Why is my 42-year-old daughter’s migraine uncontrolled?

Question

Hello doctor,

My 42-year-old daughter suffers from chronic migraines and recently started receiving migraine injection treatments, but with mixed results. She experiences 15 to 20 migraine days per month, which completely disrupts her life as a single mom of three kids.

She has tried every preventive medication like Propranolol, Topiramate, and Amitriptyline, but all have caused severe side effects. Her neurologist started Botox injections three months ago, which reduced the frequency to about 12 days per month. She was also prescribed Sumatriptan injections for acute attacks, but she can only use them twice a week.

The problem is that she develops rebound headaches from Triptan overuse and then requires stronger pain medications. She recently heard about CGRP injections like Aimovig, but her insurance requires that she try three other preventive options first.

Her migraines worsened during perimenopause, likely due to hormonal fluctuations and irregular periods. Sometimes, the injection site becomes infected or remains painful for days.

She is wondering if there are other migraine injection options that might work better, and whether hormones could be contributing to the increase in her migraines.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

First and foremost, it is important to take good care of yourself and focus on managing your migraines.

Avoid common food triggers for migraines:

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: Found in aged cheeses, soy products, miso, and some beans.
Foods with nitrates: Lunch meats, bacon, and salami are common examples.
MSG (monosodium glutamate): This flavor enhancer is found in many processed foods, fast food, and some seasonings.
Artificial sweeteners: Aspartame and others can trigger migraines.
Caffeine: While it may relieve headaches for some, it can trigger migraines in others.
Other fruits and vegetables: Avocados, bananas, onions, and tomatoes may be potential triggers.
Dairy products: Yogurt, sour cream, and other cultured dairy products can sometimes cause issues.

You should consult a neurologist for further evaluation and treatment planning.

Many medicines have been developed to treat migraines. They fall into two broad categories:

Pain-relieving medicines (acute or abortive treatments) – taken during migraine attacks to stop symptoms.
Preventive medicines – taken regularly, often daily, to reduce the frequency and severity of migraine attacks.

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

Pain-relieving medicines work best when taken as soon as migraine symptoms begin:

Pain relievers: Over-the-counter or prescription medicines such as Ibuprofen (tablet, twice daily) or Acetaminophen may help with mild migraine pain.
Triptans: Prescription medicines that block pain pathways in the brain. They are available as tablets, injections, or nasal sprays. For example, Sumatriptan 100 mg (tablet, twice daily). However, Triptans may not be safe if you are at risk of stroke or heart attack.

You should also consult a psychiatrist if stress, anxiety, or depression is contributing to your migraine attacks.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.