Blog Layout

Preventive Migraine Medications: Generic and Brand Name Treatment Options

Evangeline Lindorf

What to try before trying Botox shots for your migraines

Migraines can be a real pain—literally! But did you know there are medications you can take regularly to help prevent them? In this post, I’ll discuss different types of preventive medications that can make a huge difference for those who suffer from frequent migraines. Let's break down what these medications are, how they work, and what side effects you might encounter.

It’s also important to note that before insurance will cover injectable medications (such as monthly preventative injections or Botox shots), you will need to try and fail–or have medical contraindications to trying–medications from each of these 3 categories. This is not an all inclusive list. After you have done a trial of medication from each of these first 3 categories insurance will typically cover quarterly Botox shots or monthly injectables including Aimovig, Ajovy, or Emgality. Note that some insurance companies require trials of additional antidepressants such as Effexor etc., and not just tricyclic antidepressants. 

Category 1: Antiseizure Medications–Topiramate, Gabapentin, and Pregabalin
These medications are usually used to treat seizures, but they can also help prevent migraines. They work by calming down the nerve activity in your brain, which can help stop migraines before they start. Some common side effects include feeling dizzy or tired and changes in weight.  

Category 2: Tricyclic Antidepressants Medications–Amitriptyline and Nortriptyline
These are types of antidepressants, but they can also be used to prevent migraines. They work by balancing certain chemicals in the brain that affect pain. You might experience a dry mouth, feel sleepy, or notice some weight gain when taking these.

Category 3: Blood Pressure medications–Propranolol and Verapamil
These medications are typically used to lower blood pressure, but they can also help with migraines. They relax your blood vessels, improving blood flow and reducing the chances of a migraine. Some side effects could be feeling tired, dizzy, or having lower blood pressure.

Monthly Injectable Medications: Ajovy, Aimovig, and Emgality
These are newer migraine prevention treatments. They work by blocking a molecule that triggers migraines. You take them as injections, and they can significantly reduce how often you get migraines–most patients see a 50% reduction in monthly migraines! Common side effects include injection site reactions (redness, itching) and more rarely constipation.
Understanding these preventive options can help you manage your migraines better.

