MDJunction - People Helping People
Ask a Question
06/22/2013 07:44 AM

When to go to the ER?

trixxPosts: 576

Hi all,

I just posted this in the migraine forum, sorry if you see the repeat.

I've had chronic daily headaches and migraines since Jan. 2013.

I am currently on day 3 of a migraine, it's moderate pain at the moment but I know it will likely get bad later.

I am on 30mg of amitriptyline (since February) and saw a neuro 3 weeks ago who told me to go up to 40mg of the amitriptyline. I haven't done that yet, due to fear of the side effects..

My neuro wouldn't prescribe me any triptans, he said they are 'inappropriate' for someone with chronic migraines. I'm only allowed OTC pain meds 2 days a week.

So day 1 of this migriane, I waited as long as I can, then took 400mg of Advil (ibuprofen) which knocked it down from an 7 to a more tolerable 6/10.

Day 2 (yesterday), in pain after 4pm, took another 400mg of Advil before sleep (couldn't sleep due to pain).

Today- I'm currently sitting at a 5-6/10. If it gets bad again I'm going up to 600mg of Advil later.

So my questions would be: how many days of a migraine before you decide it's ER time? I've only been to Urgent Care once and they gave me an IV muscle relaxant which didn't help and sent me home.

I can move my amitriptyline to 40mg tonight, but I doubt it will help...?

Weather forecast for here: temperature going up to extremely hot 36-41 C (100+ F) with a 40-70% chance of thunderstorms every day starting today until next Friday. Blink


06/22/2013 04:32 PM
tortoisegirlPosts: 3237
Group Leader

Preventative meds take time to work. Sounds like your need to discuss with your doctor a better migraine treatment plan. If Triptans help, why can't you take those 2 days a week and an otc analgesic 2 days a week (if needed). Some doctors will even prescribe a rescue type med, possibly something injectable to keep someone out of the ER.

Or, steroids infrequently to break a migraine cycle. I won't go to the ER anymore just for pain as it doesn't wait for possibly hours just to get meds that might take the pain down some for a few hours, then it comes back. I do however have several at home med options (three types of Triptans, a narcotic, and Sprix Toradol nasal spray).

Does one of your doctors call in meds if you call, or could you get an appointment on Monday? If not, if you feel the need, then you might want to go to urgent care and see if they have ideas. Then, schedule a doctor appointment to come up with a better plan. I think its lame your doctor just tells you to take otc meds...there are definitely more options without even resorting to Triptans or narcotics.

Also, ask your doctor or pharmacist, but 800mg of Advil should be safe, especially if you aren't taking multiple doses a day for days on end. That won't break the cycle though, just possibly tone it down for a few hours. Otc meds have never helped my headache. Best wishes.

06/22/2013 05:42 PM
trixxPosts: 576

Thanks Kate!

From reading online, it seems I should have worked with/insisted on my neuro in a migraine abortive/rescue meds plan. I had a cancellation appointment, ran out, was anxious and forgot to ask so many questions.

I did ask him "what do I take if Advil stops working on the bad days?" and his response was "You're asking the wrong question, it should be what you should take to prevent the bad days altogether"... and that was the end of that.

At the time (3 weeks ago) I was having two bad days a week (pretty consistently), which still response some with Advil and sleep so I didn't push it. Though this week, I've had 5 bad days... possibly weather related.

I'm going up to 40mg on the amitriptyline tonight *deep breaths*. Don't mind me if I come on here with more questions on side effects...

On that topic, say I go up to 40mg, find the side effects to be unbearable after a few days to a week, can I just drop back to 30mg (current dosage)? In that short time, would there be any withdrawal effects (I've never been on any meds long time)?

I'll go to my GP on Monday, I can always get an appointment the day of. I just don't know if he'll do anything, he tends to defer to specialists and not prescribe something 'to step on their toes' so to speak. He wouldn't refill my birth control pills even though he's prescribed the exact same ones to me years ago, because my gyn is the one who now prescribes them (even though my gyn was on vacation at the time).

I have a feeling when I call the neuro, he'd probably point out that I should have gone up in dosage like he said to do three weeks ago...

Thanks again!

06/22/2013 08:29 PM
tortoisegirlPosts: 3237
Group Leader

I think there should be a plan for the bad days while you are working out how to best prevent the pain. Even if he gave you something that ended up not working, at least it would be trying something. I definitely think you should try to get in with an actual headache specialist (but keep your current doctor until then).

It shouldn't matter if you didn't go up in dosage three weeks ago because it is very likely that isn't going to be some miracle cure. The standard goal for a preventative med is 50% reduction in frequency and/or severity. Although reaching that is life changing for most folks, even then, folks often need prescription abortive meds.

Do you think the Amitriptyline is helping? How long have you been on it? I don't see any issue going from 30 to 40 back to 30mg. Even if you stayed on that dose for awhile I wouldn't expect withdrawal from that low of a drop. Best wishes.

06/23/2013 10:29 AM
Posts: 131

What kind of side effects you are getting with Amitriptyline?

06/23/2013 12:14 PM
trixxPosts: 576

Kate- I've read a lot about the goal of preventatives to reduce the headaches/migraines by 50% in severity and/or frequency. Also I've read that the preventatives (any of them??) may only work on 50% of people.

My problem is I'm not sure what time period to compare it to, migraines wise. Before the daily headache? or After?? I started the amitriptyline at 10mg on day 11 or 12 of when the daily migraines/headaches hit. So the first two weeks, it was nearly every day migraines. I went down to about 2-3 migraines a week with a low-mid level headache daily the last couple of months.

So with that comparison, I *think* it helped? I have been on 30mg since the end of Feb. I went up to 40mg last night. My neuro said that 2 migraines a week is still too many, so that's why he said to up the amitriptyline. Since I only met him once, I don't really know him, but I'll call tomorrow and see if he can prescribe me any type of abortives. Even if its a stronger pain killer.

This last week I had 5 migraines, and I predict more to come next week because of the weather. Thunderstorms predicted every day this week (starting yesterday) until next Friday. It's humid, with temp. @ 40C or 104 F. I'm seriously debating driving up north or something.

Srishti- I've had a lot of side effects, some of them went away after a few weeks of starting the med, and some stayed.

The ones that went away after a couple of weeks:

- Drowsiness, dizziness, blurred vision, slight trouble urinating, falling asleep soon after taking the med, small muscle twitches (didn't hurt and lasted for 2-3 seconds) all over, and dry mouth in the morning. (These were the main ones I can remember...)

The side effects that never went away:

-Anxiety, fast heart rate & palpitations.

- I still get dizzy some days (low pain ones) or when I stand up too fast.

Side effects that are common but I did *NOT* experience:

- constipation, weight gain, carbs craving and difficulty waking up in the morning. (<- common complains I read about when researching the med).

Since I went up to 40mg last night, I feel ok. Heart's still racing, a few weird flip flop of the heart (palpitations), and dry mouth...other than that, no return of the other side effects.

Sorry for the long post!

06/23/2013 12:30 PM
Posts: 471

have you been tested correctly for lyme? has to be a western blot and have zero positive bands to know your negative. my daily headaches turned out to be lyme/babesia. you need triptans to keep you out of ER. i take them all the time, plus fioricet. i just stopped amitriptyline cause none of the preventatives hhave worked.

get tested, get some imitrex dfor migraine emergencies.

good luck

06/23/2013 04:28 PM
tortoisegirlPosts: 3237
Group Leader

Are you keeping a log so you can compare any progress? It sounds like you have been helped quite a bit by this med. Do you think the side effects are worth the pain relief? They may still subside some over time. I think 50% of people responding to a certain med is quite generous actually.

I know a lot of us here are the exception though. Have you been exploring any potential avoidable triggers like food or activities? Agreed you should have some sort of abortive. Its often tough to get doctors to prescribe anything new over the phone though (comfort wise). Plus, its a lot of work for them to do things between appointment. Its quite possible you will just have to try to move your appointment up / get on a cancellation list. Best wishes.

06/24/2013 11:37 AM
trixxPosts: 576

nspeedracer- I was looking into lyme last month, and I've spoken to a few people with lyme in the area about which doc they go to etc.. I'll have to order the test from Igenex soon, but it's a money issue (for the tests and subsequent LLMD appointments + meds if lyme positive).

Kate- I do keep a log, it used to be daily but now its only the bad days and unusual symptoms I write down. I think my main trigger is stress and the weather. Nothing I can find food wise but I did go gluten-free (80-85% gluten-free...) for almost a month now.

I called the neuro's office, talked to the secretary, I've had an increase of palpitations/chest flutters today so I asked about that and an abortive for the migraines. She told me the doc would call me back, but he didn't, he gave her a msg to pass back to me.

He told me to go back down to 30mg on the amitriptyline because of the palpitations and then she said "he discussed all of your meds with you at your last appointment, he's not adding anything." So when I told her, he was the one that told me 30mg of amitriptyline was still too low because I was getting too many migraines still... she told me I had to book an appointment then to talk to him. I also told her, all I've got to take is Advil, but he told me upping the amitriptyline would decrease my migraines= no need for the Advil...but now I'm back to 30mg=more migraines... sorry I'm going in circles and ranting.

I have an appointment to see him in 2.5 weeks. So I'm going to my GP tonight to see what he can prescribe, if anything, until my neuro appointment.


Just got back from my GP empty handed. Told me he doesn't think the neuro wants me on prescribed painkillers or triptans since he didn't prescribe any. So my doc is following suit. Was told I can take 600mg of OTC ibuprofen (Advil) when migraine hits, instead of the 400mg that I take now. Great. Pinch

Post edited by: trixx, at: 06/24/2013 05:52 PM

06/24/2013 09:04 PM
tortoisegirlPosts: 3237
Group Leader

Sorry you didn't get a solution today. Hopefully the pain stays manageable until your appointment. What about seeking out a headache specialist and getting on their appointment list? There is no issue with seeing multiple doctors, especially if you only get meds from one doctor and are interviewing the others to see if one may be a good fit to transfer to.

From what you've said your doctor doesn't seem too compassionate, nor does he seem to be trying anything to actually break the cycle. Unfortunately that is par for the course...I've had more bad doctors than good ones. Although the good ones have been awesome.

If you are needing something more than a couple days a week, you may want to rotate the otc analgesic at a minimum (ex. Aleve instead of Advil). You don't want rebound (or even your doctor thinking it is rebound and insisting you take nothing at all). Some folks get some help from meds like Sudafed, Benadryl, or Muccinex. Probably something to confirm with your doctor it would be ok to try though. Hang in there! Best wishes.


Share this discussion with your friends:
<< Start < Prev 1 Next > End >>

Disclaimer: The information provided in MDJunction is not a replacement for medical diagnosis, treatment, or professional medical advice.
In case of EMERGENCY call 911 or 1.800.273.TALK (8255) to the National Suicide Prevention Lifeline. Read more.
Contact Us | About Us
Copyright (c) 2006-2014 All Rights Reserved