How to manage migraine and chest pain in a female?

Question

Hello doctor,

I am a 21-year-old female with a height of 5.4 feet. I was diagnosed with migraine by an ENT doctor a few months ago. He prescribed Inderal LA 40, Bilambic-M, and Zincoresp. I continued these medicines for about three months and then stopped them, as I was feeling fine.

After stopping the medicines, I remained okay for around two months. Then the migraine returned severely, this time associated with daily vomiting. After about one more month, I also started experiencing chest pain.

I restarted Inderal LA 40, but I feel it is not working anymore. I continue to have chest pain and severe headaches even after taking the medication. I experience a severe headache throughout the day. Even after sleeping for eight hours, I wake up in the morning with a headache, and I go to sleep at night with the same pain.

Now the headache is constant and extremely severe. It feels unbearable, as if someone is hammering or biting inside my head. I also have ringing in my ears, pain in my eyes and legs, extreme lethargy, and fatigue. I do not know what to do, as the pain has become very difficult to tolerate.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

Chest pain associated with migraine can sometimes be related to the headache itself and may improve once migraine control is achieved. However, in young females, chest pain should not be ignored and requires evaluation to rule out cardiac or other causes, such as cardiac cephalgia.

Symptoms like tinnitus, eye pain, and fatigue are commonly seen in migraines. That said, the presence of new or worsening symptoms along with chest pain is concerning and needs urgent medical attention. If there is sudden worsening of pain, vision changes, weakness, confusion, or shortness of breath, immediate evaluation in the emergency room is strongly advised.

Since this was initially diagnosed by an ENT (ear, nose, and throat) specialist, it is important to consult a neurologist for a comprehensive evaluation and full migraine workup. Medications such as Bilambic-M (Levocetirizine and Montelukast), which is mainly used for allergy relief, and Zincoresp (zinc supplement), do not directly treat migraine and may not address the underlying cause of persistent headaches.

I would suggest the following treatment options:

1. Failure of Inderal LA 40 after previous use often indicates the need to consider alternative preventive therapies. Common options include Topiramate, which is usually started at 25 milligrams once daily and gradually increased to 50 to 100 milligrams per day, depending on tolerance and response. Newer treatments such as Calcitonin gene-related Peptide (CGRP) inhibitors may also be considered as first-line options according to recent clinical guidelines.

2. Before switching medications, it is important to confirm that Inderal (Propranolol) was taken at an adequate dose for an adequate duration. Effective migraine prevention typically requires a dose equivalent to 80 to 240 milligrams per day for at least two to three months. Propranolol should never be stopped abruptly, as this can cause rebound symptoms and worsening headaches.

3. In addition, identifying and tracking migraine triggers is essential. Maintaining good hydration, following a consistent sleep schedule, managing stress, and avoiding known triggers can significantly help. Acute migraine attacks should not be self-medicated without proper medical advice, as incorrect treatment can worsen the condition.

Kindly revert if there are any queries.

Thank you.