I don't know what meds to take next?

Hi Everyone,

I been taking Paxil for 3 days now and I can’t stand the side effects…so I think I have to stop. The headache I got yesterday from it was one of the worst I have ever had in my life. Effexor was a dream in comparison to Paxil when it came to side effects in my experience. I don’t know what drugs to try next. I’ve been on Topamax, Effexor, Birth Control pills and Paxil…I can’t do the blood pressure meds nor the seizure meds because of different reasons. I have to just try another antidepressant but I don’t know which one…I’m thinking about trying Cipramil but the doc says there in not a lot of proof that it works…

I’m so depressed… :frowning:


I’m curious, do you have to stay away from ALL antiseizure drugs? Or was it just a bad experience with Topamax? One that seems to be much more well-tolerated (very few side-effects) and that has shown promise is levetiracetam, aka Keppra.

Anyway, other antidepressants are fluoxetine (Prozac) or amitriptyline (Elavil). Drugs similar to Elavil are nortriptyline, doxepin and protriptyline. Dr. Hain thinks Prozac is “ineffective but perhaps worth a try anyway,” and says Elavil is an “effective and inexpensive drug,” though “with considerable side effects.” He says, “We mainly use this drug when our favorites fail.”

There are also some other classes of drugs, like beta blockers.

There’s also a somewhat commonly used drug, pizotifen (Sandomigran), that actually is (in mechanism) the opposite of an SSRI and antagonizes (lowers) serotonin. Cyproheptadine, or Periactin, is similar (I think Sandomigran isn’t FDA-approved). These seem to have worked in a number of cases. I don’t know why SSRI’s work for some people and “anti-SSRI’s” work for others…

Someone once posted a list (here on MVertigo) of 100 medicines that have been used for MAV, so there’s lots of choices. Some doctors combine two or more medicines when multiple single ones fail. So, there’s still lots of options. I would discuss this matter with a doctor. You see Hain, right?

If you can’t do the blood pressure meds or seizure meds then I would try the different class of anti-depressants called tricyclics.

If you look at the stuff Dr Rauch wrote, he mentions nortriptyline is his favourite. You could give that a go. There are a number of other tricyclics too.

These are old style anti depressants that were used prior to the newer SSRI and SRNI’s, like prozac and effexor. I think it’s relatively recently that they started using drugs like paxil etc for migraine, whereas they have been using tricyclics for a long time as a migraine preventative.

It’s worth a go. Alternatively, as George says, there is pizotifen. A friend of mine did very well on this.


I was on nortriptyline for almost a year and it worked pretty well for me. I was averaging around 80-90% most days. I didn’t think the tiredness was too bad as long as I took my dose up slowly. Unfortunately for me, I had to discontinue it because of side effects around the year mark. So I would say give it a shot!

Hi Everyone,

Thank you so much for your responses!!!

I talked to Hain and he told me to give Paxil another go but on a lower dose. If that doesn’t work I have to move onto something else. I’m thinking of trying Celexa…Has anyone tried it?



Hi Emma,

I know you know this already but thought I’d throw this in here for others to read. Celexa (Cipramil in Australia) was what pulled me out of a permanent dizzy world in 2004 following a massive VN attack in late 2003 which, in turn, triggered MAV. Cipramil never killed my headaches and, in fact, they got worse over time. My sensitivity to water temperature also got worse while on Cipramil although I can’t be certain Cip was responsible. One other girl I know in Sydney also got well using Cipramil. It was because of her advice that I used it back then and stayed on it for about 4 years.

Scott 8)

Hi Emma,

I was on Paroxetine (Paxil, here in Australia known as Aropax) a few years back for depression. I can’t remember what dose I was on but it really knocked me round for the first couple of weeks. To assist, they gave me Prothiaden (Dothep, a tri cyclic). Things did settle down. Ironically, I’m now again on Prothiaden for MAV and it’s doing OK (about 80-90% most of the time). I recently got a new prescription however and didn’t read the dose - I kept taking three pills (as previously 25mg dose each) but the new pills were 75mg each. So all up 225mg per day! No noticeable difference but I just got back from a holiday in NYC where I was back down on 75mg. With all that crazy dosage mix up and the jet lag (a mere 22 hour flight and 12 hour time difference) things were a bit wonky over there but manageable.

Ah the joys of MAV!

Good luck with the Paxil if you can hang in there.


You say you’ve been on topamax but you say you can’t take any of the anti-seizure meds. Topamax IS an anti-seizure med so I’d love to understand what is your situation exactly. Did you give topamax a FULL 4 months? Did you take at least 100mg? 50mg is all I needed to get me to 90-95% on most days but some people needs mor. But if you quit before the full 4 months, it’s possible that you may have stopped too soon. Some docs will tell you that it should start working within a month, but it can take up to 4 months to work. It took me almost 4 months myself to experience the relief. Just FYI


Hi Rich,

I was prescribed Topamax from another doctor before I met Dr. Hain. I felt really bad on Topamax after a few days and my doc told me to stop taking it. Because of my profession, Dr. Hain thought it would be better if I stayed away from the anti seizure medications. I understand you have to give it some time to work, but in my case it wasn’t worth it.

Victoria, thanks for your thoughts. I’m not sure if I will give Paxil another try…I’ll figure it out tomorrow.



— Begin quote from “emmasaga”

Because of my profession, Dr. Hain thought it would be better if I stayed away from the anti seizure medications.

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Hi Emma,

Just some food for thought in case you ever get to a point where you want to try something other than an antidepressant: Zonegran (zonisamide) is similar to Topamax but is often more tolerable in terms of side effects. My neurologist had me try it because he said he has had several patients who could not tolerate Topamax do fine on Zonegran. I found this to be the case for myself in terms of cognitive side effects. I had horrible cognitive side effects with Topamax but not with Zonegran. I was on each for about two months. Unfortunately, when I reached 125 mg of Zonegran, I developed a dry cough so I stopped it. However, I’ve since started back on it at 50 mg because it helps with my headaches and energy level. So far, the cough hasn’t returned.

Good luck with whatever you try!