Leslie Cisar, ND (00:00)
Welcome to the Healing Migraines Naturally Podcast. I'm your host, Dr. Leslie Cisar, and I'm a licensed naturopathic doctor, former chronic migraine sufferer, and I've dedicated my life to helping other women with migraines rediscover a migraine-free life. So welcome to the podcast today.
Don't call my doctor. That's what a woman said to me on a call recently, you know, half joking, maybe only half. we were going through her current medications, and I asked her how many sumatriptin she takes in a month. Now, sumatreptin is a generic name for Imotrex.
It's a tryptin medication, one of the most common migraine medications there is. It's called a migraine abortive medication. and people take it to try to stop the symptoms of their migraine.
She said, I guess nine, unless I have some extra, and then I'll take that, but I'm not supposed to. But clearly I'm already in rebound. And yes, she she was in rebound. That was one of the major reasons why she reached out to me for help. Now nine is the number her insurance pays for. So nine is the number that she gave me. And I knew that wasn't the real number. If you're in rebound, nine a month isn't gonna cover it. So you know, um my
My intuition was a little raised here, right? So I kept asking. was she ordering any from online pharmacies outside of insurance? No. And then she said, Sometimes I steal my daughters too. Sorry.
I told her I I don't care if you're taking more than nine, I just want to get a good read on what you're actually taking. And then she said closer to fifteen to twenty if I can. Fifteen to twenty suma tryptin a month. And on the day she doesn't take a tryptin, she takes excedrin. She's taking something for head pain every single day of the month.
And then she said, I'm not proud, but that's what I do. And I said, you know what? I'm not gonna call the police here. You just tell me what you're doing. And then she said, don't call my doctor, right? We we both chuckled. A woman in pain every single day, more afraid of her doctor treating her than the pain, right? By the end of this episode, you're going to know how she got
there.
You're going to know what her neurologist handed her when she got there. And the one side effect she was told about. And you're going to know why the real number she finally gave me turned out to be good news for her. So I'm going to call her Dina. That's not her real name. And I've changed and blended some of the details here so that you can't you can't identify her. But the words you'll hear from her are real.
Now, Dana is in her fifties and she's had migraines since her twenties. Back then, they were tied to her period and stressful stretches of life. But over the years, they slowly got more frequent. She's past menopause now, and they did not stop with menopause. if you were told that your migraines would end at menopause, I did a whole episode on that, episode 146.
we'll link to that in the description. but for the past few years, Dana's head pain has been daily.
Every day goes about the same. During the day, she's mostly fine. Then sometime between eight or nine at night and three in the morning, it comes back. Some nights it starts before she falls asleep. Some nights she wakes up at two or three in the morning, and there it is. And she told me, I'm not even thinking about it or expecting it. It just comes and I'm like, okay, there you are again.
So then I take a pill because I know it's not going to get any better. She does not let it escalate, and she has good reason not to. I asked her what a full blown, unmedicated migraine looks like. She said that she's in so much pain, she's throwing up, and she's deciding whether she needs to go to the ER.
And if you've been to the ER, you might you might recognize this statement. It doesn't help at all because you just get a rebound from what they give you in the ER. So she takes the sumatreptin or the excedrin every night. And Dana has done everything right. She's done neurofeedback, she's been to a functional medicine doctor, she's done acupuncture.
She's on a migraine preventative, one of the monthly injectables. she was on one of those for years until her insurance stopped paying for it, and now she's on a different one. When we went through her medications, she even forgot to tell me about the preventative. She said, I totally, totally forgot about that one. There's been so many meds that I've tried over the years. So many medications that the monthly injection slipped her mind.
Keep that list in mind. We're gonna come back to it. A couple months before she came to me, Dana got in trouble with her neurologist. Her neurologist looked at how much medication she was taking, all those immatraxes and all those excedrins, and told her that she was in rebound, told her she shouldn't be taking so much, and told her to stop cold.
Turkey. She was given 10 days of prednisone to help her through it. Prednisone is a steroid and it's often handed out as a bridge to help people through the excruciating pain of stopping their migraine abortive medications, cold turkey, when they're in rebound. Now, Dana, this was one, this was not her first rodeo.
Dana did not do it cold turkey because she did not want to be in that agony, and I certainly can't blame her. Cold turkey from from a tryptin or from Excedrin when you're in rebound is about two weeks a hill. So she tapered herself. She was cutting her suma triptin into quarters. She eventually stopped taking it for over a week. And then, in her words, it just came back exactly the same.
Well, unfortunately, of course it did. What did her neurologist expect? Nothing about what was generating her migraines in the first place was addressed, not one thing. Her body was in exactly the same state of health, or you might say state of imbalance or out of health as before she stopped those abortive medications.
