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Comment by tylermac1 | Hacker News Reader

What was the medicine that ended up helping your migraines?

I suffer from migraines semi-regularly and have at separate times taken Maxalt, Imitrex, or generic OTC migraine meds + caffeine.

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No the op, but for me 50mg nortriptyline daily is the no-migraine magic. Been thru most of the other available meds and nothing worked, except zomig, which you take after onset and for me, relived the pain, but none of the other symptoms. Nortriptyline is a really old tricyic antidepressant/nerve pain med, with pretty low risk of interaction/bad reaction. Without it I have clusters of 2-6 migraines over 4-5 days every 3-6 weeks. If you don't get them regularly, you may not want to have to take something every day, but if you get them with any frequency, it's a million times worth it. I can miss up to 2 sequential doses without problem but if I miss 3 or 4 I will get a migraine every time.

Best of luck.

Excedrin worked for me before I quit coffee.

Also, since starting a low-carb keto diet two years ago, I haven't had a single migraine (I used to get 2-3 per month, both painful ones and visual auras). When I was a pediatric neurology prof a few years ago, a keto diet was standard of care for the kids, and the department was starting research into keto for chronic migraines. Give it a try!

For those unaware: Excedrin's principal ingredients are acetaminophen (Tylenol) + aspirin + caffeine. Each pill contains about 65 mg of caffeine (roughly equivalent to a shot of espresso).

I had the same result after switching to a keto diet 10 months ago. Do you know if there are any research papers on this? I was really surprised how effective the change in diet was because I did it on a whim without receiving medical advice.

Not exactly research paper, and not migraine but it was mentioned in a ted(x?) talk linked from HN a week ago or so IIRC. The talk was about keto and cancer but touched into keto against epilepsy as well. I think the Charlie Foundation or something was mentioned as well.

Maybe some of that research can hold some pointers?

I have had some luck reducing the frequency of my migraines with high-dose vitamin B2[1], around 400mg a day. Caffeine (I only drink tea) is helpful for recovery from my migraines.

1: https://www.ncbi.nlm.nih.gov/pubmed/15257686

Thanks for sharing, I drink a ton of tea, black tea has about 30 to 60mg of caffeine in it. So I find that caffeine doesn't do much for me, but the Vitamin B2 is interesting, i'll try it!

I think he meant caffeine + no caffeine tolerance.

"until about a year ago when I finally found a medicine that has successfully prevented Migraine (completely)"

I've had Migraine for the last 20 years of my life, on and off, about monthly in the summer/winter and 4-8/month in the spring and fall. The frequency of the problem actually caused me to write a Visual Studio plug-in so I could use my monitor in low-contrast in a dark bedroom.

I didn't share the medication in the original post because there are a lot of caveats, but I take Depakote at 250mg twice daily and it works completely without side-effects (same dosage for 1.5 years and not a single instance of Migraine).

I happened upon this cure by accident, though, due to my body's intolerance for a myriad of common medicines used for Migraine treatment (and nothing OTC worked except Caffeine)

I cannot take Triptans (Maxalt/Imitrex). They work, but with huge mood side-effects. I was prescribed an anti-depressant (name escapes me) that showed promise in Migraine prevention. I got a Migraine headache while I was taking the anti-depressant and took a Maxalt (OKed by the doctor) and was hospitalized with Serotonin Syndrom. I cannot take anti-depressants, I learned later, due to my genetics[1].

I've seen many specialists but it wasn't until this hospital visit (on a holiday) followed by a misdiagnosis, that I was prescribed a rather high dose of Depakote (1000mg/day). It was prescribed in August and when I went through September without Migraine (this has never happened according to my log), I brought it to the attention of my headache specialist. He reduced the dosage at my request (Depakote is prescribed for BiPolar--an illness I do not have--and at the original dose, I felt emotionally flat[2]). At 500mg/day (2 doses), I don't have a single side-effect (other than headache relief, which is not why it is usually prescribed) and have been on that dose for 1.5 years without a single headache.

My headache specialist said that some of his other patients got relief from this medicine but that it's hit/miss. My experience is that this drug is basically everything you'd ever want in a treatment -- side-effect free, and works 100% of the time for me.

[1] Genesight test indicates that the medicine will remain in my system far longer than it should. I strongly recommend paying for this since it would have saved me a trip to the hospital. All of the SSRI medicines are in the high risk category for me. Glad I've never experienced depression!

[2] Nothing like the movies where a guy walks around with no expression on their face staring blankly. The best way I can describe it is that when something would happen and my wife would react, I'd feel like "Data from Star Trek" not understanding why she was reacting so strongly/emotionally. At this dose, I have the same level of intensity I'm used to.

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