As I’ve mentioned before, the conventional wisdom in building your personal brand in the digital sphere is that one should use alliterative hashtags based on the day of the week. Too bad today is not Monday, as the most exciting thing that happened today was a #migrainemedicationmistake.

So, I had a migraine today. I also had one yesterday, and I had one the day before that.

If I were the sort of tragic hero that we learned about in ninth grade English class, my choice would be between taking rizatriptan or not taking rizatriptan. This is the medication that miraculously makes my headaches go away—entirely—for the rest of the day and that usually works within an hour. However, the insurance company will only allow you nine tablets per month. Also, if you take this medication too often, it will give you headaches. (No joke.) (Code: G44.41.)

Foreshadowing: I combine my rizatriptan with naproxen sodium, which is kind of like Aleve but somehow slightly different.

So the game is if you get enough headaches per month that you are at risk of ending up on the path to G44.41, then you try to find something that you can take every day that stops you from getting headaches. You might start, like I did, with propranolol. If you are like me, you will get annoyed that the nurse at the allergy shot clinic had not asked you if your medications had changed and gave you your allergy shots even though you had been prescribed propranolol and picked up the prescription (so if our regional electronic medical records system was working at all properly, the nurse might have known that I could be taking propranolol). And you would have written a letter (on paper!) to the doctor in charge of the allergy clinic. Propranolol is a beta blocker, and it is very dangerous to get an epinephrine shot when you are taking beta blockers. And allergy shots have a non-zero chance of triggering an allergic reaction. But propranolol did not do anything at all to help my headaches, so I stopped taking it. And I am not going to go back to the allergy clinic because not only is it inconvenient, but I still do not trust the nurses. One nurse started to write down in my file that I was pregnant, and she was going to adjust my allergy shot dose based on that assumption—but I was just fat, that was all. (WHO DOES THAT!?)

So when propranolol doesn’t work, next you take amitriptyline. To save you from having to open a separate browser to look these up without ruining your search history, propranolol (the first drug I mentioned) is a blood pressure medicine. Amitriptyline is an old anti-depressant. My guess is that Michelle overdosed on it. But I was taking a very low dose. It made me sleep a lot, and it did nothing for my headaches. Topiramate (anti-seizure medicine) was next. Before I had even stepped up to the 45 mg/day dose that my doctor wanted me to take, I had to quit because the side effects were completely unacceptable. As noted in the 2004 paper by Silberstein, Neto, and Schmitt, “The mean change from baseline in migraine frequency was significantly greater for patients treated with either 100 or 200 mg/d of topiramate (P <.001 vs placebo) but not for those treated with 50 mg/d of topiramate (P = .24).”

Next was the Botox run-around.

Me: I heard that Botox is FDA approved for migraine. Can we try it?
Doctor: The insurance companies hate paying for it.
Me: I have money. Let’s try it.
Doctor: The insurance company won’t pay for it.
Me: I will pay for it.
Doctor: I don’t know how much it costs.
Me: I don’t care. I will pay for it.

The doctor was not willing to prescribe a treatment that the insurance company won’t pay for.

And then there was that whole weird migraine aura thing that had me in the hospital last summer. And it seemed like levetiracetam (another anti-seizure medication, but one that does not give me any side effects) helped with that, so now I am taking that.

That brings us to today’s minor adventure. Recall: my standard response to having a migraine is to take rizatriptan and naproxen sodium. Meanwhile, I take levetiracetam twice a day: once in the morning, and one in the evening.

You probably can guess how this played out.

This is rizatriptan:

rizatriptan

This is naproxen sodium:

naproxen

This is levetiracetam:

naproxen

Fortunately, I am on a low enough dose of levetiracetam that taking an extra pill is not dangerous at all. Most adults take twice as much as I do. Also this confirmed my suspicion that the rizatriptan is primarily responsible for making me feel better, rather than the naproxen sodium.

Since I’m pretty sure that the levetiracetam isn’t working that well for me, when I see the doctor next month, I’ll find out if I can try something else that doesn’t look remarkably similar to any of the other drugs that I take.