I’ve recently re-read an old Patient Information Leaflet produced by the UK Grampian regional health authority which listed its first choice as being Blood Pressure Medications, ie Beta blockers (Propranolol, Atenolol, Metoprolol), ARB class (Candesartan) and ACE Inhibitors (Lisinopril) and its second as antidepressants either the tricyclics (Amitriptyline, Noritriptyline, Dosulepin) or the SNRI Venlafaxine. Then the Anti-epileptic medications (their words not mine) Topiramate, Sodium Valproate and Gabapentin and the Antihistamine medication - Pizotifen. (First choice for children).
I was interested to read it stated 80% people found with slow titration that they could tolerate Topiramate. That it stated many people needed 100mg Amitriptyline for control and up to 150mg was possible. That they attributed the low uptake of Pizotifen to the high doses needed (up to 4.5mg) and the fact that the text seemed to infer a dose of 240mg of Propranolol would need to be maintained, which is way over the National recommendation of 160mg. Written for patients on their own Scottish clinics on recommendation of their own experts just goes to show how opinions vary. It’s obviously what works for them.
I was contemplating putting a link on here but when my broadband failed me and I was forced to re-find the original I hit upon what must be a more recent update which contains even more useful bits of information so decided to link that instead. It mentions Topiramate can take between 3-4 months to work! It lists Candesartan, Effexor, Gabapentin and Sodium Valproate as ‘treatment should only be instigated on the recommendation of a migraine specialist’ which certainly surprised me. Why such restrictions one wonders. It refers to the ‘special UK status’ of Flunarizine which can only be prescribed by a migraine specialist and issued from a hospital pharmacy. It also states the Flunarizine is not widely available throughout the UK. Includes references to the special status of fertile females, pregnancy and preventatives together with a section on the ‘highly specialised restricted use’ of Botox. Altogether a worthwhile read. Might be a useful article to put in front of an obliging UK doctor who was willing to help but not quite sure? Helen