Preventative Medication Tracker

17th October | Nortriptyline

• Started day #1 17th October.

• 10 mg at night-time (the dose may need to be increased by 10 mg steps every 2-4 weeks to a maximum of 70 mg

• Told to be vigilant for any potential interactions with Ozanimod.

• Had to stop while still on the initial dose as blood tests showed high liver ALT values. Ozanimod also stopped.

21st November | Candesartan

• 21st November 2024: Started 2mg dose

  • Taking before bed.

  • Advised to increase weekly up to 8mg.

  • At 2mg as of 26th Nov (so 5 days in) no side effects have been experienced.

  • No noticeable improvement to headaches/ migraines.

• 28th November 2024: To start 4mg dose

  • No noticeable side effects.

  • No noticeable alleviation of chronic migraine.

• 5th December 2024: To increase to 8mg

  • Was due to to increase to 6mg, but since stopping Propranolol on 28th November, my symptoms went back to square one. So having had an emergency call with the GP on 2nd Dec, they advised to increase straight to 8mg, then monitor until my next appointment which isn't until 27th Dec.

• 12th December 2024: To increase to 10mg

  • Since increasing to 8mg I haven't had any bad migraine attacks, but the constant chronic migraine has remained, in addition to several headaches which I've managed to quell with regular acute medications (1g paracetamol + 1 x 5mg Prochlorperazine

• 19th December 2024: Increased to 12mg

  • No changes. Still constant daily migraine with some days far worse than others. Taken acute meds daily/ every other day.

• 26th December 2024: Increased to 14mg

24th October | Propranolol

• 24th October 2024: Started 40mg Day #1.

  • Switched from evening to morning as it was giving me insomnia by day #2.

• 7th November 2024: Increased to 80mg.

  • Full dose taking in the morning at once.

  • Slight dull left chest pain but subsided after day #3.

  • First day of this increased dose made me fell better than the past couple weeks, but after that initial day on the increased dose I went back to my normal chronic migraine condition.

• 18th November 2024: Increase to 120mg.

  • Full dose taking in the morning at once.

  • Dull left chest pain within 30 to 60 mins of taking the dose. Was bad in the AM, subsided PM then came back late evening to the point where the pain stopped me from sleeping.

  • Tried again the next day and same bad left chest pain returned. Like a dull, tight ache.

  • Shame as the first day I increased the dose to 120 mg I felt the most clear headed I've felt in a long time.

• 20th November 2024: Begin tapering down.

  • Saw the GP today and after discussing the chest pain they asked me to stop the Propranolol and to begin tapering it down. So back to 40mg for 1 week from today then stop.

  • GP said the chest pain could be flaring up of past Asthma being triggered in the form of chest pain by the Propranolol. Skeptical of this logic but either way it caused the chest pain.

  • Advised to switch to Candesartan while tapering down.

27th December | Nortriptyline + Candesartan

• 27th December 2024: Started 10mg Nortriptyline

  • Saw GP today and they have referred me to a Neurologist which could take 9+ months.

  • Meanwhile, they said now my liver levels have stabilised to try the Nortriptyline again. Starting at 10mg and increasing weekly by 10mg up to 70mg.

  • Continue the Candesartan at the same time. Stay on 14mg. No point increasing to 16mg given no change in migraine. GP doesn't want to stop the Candesartan in fear of making the migraine worse.

• 3rd January 2025: Started 20mg Nortriptyline

• 10th January 2025: Started 30mg Nortriptyline

• 15th January 2025: Started 40mg Nortriptyline

• 22nd January 2025: Started 50mg Nortriptyline

  • No side effects other than constipation which caused bad haemorrhoids. Under control after popped and using

28th January | Tapering Down Nortriptyline + Candesartan

• After new consultations with Neurologist Dr Tim Yates and separately with Dr Simone Gregoire from the Nation Migraine Centre, I decided that my next and first advanced preventative treatment will be atogepant.

• In order to start this, I need to taper down Nortriptyline completely as both that and atogepant cause constipation so it's ill advised to be on both. The plan is to start the atogepant once I've reduced the Nortriptyline down to 20mg.

• 28th January 2025:

  • Reduced Candersartan to 8mg

  • Reduced Nortriptyline to 40mg

10th February 2025 | Atogepant

I made the decision to being Atogepant as my first advanced treatment. Mainly due to it being a once a day tablet that also doesn't need to be tapered. It's a max 60mg dose from the start; meaning it's quick and easy to administer and stays in your system regularly. As a opposed to the once every 3 months options like Botox and Vyetpi. Which is an option I'll explore if Atogepant is unsuccessful.

Before starting my neuro suggested tapering down Candersartan to 0mg and Notriptyline to 20mg and finally 0mg. As Notriptyline and Atogepant can cause constipation. But 20mg is a low enough dose to be able to start the Atogepant on while i continue tapering weekly until 0mg.

I also had to do some liver blood tests to ensure my levels are ok given these medicines can affect your liver. They came back clear last week (3rd Feb).

• 10th February 2025:

  • Candersartan already at 0mg since 4th Feb

  • Nortriptyline down to 20mg

  • Begin 60mg Atogepant (one tablet before bed)

  • First 3 days on Atogepant:

    • Side Effects: vivid dreams, and difficulty getting to sleep on nights 2 and 3. If continues may consider switching to mornings.

    • Effectiveness: Still have a dull constant migraine, but the pain threshold has been stable at 3/10 for the most part. Slight reduction in facial spasms too although these tend to return towards late evening at which point maybe the Atogepant is wearing off?

    • Will continue to monitor...

• 13th February 2025:

  • This week I have also noticed blood in stool (prior to the Atogepant). Could be my UC returning or related to the constipation-caused haemorrhoids i had a few weeks before. Will continue to monitor but in the meantime I've increased my Mesalazine (as of 13th Feb) to 3 tablets night + 3 tablets morning now. (so from 2400mg to 4800mg) and have re-introduced the nightly Mesalazine suppository.