In next week's post, I'll talk about quick-relief rescue treatments for migraines, including triptans (Sumatriptan, Rizatriptan) and gepants (Nurtec, Ubrelvy), and how to handle their side effects.  We will also discuss Qulipta in the next post. 
By eklindorf 20 Aug, 2024
Natural Treatments for Hashimoto’s Thyroiditis: A Holistic Approach Hashimoto's thyroiditis, also known as autoimmune thyroiditis, is a condition where the immune system mistakenly attacks the thyroid gland, leading to chronic inflammation and, over time, impaired thyroid function. Practicing as a holistic, integrative nurse practitioner in Provo, Utah, I often encounter patients seeking natural treatments for Hashimoto’s to complement conventional care. Individualized treatment is crucial. Several natural protocols have shown promise in managing this condition. Below, I outline some of the most effective holistic approaches, including iodine protocols, castor oil packs, essential nutrients and supplements, treating underlying infections, and the importance of a gluten-free diet. 1. Iodine Protocols Iodine is essential for thyroid function, as it plays a critical role in the synthesis of thyroid hormones. While iodine deficiency contributes to thyroid dysfunction, excessive iodine intake may, in very rare cases, exacerbate autoimmune activity in the thyroid. Therefore, it’s important to approach iodine supplementation cautiously. For patients with Hashimoto’s, I offer and recommend an iodine loading test to determine baseline levels before starting supplementation. If deficiency is confirmed, low-dose iodine supplementation can be considered, typically in combination with selenium. Selenium is crucial because it helps mitigate the inflammatory detoxing effects from iodine supplementation. We carefully titrate based on the patient’s response and lab results. 2. Castor Oil Packs Castor oil packs are a time-honored remedy in holistic medicine, valued for their anti-inflammatory and detoxifying properties. When applied over the thyroid gland, castor oil packs can help reduce inflammation and support lymphatic drainage, which can be very beneficial for patients with Hashimoto’s. The castor oil packs and castor oil I have found to be of the highest quality are available at the following link: https://www.shopqueenofthethrones.com/ Many patients report reduced neck pain and swelling, as well as an overall sense of well-being with regular use. 3. Essential Vitamins and Nutrients Several vitamins and minerals play a pivotal role in supporting thyroid health and modulating the immune system. Key nutrients to consider include: Vitamin D : Low levels of vitamin D have been linked to an increased risk of autoimmune diseases, including Hashimoto’s. Supplementation with vitamin D3 can help modulate immune function and reduce autoimmune activity. A typical dose ranges from 2,000 to 5,000 IU daily, depending on the patient’s blood levels. The best way to get Vitamin D is through your skin from the sun. In Utah, we are so far north of the equator that many people are deficient year round, and may need sun exposure + supplementation. I test all of my patients' Vitamin D levels routinely. B Vitamins : B vitamins, particularly B12, are essential for energy production and neurological function. Many patients with Hashimoto’s are found to be deficient in B12, which can contribute to fatigue and cognitive symptoms. Supplementation with a high-quality B-complex can support overall thyroid function and energy levels. I also test for the MTHFR gene to see if you need methylated B vitamins. Magnesium : Magnesium is involved in hundreds of biochemical reactions in the body, including those related to thyroid hormone production and utilization. It also supports adrenal health, which is often compromised in patients with chronic autoimmune conditions. Magnesium glycinate or citrate are well-absorbed forms that can be taken daily. Zinc and Selenium : Both of these minerals are crucial for thyroid hormone synthesis and immune regulation. Selenium, as mentioned earlier, is particularly important when supplementing with iodine, while zinc supports immune function and may help reduce thyroid antibody levels. 4. Treating Underlying Infections Chronic infections, such as Epstein-Barr virus (EBV), Lyme disease, and intestinal dysbiosis, have been implicated in the onset and exacerbation of autoimmune thyroiditis. Identifying and addressing these underlying infections is a critical component of a holistic treatment plan. For example, if EBV is suspected, antiviral herbs in combination with generalized immune system support may be beneficial. In cases of intestinal dysbiosis, a comprehensive gut-healing protocol, including probiotics, prebiotics, and digestive enzymes, can help restore balance to the microbiome and reduce systemic inflammation. Functional medicine testing can be useful in identifying these hidden infections, allowing for targeted treatment that addresses the root cause of the autoimmune response. 5. Gluten-Free Diet A gluten-free diet is often recommended for patients with Hashimoto’s thyroiditis, as gluten has been shown to trigger autoimmune responses in susceptible individuals. This is particularly true for those with celiac disease or non-celiac gluten sensitivity, both of which are more prevalent in people with Hashimoto’s. Eliminating gluten from the diet can reduce inflammation, improve gut health, and lower thyroid antibody levels. Many patients report significant improvements in symptoms such as fatigue, brain fog, and digestive issues after adopting a gluten-free diet. In addition to avoiding gluten, it’s beneficial to focus on a nutrient-dense diet rich in anti-inflammatory foods, such as leafy greens, fatty fish, nuts, seeds, and berries. Reducing the intake of processed foods, refined sugars, soy, caffeine, and dairy can also support thyroid health and overall well-being. Conclusion Managing Hashimoto’s thyroiditis requires a comprehensive and individualized approach. By integrating the use of castor oil packs, essential vitamins, minerals, and supplements, going on a gluten free diet, and treating underlying infections, patients can significantly improve their thyroid function and overall quality of life. My goal is to empower my patients with the tools and knowledge they need to take control of their health, addressing not just the symptoms but the root causes of their condition.
