Hi everyone, been a while since I posted. Just wanted to report my progress - I’ve been on 160mg propranolol and 37.5mg venlafaxine since March 2023, and basically been functioning normally since then - going to the gym, lifting weights, going to work every day, driving, and even riding my motorcycle.
I still have 24/7 symptoms, but they’re mild enough to ignore most of the time. Sometimes it causes me a little trouble, but more a nuisance than an actual problem.
Just wanted to report this for anyone who may be reading. I encourage you to pursue medication if you’re on the fence, because medication can definitely give you your life back. Propranolol and venlafaxine gave me 90%+ of my life back just a few months after I started - in December I was super low after my COVID bout and by mid-April, I was functionally normal. I’ve also hardly had any side effects from either medication. Propranolol makes it harder to push the last 10% in the gym, but other than that and some disturbed sleep for a few weeks, I had no side effects and I was able to bump up the dose all the way to 160mg extended release. With venlafaxine I felt mildly spaced out for a few days each time I’d bump the dose, and then no side effects. I was able to go to work every day through all the medication changes, once I got to a high enough dose of propranolol (120mg) to actually manage the migraine.
I plan to stay on the meds as long as I need to since they’re causing minimal trouble at this point. I’m not at the point where I’d think of discontinuing/stopping them, but hoping to get there eventually.
Amen Sid, I went to more doctors than I can remember before one of them decided my problem might be neurological. Then it took two neurologists to decide it was migraine related before. They steered me to a neurologist specializing in headaches. Along the way, I tried every medication, exercise, procedure the various doctors could think of. None of them helped.
When I made it to the Migraine Specialist, she put me on a different variant of a drug I had already tried, and a supplement. She also sent me to a Physical Therapist that had me do a battery of exercises to strengthen my Vestibular System. But the key to my getting better was the right drug in the right dosage.
Never give up. I was tempted to quit a couple of times, had I done that, I shudder to think how bad it could have gotten.
Update Sep 2025: I’ve been doing so well for so long now that it’d be good to post a summary of my experience here, along with my timelines.
May 2014: dizziness which came out of nowhere and never ended, but got better over 2-3 months. Never completely went away but I was living a normal life for the next 9 years. Constant 24/7 visual snow but I learned to ignore it, occasional dizziness but not severe. No medication, just magnesium supplements.
December 2023: hardcore vestibular migraines triggered after I had a COVID infection. Unable to leave the house for 1+ month. I already knew this was VM so I went to the doc who’d originally diagnosed me and started propranolol.
Feb 2024: Propranolol dose was at 160mg by this time and I was able to go to the office 2-3 days a week and work from home the rest of the time. Feeling about 70% better. No significant side effects from propranolol except weirdness for one week each time I escalated the dose.
Apr 2024: Added venlafaxine 37.5 to my regimen, which cleared me up further to about 80%. I didn’t have any significant side effects from venlafaxine. On this regimen 160mg propranolol + 37.5mg venlafaxine, I was able to live mostly normally - worked a high stress job full time at the office, got married, maintained a normal social life, took a couple of small vacations, and even could ride my motorcycle sometimes (although I’d still get a bit dizzy while doing that so I had to be careful)
October 2024: Was still at 80% and mostly normal life but kind of annoyed at the propranolol’s effects on my heart rate and exercise ability, so I decided to increase the venlafaxine and taper off the propranolol. Had some weirdness for 2 months as a result, but was still able to continue living and functioning normally. Ended up at 112.5mg venlafaxine by December 2024
December 2024: It was my 32nd birthday so I decided to talk to the neuro again and see if I could try to get to 95%. Neuro said my venlafaxine dose was fine, but recommended adding in Emgality. I started Emgality and got Nurtec to use as an abortive. At this point I hit 90-95% and am very happy with where I am.
After December 2024: Medication regimen unchanged with just a few minor side effects which don’t bother me at all. Living a fully normal life. Very high stress job in finance in Manhattan, long hours. Active social life with copious amounts of alcohol consumption (though this does make me feel a bit worse, lol). Taken multiple vacations in this time - went to Miami with my wife in April, did a week-long motorcycle tour in May through the mountains in Tennessee & Virginia (these can be quite grueling so this is where I set my reference - if I can do motorcycle tours, I’m pretty much normal). Took a 2 week long trip to London & Scotland. And just yesterday got back from a week of backpacking/hiking in Montana.
To whoever is reading this, I hope the above gives you confidence to try medication. I was mostly functional by a couple months in, just because I wasn’t afraid to escalate doses to whatever point was required. I did have to add in another med, but that process is nowhere near as problematic as starting the first med, was able to function normally through most of it. Side effects from all 3 meds (propranolol, venlafaxine, and emgality) were minor enough to not really matter - plus there’s the benefit of knowing that they’re just med side effects and no big deal. I was really worried about Effexor in particular (the horror stories online) but it’s been a godsend in my case - not only are the side effects very minor (as long as you taper up slowly), but it has also helped my mood be more balanced and I feel more like myself without feeling like it’s dulling my emotions at all. In fact with how I feel right now, 2 years in, I’d want to take Effexor even if I had no migraines. Once I started taking it I realized I had these weird emotional lows a couple of days every week which are now gone. Since migraine brains are correlated with depression, it makes sense. Even though my depression was not clinically significant, it’s still nice to have it gone. With Emgality I literally had zero side effects.
Anyway, I am very satisfied and living a full, happy life now. I have no plans to reduce the venlafaxine until a few years later, but even then I don’t feel any pressing need to, since I function very well with it. At this point, my migraines are at 90-95% better and I feel completely normal with respect to side effects. I do realize that migraines can change and I may have to deal with them again, but now that I have seen that they’re manageable overall, it’s much less concerning. Oh and one more thing - I completely quit caffeine and in my case that alone reduced migraine incidence by like 30-40%. I wouldn’t have been able to figure this out without the medication, but it became obvious once the meds had increased my overall migraine threshold to the point where the caffeine was an obvious trigger.
If you’re still dealing with all this, hope this post can show you that it’s definitely possible to manage it and live a fully normal (even overly active and indulgent) life.
Very insightful post, thanks for sharing. I have yet to try Effexor, but keeping it there as a “next option” if I need to - your experience with it bumps it up near the top of my list. I seem to have some emotional lows during the week for sure, can’t tell if its sleep or migraine, or both. It’s mild depression I suppose, but I think it correlates with migraines / sleep. As I get a handle (with meds) on migraines here (good progress so far) I’m hoping that it fades.
My only constructive criticism is to take it easy with the alcohol and stressful job, but of course you already know that. Just saying as you get closer to 40 that stuff can really wear on you…