Chronic daily headahces has to be the bane of most doctors frustrated by fact use of painkillers will potentially only make things worse. Now it looks like Mexiletine may help but …the patient has to be prepared to accept side effects.
Headache. 2008 Sep 12. [Epub ahead of print] Mexiletine for Refractory Chronic Daily Headache: A Report of Nine Cases. Marmura MJ, Passero FC Jr, Young WB. abstract
1) Lidocaine IV does temporarily remit chronic daily headaches and given daily over a period of a month can reduce them to a tolerable level (while totally destroying any veins you may have).
They reference two article “A recent study has shown that intravenous lidocaine is effective in reducing the frequency and intensity of headache associated with medication overuse for up to 6 months post-infusion.”
. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia. 2003;23:963–971.
. Effects of Intravenous Lidocaine in the Treatment of Refractory Chronic Daily Headache. Abstract presented at American Headache Society Annual Scientific Meeting, 2005.
2) Mexiletine has lidocaine properties and can be given orally. I have not used it because the side effects tend to be too much.
3) However, someone with chronic daily headaches may be willing to do anything.
4) They were given a trial of IV lidocaine. – 100 mg given slowly while watching reaction might work (always a 2-3 minute delay)
5) Mexiletine was worked up to 600 – 1500 mg without any reference to how fast that was done. They did say it might be prudent to start with 150 mg and work up slowly. They do admit relief does not usually appear until they get to a level that causes side effects.
6) Side effects included nausea, tremor, fatigue, dizziness, palpitations, incoordination and one case of confusion. 2/9 denied side effects. Apparently blood levels can be checked.
7) pain before – average 6.6 after – 3.1 This is more than I would expect form placebo but this is still a possibility.
8) They caution: “Many patients did not improve with mexiletine, and side effects were significant so we do not recommend this as a first-line treatment.”
Anyone have any experience with it?
I am on 600MG Mexiletine daily as a patient of one of the doctors who conducted this study. It seems to help significantly (along with the other meds I am taking – Topamax and Verapamil) and I have had no discernible side effects whatsoever.
William, are you still on the mexiletine? I was recently put on it and I am having trouble figuring out the best way to get the 4th dose in. She said I could double up but it scares me to try that. Or I could take a 4th dose in the evening but the one time I did that I had trouble falling asleep. The only side effect I seem to have is chest pressure.
William, I am curious how you spread the doses out to reach the 600mg. I am on 450 mg right now and they want me to be taking 600 mg. She said I could take two doses at once (which I have been hesitant to try) or take a 4th dose at bedtime (tried that once and had trouble sleeping). The only side effect I seem to have is chest pressure which is decreasing the longer I am on. I really would like this to work because so many of the other meds haven’t.
This drug is pretty mild I have found. I have been put on this drug by a doctor who is very important in the neuroscience community. This is a study at Jefferson Hospital in Philadelphia Pennsylvania. I took the drug while pregnant and there were no known side effects to the Twins I was carrying. I had to take the drug because they found the benefits outweighed whatever you call it. I can’t think of the words. Anyway it worked great and I was taking three pills in the morning three pills at lunch three pills at dinner and three pills at bedtime that’s a total of 12 pills and each pill I believe was 175 mg. That is what I was taking when I was at my highest point and it was helping significantly with only two migraines per week. And I was getting them every day, with a diagnosis of chronic daily migraines. Topamax is also a wonderful drug I never had a headache on Topamax it’s a miracle drug. However, I had to stop taking it because I started feeling suicidal and very depressed, so they recommend if you are on Topamax to take it with an antidepressant however many antidepressants do not work for me. I also started to become or was unable to urinate on Topamax. The first time I took it this was not an issue however the second time I took it became an issue, I am not sure why. Also Topamax makes you lose a great amount of weight so it was kind of nice after my twins to lose a good amount of weight on Topamax. Some people take Topamax adjust to lose weight and they don’t even have migraines. It is a good drug I would recommend it but watch out for the depression if it creeps up on you ask your doctor for an antidepressant. If you can tolerate antidepressants. Another good drug that worked for me is called Methergine. They actually use it in women to help contracts the uterus after childbirth, however it also is helpful in migraine therapy.
I take four, 150 mg Mexilitine daily, 2x morning and 2x afternoon. No side effects that I am aware of. Helps with migraine significantly.
Those of you that have had success with mexiletine, did you have iv lidocaine first to see if it worked for you? The iv lidocaine did not work for my daughter, but they still are considering having her try the pill form….just wondering if it is worth the side effects as she has many health issues in addition to severe daily head pain.