If you could pick ONE med to start with..what would it be?

Hi MAVers :slight_smile:
I am going to my GP tomorrow…out of desperation for some medication. My question is this…If you had to pick one med to trial (early on) what would it be and why?

My GP said previously she thinks I need an antidepressant/anxiety drug such as lexapro, celexa, zoloft, paxil ??? I do get headaches, dizzies, all the fun ear symptoms (mostly in one ear) and I do cry off & on daily (but I think that’s because I’m so new to this overwhelming new life- 1st attack was in Feb)-- and I think I cry alot because I have no dx and I am fearful… :? I rarely drive because I’m scared something will happen to me…and my hubby works shiftwork so I am alone alot.
Others keep mentioning Nortriptyline but what all does that help? I do have Ativan so I take it for the dizzies almost daily but have never taken a full pill because the ENT told me not to. So I’m also going to ask for either more Ativan or Valium.

I am sorry if I keep asking the same questions over & over in different posts…I’m so frustrated.

I have fibromyalgia and I’ve heard the tricyclics can help with that also…so maybe I could kill 2 birds with 1 stone.
Thanks for continued input.

my first med was amitriptyline…i started taking that almost one yr ago. It helped “at first” but then things got worse…its like a roller coaster, i think we can agree, we have good days & bad days… :frowning:

then i went on celaprex b/c i have trouble sleeping & my dr hates to prescribe sleeping pills. :expressionless:
Then i saw a new dr that diagnoised me as having basilar migraine & she prescribed Veramapil.

Ive been on that for 1 month & the first 3 wks I didnt have ANY headaches. that was a blessing. I think i would have like to started on that.~~
right now i am on all 3 meds & i just take it day by day.

PS…shell…my sister has fybro as well & she takes amitriptyline, she says it helps her sleep.we are both on the lowest dose.


If you have anxiety and depression problems associated with this then either an SSRI, SNRI or a TCA may be effective. TCAs come with more side effects but can be effective and at a low dose and so you might avoid the side effects – the same can be said about SSRIs and SNRIs.

I’d have a chat with your GP about what he thinks is a good start. If you look at the level of evidence supporting the use of these medicines, they all fall under Level B.



Thanks Amaretto, I’m glad you haven’t had any headaches! :smiley: I know what you mean about taking it day by day…we probably could change that to hour by hour! I’ve heard quite a bit about verapamil and pizotfen?

Thanks to you too Scott! I’ve read extensively about the SSRI SNRI and TCAs…I’m not thrilled about the side effects of any of them! :expressionless: It kills me to read that some side effects are dizziness and headache–ughh. And not thrilled about the weight gain either since I just lost 13lbs! Thanks for the link to the evidence for the meds. I will share that with my GP tomorrow and let you all know how it goes. I guess I just need to try SOMETHING. Didn’t you say Celexa helped you a lot at some point? ( I read that somewhere on the site) but now you take low dose paxil?

I really appreciate your help…

Perhaps a low dose of Cymbalta (SNRI) would help? It is also approved to treat fibro. 60mg is the therapeutic dose, but maybe you could start at 20mg, then titrate to 30, then to 60? It is usually weight-neutral, and does not make people as drowsy as some tricyclics.

I’m a type A personality with a desire to get to the bottom of things as soon as possible. I agree that an SSRI (low dose) can be helpful in dealing with the emotional field trip this puts you through–not to mention the fact that there is some evidence that large shifts in seratonin levels may be a trigger for migraine activity–and can sometimes be caused by changing environment (internal or external environment). In other words–it is possible that something along the way caused a shift in your emotional well being that caused a cascade effect in your seratonin production/uptake that then triggered migraine activity. This would then, of course, frighten and upset you, causing a positive feedback loop causing more imbalance in the chemical production and uptake mechanism–which would trigger more migraine activity and more upset…blah blah blah. In other words–it wouldn’t hurt to begin a low dose SSRI–though I DO NOT RECOMMEND PAXIL as it has a slightly higher occurence of side effects and a shorter biological half life meaning that it can cause more severe chemical withdraw symptoms upon stopping the drug if you’ve used it for an extended period of time at certain doses. Prozac (generic name fluoxetine) tends to have a lower incidence of that problem–so you can “get off it” easier.

That said–for the migraine–I know it has a bad reputation for initial sometimes nasty side effects that can be frightening and frustrating–but topomax started to make a difference for me at as low a dose as 37.5 mg. It wasn’t much of a difference but I wasn’t constantly off balance–and thought I could see improvement. By 50 mg I even considered staying at that dose and living with the results!!! I’m now at 100mg and have really great WEEKS when I feel nearly normal!!! I can’t help but vote for that medication as a drug of choice, though as I said…I completely understand the difficulty in dealing with the side effects. The first three months were really really tough…hah, but they weren’t any tougher really than the stupid migraine life was…just different.

hi shell,

not sure if you saw this in another post but i also have fibro. several of the drugs that treat mav also treat chronic pain so it is in theory possible to kill 2 birds with 1 stone. drugs you might consider are nortriptyline, amitriptyline, effexor, cymbalta, topamax, lyrica, gabapentin, etc. I myself found tremendous pain relief from gabapentin- unfortunately it made my balance much worse which is beyond frustrating. anyway you have a lot of options here- are you on anything now for the fibro?

Thanks sarahd, I almost didn’t see that other post! Yeah I am aware of those. I tried cymbalta several years ago and it didnt go well. Today the GP gave me an “emergency kit” for me to carry in case of an attack–(Ativan, Zofran and meclizene) so I do feel like I have a safety net if I have an attack of some kind, I dont feel defenseless. We discussed antidepressants but didn’t decide on one as of yet. I did mention ami and nortrip to her but she made a face and talked about the side effects. Well, to me the side effects of the SSRIs are too much better! I will wait and see how my anxiety level does after this week, She’s going to try to find me a neurotologist somewhere that we can travel to. Thank you for trying to help me! Alls I take for fibro is my ambien for sleep and I take occasional flexeril if I’m flaring. Thanks for asking, sharahd! :slight_smile:

Have you considered Lyrica?
I would try Celexa and then Lyrica…I would use the benzo as an “as needed” medicine.
I would have suggested Cymbalta, but you already went that route. Bummer.