Miss Migraine: Efficacy vs. side effects

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The Adventures of Miss Migraine is an ongoing column about my life with chronic migraine. A version of this post appeared first on July 30, 2012, on my blog of the same name.

I’m taking 150 mg of Effexor every day. Photo by Kelly Lynn Thomas.

When it became clear that zonisamide (brand name Zonegran), an anti-seizure medication sometimes prescribed for migraine, was doing little more than eliminating my aura, my doctor gave me a choice.

“Are you more worried about side effects or efficacy?” she asked me. “Because you can try Prozac, which is easier to handle but not as effective, or you can try Effexor, which is much harder to handle, but more effective.”

I didn’t want to take an anti-depressant, but my blood pressure is too low for the blood pressure medications that can be prescribed for migraine patients. So I weighed my options. The throbbing in my right temple spoke for me.

“Efficacy,” I said. “Things have been pretty bad.”

She explained the possible side effects: sexual dysfunction, risk of increased depression or anxiety, trouble sleeping. In the past, those would have been unacceptable side effects. But after four years of constant, unending, continuous pain, I was willing to make sacrifices.

I left feeling hopeful.

Three weeks later, all feelings of hope have evaporated. I wake up every hour or half hour during the night. In the morning I feel anxious for no reason. I am lightheaded and dizzy, and sometimes nauseous. The poor sleep is leading to more severe migraines.

I remember why I hate medications, why I hate doctors, that nothing has ever helped. Waves of despair wash over me and I feel like nothing ever will. Taking Effexor is harder than I imagined.

But then I take a deep breath and remember that my doctor told me tapering up is the hard part. I haven’t even been taking the full dose for a week yet. I have to be patient, but that’s not something I’m very good at. It should get better. My body should adjust. And if it doesn’t? We’ll try something different.

I just have to work on being patient.


Where I’ve been (Hint: Not in a good place)

I’ve been struggling. My migraines are terrible, my insurance has denied coverage for a medication that would probably make me feel better, and I’ve lost the ability to make decisions.

For awhile, I thought I was going to shutter this blog entirely, but I’m reluctant to let it go. Sometimes writing about migraine disease is the only thing that prevents me from succumbing to the depression that goes hand in hand with being in pain 24/7. But like I mentioned earlier, I’m giving this blog a sort of half-life by only posting once or twice a week and not telling anyone it exists.

The whole reason I started this blog was to a.) help me process and understand migraine and what I have to go through because of it, and b.) to help make people more aware of migraine disease and its affect on sufferers.

I still feel strongly about that second part, and I suspect the first part is more important to my mental health than I know. Writing is how I process things, how I work things out. When I’m not writing about migraine I’m often stuck in a loop of “my life sucks.” When I do write about it, I can see the positive side of things better, like when I have a good day or am productive despite the pain.

So for now I’ll continue. I’ll get back to posting every Wednesday, and try my best to post more often. I’ll spend more time promoting the blog (in a social, friendly way, of course!), in hopes that I can engage not only fellow migraine sufferers, but also those who don’t have migraine but would make good friends and allies.

Onward and upward!