I am 36, female on Galcanezumab. Is it worsening my anxiety?

Question

Hi doctor,

I am a 36-year-old woman diagnosed with chronic migraines, experiencing around 15 headache days per month. I have been receiving monthly Galcanezumab (Emgality) injections for the past four months. While the frequency of severe migraines has reduced to about seven to eight days per month, I still experience nausea, sensitivity to light, and occasional vomiting during attacks.

In addition to migraines, I have generalized anxiety disorder and take Escitalopram 10 mg daily. My latest blood pressure was 136/86 mmHg, and my resting heart rate is around 92 bpm.

Since starting the injections, I have noticed increased restlessness and occasional chest tightness. My weight has also gone up by 9 pounds over the last three months. I am worried if the injection is interacting with my anxiety medication or worsening my symptoms. Is this a known side effect? Should I consider switching to a different preventive therapy or adjusting my SSRI dose? Would cognitive behavioral therapy help in my case?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

I am deeply concerned about your worries; You should avoid common food triggers for migraine, like:

Aged cheeses: Blue cheese, Parmesan, and other aged cheeses contain tyramine.
Chocolate: The beta-phenylethylamine in chocolate can be a trigger, according to the American Migraine Foundation.
Alcohol: Red wine and beer are frequently cited as triggers.
Processed meats: Hot dogs, pepperoni, and other processed meats often contain nitrates.
Citrus fruits: Oranges, grapefruit, and other citrus fruits may trigger migraines in some individuals.
Nuts and nut butters: Peanuts, peanut butter, and other nuts can be problematic.
Foods with tyramine: In addition to aged cheeses, tyramine can be found in soy products, miso, and some beans.
Foods with nitrates: Lunch meats, bacon, and salami are examples.
Monosodium glutamate (MSG): This flavor enhancer is found in many processed foods, fast food, and some seasonings.
Artificial sweeteners: Aspartame and other artificial sweeteners can trigger migraines.
Caffeine: While some people use caffeine to relieve headaches, it can trigger migraines in others.
Other fruits and vegetables: Avocados, bananas, onions, and tomatoes are also potential triggers.
Dairy products: Yogurt, sour cream, and other cultured dairy products can be problematic.

Management of migraine: You should consult a consultant neurologist for further planning and treatment. Many medicines have been designed to treat migraines. They fall into two broad categories:

Pain-relieving medicines. Also known as acute or abortive treatments, they are used to relieve migraine pain and work best when taken as soon as symptoms begin. These medicines include pain relievers that you can get with or without a prescription. You can take tablets Acetaminophen and Ibuprofen twice daily, to be used for mild migraine pain.

For severe migraines, Triptans are used. These prescription medicines can relieve many symptoms of migraine by blocking pain pathways in the brain. They are taken as pills, shots, or nasal sprays. They include a tablet of Sumatriptan 100 milligrams taken twice daily. They might not be safe to take if you are at risk of a stroke or heart attack. And also, you should consult a consultant psychiatrist for further treatment, and I will advise you to take the tablet Propranolol 10 milligrams two times a day for three months.

Preventive medicines. These medicines are taken regularly, often daily, to reduce migraine symptoms.

Your treatment choices depend on how often you have headaches and how painful they are. Your treatment also depends on whether you have nausea and vomiting, whether your headaches are disabling, and whether you have other medical conditions.

I hope this answers your query.

Thank you.