Trial 3

I’m now on 25mg Amitriptyline once daily. I have to build up to 50mg twice daily. Amitriptyline is an antidepressant. I really like this one because it is ridiculously cheap. Seriously. I got a handful of tablets for Kshs. 22. I kid you not. Wonderfully pocket-friendly. But I’m also worried because I’m scheduled for an ECG.

Turns out Amitriptyline may cause heart arrhythmias. Therefore, they just need to make sure my heart is fine after I use Amitriptyline for a while. Unfortunately, I’m only able to stay on this drug for a few days because it has another unfortunate side effect: constipation. I have IBS (irritable bowel syndrome), so I can’t have a medication that makes my constipation worse.

Trial 4

The neurologist suggests Valproate. Valproate is another anticonvulsant. It has harsher side effects than Gabapentin and Topiramate. You are also given a stern warning to not fall pregnant when taking Valproate (but you took my birth control??) because it is one of the anticonvulsants that cause foetal anticonvulsant syndrome. Ultimately, I decide against Valproate. I decide to try Topiramate once more. I go back to 50mg Topiramate twice daily. This time, I also get pain relievers, yay! I’m prescribed 1000mg Paracetamol and 10mg Metoclopramide to take whenever I get a headache.

Currently

I’m currently at trial four. I’m hoping this is the one that sticks. I’ve read testimonials from migraineurs who have gone up to trial ten and beyond!! Sigh. One can only hope that science cracks this puzzle soon enough. Thankfully though, I can now say I’m down from chronic migraineur to episodic migraineur. Isn’t that something? Progress.

About the writer

Yvonne Wabai is a young Kenyan scientist and writer. She holds a Bachelor’s degree in Forensic Science and has done research in the field of teratology. She plans to do her Master’s degree in Medical Biochemistry. She runs a blog by the name Randomly Creative. Find her on Twitter, Instagram, Facebook, and Pinterest.