JUST GOT SENT THIS INFO FROM THE MIGRAINE TRUST - thought some of you might find comfort in their admitting the frustration of finding the right meds… but you can and do get there eventually.
i’ve been advised by my neuro to stay on 20mg for 6 weeks - and if i’m still not feeling any better to change to topirimate or propanolol. FINGERS CROSSED 
‘There is increasing recognition that migraine sufferers experience ‘dizziness’ and vertigo more commonly than non-migraineurs and it was first written about in medical literature in 1873. The association between migraine and vertigo is variably termed ‘migrainous vertigo’, ‘vestibular migraine’, ‘migraine related dizziness’ as well as older terms such as ‘benign recurrent vertigo’.
Vertigo can also occur as part of the aura of migraine when it is termed basilar type migraine as there are other associated transient neurological symptoms such as slurred speech, double vision, unsteady walking, impaired consciousness and collapse or bilateral simultaneous sensory aura symptoms, i.e. pins and needles or numbness in both arms and/or legs simultaneously.
Migrainous vertigo may affect between a third and a half of all migraine sufferers at some time during their life. In young children recurrent attacks of rotational vertigo (termed benign paroxysmal vertigo of childhood) can be the first indication that they will develop typical migraine with headache in later life. Migrainous vertigo can however occur at any age with or without headache and is reportedly most common amongst people aged between 25 and 45.
The vertigo of migraine may be a sense of rotational movement “the room spinning like on a roundabout” or less often an illusion of self-movement. Nonspecific unsteadiness, postural imbalance and dizziness are even more common. Vertigo symptoms may be intermittent i.e. attacks similar to episodic headaches. They may arise spontaneously (without an identifiable trigger) or be provoked by positional change, e.g. rapid head movement and less commonly by identifiable migraine triggers such as menstruation.
The duration of attacks is highly variable both between and within individuals and may vary over time. Most commonly attacks of vertigo last minutes to hours with non-specific unsteadiness for days.
Migrainous vertigo may occur without headaches in up to 50% of individuals who experience such attacks and progressive deafness should be absent, but other features of migraine such as light or noise sensitivity or tinnitus (ringing in the ears) may be present. If discrete attacks of rotary vertigo occur especially if there is deafness then ear disorders should be considered as a condition called Menieres Syndrome can also cause similar symptoms. If there is doubt then your doctor should help to distinguish between these entities.
The best treatment is unclear. If vertigo is acute then symptomatic medications taken for a short period (less than two weeks) can prove helpful (prochlroperazine or promethazine). If attacks are frequent or recurrent the same medications used for migraine prophylaxis have been advocated, but there are no prospective trials on best treatment.
If in doubt it is best to consult your doctor to determine if the cause is definitely due to migraine.
by Dr Brendan Davies, Consultant Neurologist.’
You can read about the prophylactic (preventative) treatments for migraine by following this link to a page from the Patient UK website: patient.co.uk/health/medicin … ne-attacks
It can be demoralising to begin on preventative migraine medication as these medicines can take time to start to work, and also it may become necessary to change the dose of your medicine to see if a higher dose will be more effective, or change to another medication. However it is wise to give your medication a fair trial otherwise it may be more difficult to discover which medicine will work best for you. A Frequently Asked Question on The Migraine Trust’s website is about taking preventative medication, the answer was written by a specialist migraine and headache nurse, you can follow the link to read the answer and it is also copied below: migrainetrust.org/faqs?page=4
‘Preventative drugs are generally recommended when people experience three or more migraine attacks per month for at least three consecutive months. There are two reasons for this:
Preventative drugs can help to reduce the frequency of attacks by approximately 50% and therefore improve the individuals’ quality of life;
Reducing the frequency of migraine attacks also sees a corresponding reduction in the use of acute treatments.
A reduction in the use of acute treatments generally improves their efficacy and attacks are brought under control much faster.
There are four groups of drugs commonly used in the prevention of migraine:
Beta-Blockers, e.g. propranolol, atenolol, metoprolol;
Tricyclics, e.g. amitriptyline, imipramine, nortriptyline, dosulepin;
Anti-epileptics, e.g. topiramate, sodium valproate, gabapentin;
5HT2 antagonists, e.g. pizotifen.
We know that these preventors work, what we don’t know is how the individual will respond to them in terms of side-effects and efficacy.
Two of the main reasons that the preventor drugs “don’t work” is that the dose isn’t high enough to be therapeutic and the drug isn’t taken for long enough. In order to give a drug a fair and realistic trial, we would recommend at least three months at a therapeutic dose. Improvement often occurs on a month by month basis.
The third main reason why a preventor fails to be effective is intolerable side effects. If side effects prevent you taking a drug, then it would make sense to try a different one, either within the same drug group or from a completely different drug group.
Preventor drugs are started at low dose and increased over several weeks to reduce the impact of side effects, and to achieve a therapeutic dose for the drug to be effective. This will take perseverance by you to find the right drug that works for you, and will require regular visits to your GP or headache specialist in the initial stages to get the treatment regime correct.
by Jill Murphy, Headache Specialist Nurse.’
It can help to keep a migraine diary to monitor the effectiveness of your medication, please find attached The Migraine Trust’s factsheet about keeping a migraine diary which includes template diary pages that can be duplicated and used to form your migraine diary.