By eklindorf 10 Jul, 2024
Welcome to the gut health series! This week, I'll discuss with you how nutrition and diet play a crucial role in maintaining a healthy gut. Your gut is home to trillions of bacteria that help with digestion, nutrient absorption, and immune system function. Your gut creates neurotransmitters and affects your mood too. You should, actually, trust what your gut is telling you! The Gut Microbiome: Your Digestive Allies Your gut microbiome consists of a vast community of microorganisms that live in your digestive tract. These bacteria, viruses, and fungi play a key role in breaking down food, producing vitamins, and protecting against harmful pathogens. A balanced diet can help maintain a healthy and diverse gut microbiome, which is essential for overall health. The more good bugs you have, and the more types of good bugs you have, the better you will feel. Fiber: The Gut's Best Friend Fiber is one of the most important nutrients for gut health. It acts as food for the beneficial bacteria in your gut, helping them thrive and produce short-chain fatty acids (SCFAs) that support gut lining integrity and reduce inflammation. There are two types of fiber: soluble and insoluble. Soluble Fiber: Found in foods like oats, beans, fruits, and vegetables, soluble fiber dissolves in water to form a gel-like substance. It helps regulate blood sugar levels and lowers cholesterol. (We have to be cautious with certain foods that contain lectins though, like oats and beans, they require special cooking methods, because they can tear up that delicate one celled intestinal lining. More on this in a future blog post). Insoluble Fiber : Found in whole grains, nuts, seeds, and vegetables, insoluble fiber adds bulk to stool and helps it pass more easily through the digestive tract, preventing constipation. (Please refer to Dr. Gundry's books on lectins to learn more). Fermented Foods: Boosting Probiotics Fermented foods are rich in probiotics, which are live bacteria that can confer health benefits when consumed. These foods help replenish and maintain the balance of good bacteria in your gut. Some popular fermented foods include: Yogurt : Contains beneficial bacteria like Lactobacillus and Bifidobacterium (low Bifidobacterium puts you at higher risk for developing COVID-19). Kefir : A fermented milk drink that is a potent source of probiotics. Sauerkraut and Kimchi: Fermented cabbage that provides a variety of beneficial bacteria. Kombucha : A fermented tea rich in probiotics and antioxidants (I do not advise making your own). Prebiotics: Feeding Your Gut Bacteria Prebiotics are non-digestible fibers that feed the beneficial bacteria in your gut. Including prebiotic-rich foods in your diet can enhance the growth and activity of good bacteria. Some excellent sources of prebiotics are: Garlic and Onions : Contain inulin, a type of prebiotic fiber. Bananas: Especially when slightly green, are rich in resistant starch. Asparagus and Artichokes : High in inulin and other prebiotics. Whole Grains : Such as barley, oats, and whole wheat. Avoid these, obviously, if you are gluten free. I recommend for everyone to utilize ancient grains such as Einkorn or Khorasan wheat, both are non hybridized and are more easily digested and better for the body. The brand Jovial Foods makes excellent healthy whole grain products, that even those who are gluten sensitive (but not wheat allergic or Celiac's) can usually tolerate. Hydration: The Unsung Hero Staying hydrated is crucial for maintaining gut health. Water helps dissolve nutrients, aids in digestion, and keeps stool soft, preventing constipation. Aim to drink at least eight glasses of water a day, and more if you're active or live in a hot climate. Avoid tap water whenever possible. Try to drink water that is distilled or has gone through a reverse osmosis process; add back in electrolytes as needed. Drinking from glass is always preferable to drinking out of plastic when possible. Mindful Eating: Savor Your Meals How you eat is just as important as what you eat. Eating mindfully can improve digestion and enhance your gut health. Chew Thoroughly: Chewing breaks down food into smaller pieces, making it easier for your digestive system to process. Eat Slowly : Eating slowly allows your body to recognize when you’re full, preventing overeating. Avoid Distractions : Focus on your meal rather than eating while watching TV, playing on your phone, or working, which can lead to overeating and poor digestion. Foods to Limit: Protecting Your Gut Certain foods can disrupt your gut microbiome and negatively impact your digestive health. Try to limit: Processed Foods: High in unhealthy fats, sugars, and additives that can harm your gut bacteria. The majority of foods found on American grocery shelves are UHPFs (Ultra High Processed Foods). Regular consumption of these foods leads to terrible gut health later. Artificial Sweeteners : Some studies suggest they can disrupt the gut microbiome and lead to digestive issues. Additionally, the brain cannot tell the difference between artificial sweeteners and real sugar, so the dopamine effect is the same and weight gain can be a serious issue, whether you are drinking diet coke or full sugar coke. Alcohol and Caffeine : Excessive consumption can irritate the gut lining and affect digestion. Conclusion A healthy gut starts with what you put on your plate-- eat lots of plants and lots of colors. Don't eat foods your great grandma would not recognize as a food . By including a variety of fiber-rich, fermented, and prebiotic foods in your diet, staying hydrated, and eating mindfully, you can support your gut microbiome and overall digestive health. Remember, small changes in your diet can make a big difference in how you feel. As I like to say, you can pay at the grocery store now, or the pharmacy later - your choice! Next week, I'll discuss supplements that can support your gut health. Stay tuned!
More Posts
Share by: