In case you missed it, there was a pretty good discussion about the migraine med Topomax in the comments of the Things I learned last week post. It worked well for some people, but the side effects could be quite spectacular (I shudder to think what would happen if my memory loss got any worse!).
I can particularly relate to the problem of aphasia that you guys mentioned because I have it as a side effect of another medication. Commenter “it’s not all bad” described what I go through as a result of that to a T (because they’ve gone through it as well):
oh yeah, speaking of memory loss from topamax, the one thing i hadin that area, was a little aphasia, where i was always having trouble thinking of *one* particular word in a sentence. it was really frustrating. i felt like i was always playing ‘Taboo’ with people, trying to get them to guess the word i couldn’t think of by defining it for them.
Exactly! I can’t wait to have my committee meeting while experiencing that little problem!
I think the most important thing to take away from the discussion is that you should always read up on the medications you are prescribed, particularly the list of side effects. Some doctors are really good at telling you everything you need to know and some doctors aren’t so much. You need to be proactive. Ask questions. Do your own research.
For instance, here’s part of a conversation I had while being examined by the neurologist. I’m at a teaching hospital, so I’m almost always seen by a resident first and then the attending.
[ATTENDING]: We’re going to give you a prescription for Elavil to help prevent your migraines.
[ME]: What kind of medication is that?
[AT]: It’s a tricyclic antidepressant.
[ME]: Is it okay for me to take that along with the other antidepressants I’m taking?
[AT] to Resident: What other antidepressants is she taking?
[RES]: Wellbutrin and Prozac
[AT] To me: You’re taking Wellbutrin AND PROZAC?!?!?!??!?!*
[ME]: nod
[AT]: Okay, well let’s give you something else, then.
In the end, I got a prescription for Gabapentin. It seems to be working so far–I’ve only gotten one headache since taking it. And it makes you sleepy so I take it at night instead of my sleeping med (so, no net gain or loss of pills).
The attending mentioned Topomax which is why I thought that’s what the sample was that he gave me. But, upon closer examination, I have found that it’s actually Treximet which is a combination of naproxen and imitrex. In any case, the ibuprofen works for my headaches which are usually not so severe as some of the commenters who took topomax.
It’s amazing to me how many people suffer from debilitating headaches (Zuska also comes to mind in addition to the commenters). I am constantly thankful that mine are very rarely that bad. I get about one a year where the pain is so bad I don’t think I can stand it, nothing helps, and I spend the day (or night because sometimes I wake up in the middle of the night with one) vomiting. Not fun at all. I am so sorry some of you have to deal with that. And I’m sorry it can be so bad you have to experience nasty side effects in order to get relief from the pain.
*Could he have sounded anymore incredulous? Way to make me feel like a freak.
I Love Science, Really 
*Could he have sounded anymore incredulous? Way to make me feel like a freak.
If it makes you feel any better, it’s more likely that he sounded incredulous because the neuro resident should have told the attending that. And that’s a pretty big piece of the puzzle to leave out! So he/she probably got chewed out after you left.
I hope that the Gabapentin works out for you!
Well, Welbutrin and Prozac are not prescribed together very often, this is probably why he went all apeshit-like at you. I’m a little surprised they aren’t prescribed more often, as they work via different mechanisms (atypical SNRI/SDRI vs SSRI) and so the additive effects might help. And I know that drugs similar in type of Welbutrin (like Ritalin) are sometimes prescribed along with Prozac to speed the effects along in the first few weeks.
I find Gabapentin really interesting, actually, I wasn’t aware that we were using GABA analogs for treatment of migraine. Are they using anxiolytics for migraine treatment, too? It’s a similar mechanism, but it’s possible that one is more or less selective.
Sci–I don’t remember the neurologist mentioning anxiolytics, but I haven’t looked into it myself. Also, my psych doc prescribes prozac and wellbutrin together all the time. Usually prozac first and then wellbutrin on top if it’s the prozac doesn’t take care of everything.
Keely–Yeah, people become concerned when they see how many meds I’m taking all at once (5 at last count, sheesh!). When I go to a new doctor, I give them a card with everything written on it so there aren’t any mix-ups. And you’re right, it’s totally worth it.
I get the “what the hell” response to celexa + wellbutrin fairly frequently. I think its also partially because I’m 20… people look at me and you can just tell they’re thinking she can’t POSSIBLY have depression bad enough for TWO crazy meds. I try to shrug it off. Yea, I feel like a freak, but I haven’t fantasized about killing myself in MONTHS. That’s worth all the funny looks in the world.
I have memory problems on Topamax, though it is not just the one word issue, but entire subjects. I remember when someone asked me a question about my protein, and I couldn’t remember what a protein was. I stood there trying to run through what I knew about proteins — do they have structure? what are they made of? what is the name of the protein I am holding? and I couldn’t recall anything. It was one of the scariest moments of my life.
But, for me, as long as I have some kind of visual stimulus to help remind me, I am fine. So, while I am utterly useless if someone stops me in the hallway and asks me a question, if I am giving a talk in front of my committee and I have a slide up with general information to jump-start my memory, I am fine. Perhaps you will find something similar, too? Sometimes during my committee meetings if I get stumped on a question I just have to go back in the slides to one that has some information on the topic at hand, and it is enough to get my brain back on track. I’d suggest it if you ever find yourself in a similar position.
I really like your blog! You have wrote a really wonderful article on migraine. Thanks they are a great help!