Wednesday, April 26, 2006

"Maxalt & Me"

Not to be confused with the current bestseller, "Marley & Me", about a guy and his dog. I wish I could turn my life story into a bestseller, but think I may need a more furry, cute, and rambunctious topic than chronic tension-type headache.

I tried Maxalt for the first time last night. A few months ago, my neurologist gave me a sample to try. You see, we don't know if there is a true 'migraine' component to my headache. I don't have the typical clinical manifestations of migraine, except for the pain. I don't have the litany of other troubles like photophobia, nausea, and excruciating pain you're all familiar with.

I have chronic tension-type headaches instead, and while they are severe at times, they don't appear to be migraine. I have occasional one-sidedness, and knife-in-the-forehead pain but it is generally not bad enough to need acute intervention, abortive meds, or whatever you call them. A couple of times a week, my pain gets *severe*, usually in the evenings, although I routinely have very bad headaches upon waking (which usually relent a bit after a couple of hours awake).

So how would I know if I had Migraine? Since I don't fit the clinical checklist, I'm left wondering if my pain is as bad as others'. At times, it seems like the pain is as bad as I can tolerate, but I know it could be worse (unbearable, excruciating). Since I don't use those words, I'm left with "very bad" and "severe" to describe headache as bad as it gets for me.

It's no picnic, though, since I have headaches every day, all the time, 24/7/365. Looking over my pain journal, I haven't had a single headache-free day since Christmas, and even then, it wasn't even a whole day. That day, I recorded two zero's (no pain) on my chart and listed a 3 that evening. So I didn't have a whole day. And I haven't had a single "zero" any time since. I literally have a headache ALL THE TIME, without exception, at some level or another.

Anyway, to get back on track, David decided I should try Maxalt (RPD 10mg) last night. After work, I was having pain "as bad as it gets" for me, and was in bed when David arrived. I'd been timid to try Maxalt after reading the list of side effects. Basically, it's a serious vasoconstrictor, so you can feel like you're having a heart attack or stroke, or it can cause one. And I wondered if it could make me have an actual migraine, as rebound. I was worried. But since my neurologist humored me last time with "we haven't had anyone die yet" when I listed my concerns, I relented...

So David brought me the drugs, and at 7pm, I let the little white tablet dissolve on my tongue and waited for (i) my chest to tighten and me to have a heart attack and (ii) my headache to magically disappear.

Nothing happened.

I felt sleepy after a while but the headache didn't miraculously disappear. What did happen was weird: about an hour after taking it, I noticed that the pressure in my head had lessened. My headache often feels like my head is about to explode from internal pressure, like my brain is too big for my skull and is pushing-pushing-pushing out. I often wish I could open a valve to let the pressure out. So the pressure did seem to stop, or relent. the edge was gone, but I still had a headache. It was more like my head was sore and achey but the pressure was gone.

I know... it's hard to describe pain. It was like the acute over-pressure pain was gone but a residual achey pain was still there. If I could make a bad analogy, it might be like hitting your head on a cupboard door or skinning your knee. It hurts like heck the second you do it, but hours later, there is still a residual pain/soreness when you move around. It was like that. The immediate "ow!" was gone but the spot still hurt.

Can I say Maxalt worked for me? Maybe a 25-50% reduction in the pain, but no miracle. More like a change in the pain. It definitely took the edge off. But it didn't stop the headache.

I imagine the results are more dramatic for someone hanging over the toilet or unable to open their eyes to the light.

Overnight, I had a restless sleep, likely because I didn't take my Elavil. I just wanted to see if Maxalt might keep working overnight and maybe I would wake up cured!

I woke up with a brutal headache.

But after getting going, I've felt okay most of the day. I felt kind of rested, but the pressure is returning and my headache is about a 6 right now. I have an ice pick over my right eye (a relatively new development that is getting more routine). Right back to normal. Work was stressful today, so I didn't exactly have a relaxing post-Maxalt day.

For now, I think I'll stick with my Elavil and muscle relaxants. My pharmacist mentioned a new muscle relaxant to try...Baclofen. I'll report on it in the future, once I see my GP. I'm curious about the muscle relaxant route because I have a huge muscular component, and have noticed that Robax Platinum (methocarbamol, a muscle relaxant + Ibuprofen) is the only drug that occasionally (without rhyme or reason) brings any headache relief. I'm thinking I might start a focussed regimen to explore the world of muscle relaxants again and see if I can find relief.

And leave the heavy stuff to you official migraineurs. : )


  1. Well at least you got "some" relief! I am wondering if maybe the problem with the maxalt is that you waited too long. I know that it will be hard for you to tell if you thinks it's switched to a migraine from your regular headache, but from what I understand, the maxalt, and all migraine abortives for that matter must be taken within the first hour of symptoms in order to be fully effective. I know for me, if I don't take my maxalt right away, I might as well not take it.

    Hope you find something that works, the new muscule relaxant sounds promising! How are things going with the massage? are you still going?

    Hope you get some rest tonight, I know that you and I could both use it!

  2. You might want to try a different triptan. I know for me maxalt isn't a good match for example. Or as jackie suggested it wasn't taken at the correct time (some of them are pretty picky). Personally I find Zomig to be quite a good and flexible medication.

    Can I say Maxalt worked for me? Maybe a 25-50% reduction in the pain, but no miracle. More like a change in the pain. It definitely took the edge off. But it didn't stop the headache.

    Well, it obviously did something. You and your Dr can decide what to do from there but it sounds potentially promising. Sometimes I have to take 2 before a triptan will fully work.

  3. I agree with katy, the thing with triptans, is they work differently for different people. Eg, Maxalt works great for me, but not for katy, whereas zomig does nothing for me, but works great for katy. At one point the doctor sent me home with a bag full of samples, and I just tried one everytime I got a migraine, and then decided which worked best for me.

    although, I'm still hopeing you don't have migraines. One problem to work on is always better then 2! lol, but I do hope you find something that works

  4. like everything else with headache, triggers and medications seem so complicated.

    jackie, you are right about the timing. since i have headache all the is hard to say when one is morphing into another. they just seem to fluctuate in pain level all throughout the day. basically when i got home, the h/a just seemed to worsen and get this sharp edge to it, so i figured that was about as much obvious "transition" as i seemed to go from regular TTH to something a little more ugly and who knows, my timing could be off. would be easier if i had no h/a and then "started" to get one and i could tell where is the beginning and the end.

    i might ask him to try me on more the zomig, or give maxalt another shot. but like i said, i have this trouble telling when something is "starting" as i have pain all the time and gradually it will just become really bad. it is hard to recognize. sometimes, i am so accustomed to pain i actually have to sit and think "ok, what level am i at?" because it is so omni-present. but excellent ideas from you me food for thought.