Responses to questions presented by the headache specialists are not intended to be professional consultations. Final decisions as to treatment should rest with the individual’s healthcare provider.

Alternative to Vioxx®

Q. After much medical trial and error, I have been able to control my migraines with daily Prozac® and magnesium and B6. In the past, I took Vioxx at the first inkling of a migraine and it almost always seemed to stop the headache. I have continued taking the preventive medicines and was not too concerned when Vioxx was taken off the market, since I was then migraine-free. Now I am again getting migraines and my old supply of Vioxx is almost gone. What is the closest substitute today available for Vioxx? Is there a COX-2 inhibitor on the market that might work similarly for me? Or is Vioxx still available? Since I would be taking it infrequently for the occasional migraine, I am not worried about the heart risk associated with daily taking of Vioxx. Also, about two months ago, I switched from Prozac® to the generic version, fluoxetine. The headaches began about two months after switching to the generic. I wonder if perhaps the generic is possibly not working as well as the brand-name Prozac?

All questions answered by: Richard Wenzel, PharmD Diamond Headache Clinic Inpatient Unit St. Joseph’s Hospital, Chicago, IL The number of medications that work on the body’s neurostransmitters has increased dramatically in the last few decades—bringing relief for millions of people with a range of conditions. Recently, though, concerns have been raised about the possibility of a reaction to combining these drugs, leading to a rare condition called serotonin syndrome. Neurotransmitters are the chemicals your body uses to communicate mood, pain, anxiety, temperature, pressure and numerous other sensations. There are many different neurotransmitters, but arguably the most important is serotonin. Research suggests that a dysfunction in serotonin is involved in migraine, anxiety, depression, sleep disorders, eating disorders and several other illnesses. Therefore, prescribing medications that help the body better utilize serotonin often provides relief. To alleviate migraine pain, the triptan medications work on specific serotonin receptors in the central nervous system. The selective serotonin reuptake inhibitor (SSRI) medications, such as Prozac®, Celexa® and Lexapro®, help raise serotonin levels throughout the body and can improve mood, depression, anxiety and chronic headaches. There are numerous other serotonin-raising medications. With millions of people taking these drugs, it increases the chances that someone will experience a rare side effect, such as serotonin syndrome. This is a situation that arises from over-stimulation of the body’s serotonin system. Since this is an unusual reaction, most healthcare professionals and patients are unfamiliar with how to identify and treat it.

Q. Yesterday I bent over to do some gardening and, boom, it triggered a migraine with sharp pain in the top right side of my head. That’s the first time a migraine came on that way. I took Imitrex® and it subsided a few hours later. Is this a dangerous situation or is this normal? Can it be from an old head injury? Do I need an MRI? I’m almost 60 and have had migraines since my 20s. They’ve become worse as time goes on, despite daily nortriptyline and atenolol. I had quite a few acupuncture and chiropractic treatments many years ago for injuries from a car accident, and even months after discontinuing them I still didn’t have any migraines. Coincidence? I want to try acupuncture and chiropractic again.

Serotonin is a neurotransmitter compound critical to the nervous system. Sufferers of migraine and other headaches probably have altered serotonin processing, which results in blood vessel dilation, inflammation and resultant pain. Many medications that are effective in both preventing and aborting migraine and other vascular...