The only thing that changed was that the medication was gone. So the migraines came back. Why wouldn't they? So she did what anybody in that much pain would do. She started taking her abortives again. And then she went back to the neurologist. And this time she really got in trouble. They were frustrated with her, mad that she got off the medication and then went back on it. She told me, you know, they were a little too.
Matter of fact, they weren't very empathetic. It feels like they don't really care. I don't know if they don't care or they don't get migraines or what, but they were just like, you shouldn't be doing this, and you should just take this. And this was Depacote. I asked her, what did they tell you about Depacote? She said her doctor told her it might cause a little bit of weight gain. That's it. Little bit of weight gain.
before we get to Depacode, I want to make sure you understand rebound. Because if you have daily head pain, there's a good chance that this is you. Rebound is what doctors call medication overuse headache. This is a new diagnosis, relatively new diagnosis in the migraine world. And the simplest way I can tell you how to spot it is this.
Basically, if you have daily pain and you're taking an abortive medication every day, you're probably in rebound. You take something, it works, it wears off, the pain comes back. You take something again. Here's how I explain why it happens. Remember that schoolyard game, you and your friend put your hands out palm to palm and press against each other with equal force?
Neither of you falls over because you're both pressing against each other with the same amount of force. But what if one of you puts your hands down? The other one falls over. She was pressing with all that force against hands that are suddenly gone. That's what the drug is doing. It's pushing down on what your body is doing. It's pushing down on the symptoms that your body is generating, the migraine that your body is generating.
With a certain amount of force. And your body learns. It says, Yep, every time I start to generate a migraine, she's gonna come in with a sumatryptin with about 10 pounds of force. So I'm gonna push back with about 10 pounds of force because I'm generating that migraine for a reason. And then the effect of the drug wears off. It's like the hands come down, and then your body falls forward into the migraine again. That's rebound.
Now, I want to also state this. And this is something, when I say this, it might make people even a little bit angry. The medication, your abortive medication, whether that's a tryptin medication like Imtrax or Maxalt, the new abortive medications like NERTEC things like Excedrin, those medications never
ended a single one of your migraines. They never stopped the migraine. Your body did. We are in a migraine until the migraine remits, until your body sort of cleans up the mess that generated the migraine in the first place. The body always puts the migraine in remission, not the abortive medication. The abortive
scrambles the signal for a while so that you don't feel the symptoms of the migraine. And if you're lucky, the scramble lasts long enough for your body to finish the job. So when Dana stopped her abortives and the migraines came right back, that didn't mean that she needed the drug. It meant nothing had changed underneath. Her body was still generating the migraines because the reasons it was.
We're still there. And when she came back to her pills, she wasn't being a bad patient. She was in pain every day. And she did the only thing she'd been given to do. I've gone into rebound in this phenomenon much deeper in episode 19, and we'll link to that. Also, episode 37.
episode 144, where I talk about a neurologist who told her patient I have failed you. So if this is a topic that affects you, I would recommend you go listen to those three as well. We'll link to them in the description. But today I want to talk about what happens next when the scolding doesn't work and the cold turkey doesn't work and the doctor reaches for something bigger.
The fact that Dana was even being offered Depacote tells you something. It tells you where she is on the medication ladder. Because there is a medication ladder. If you've had migraines for a long time, you've been climbing it, whether or not anybody ever showed it to you. So let me show it to you as I go. Find your rung where you where you are at on this ladder right now.
So, rung one is the abortives. These are what you take when a migraine starts to quote unquote stop it, right? So most women start with over-the-counter things first, like Advil, Aleve, Tylenol, etc. Then when those don't do too much or they stop working, this is when people start going into their doctor, and then they move on to prescription abortives. The first line.
Are the tryptins like Imotrex or Maxalt, Relpax, then Fioracet, which has a barbituid in it. Uh Fioricet prescriptions are becoming rarer.
And now there are newer pills like Nertec and Ubralvi.
Every one of these has a monthly limit. Dana's insurance pays for nine tryptins a month, and that limit it's not there because the insurance company is being stingy. They know the same thing your doctor knows. If you take too many, you go into rebound and you end up worse off. The medical definition of rebound counts tryptins taken on ten or more days a month. So nine sits right under that line.
So the insurance company is putting up a guardrail. When you start blowing through that guardrail, that's when you get moved up the ladder.
And so rung two is the first daily preventatives. A preventative is something you take every day or every month, whether you have a migraine or not, with the hope that you'll have fewer of them. This first rung, on the preventative side of things.
Is the old cheap pills the generic pills? Okay, so blood pressure medications like propranolol or metoperlol, antidepressants like amitriptyline, norotriptyline, venlifaxine, and topamax, which is a seizure medication. Notice something about that list. None of those drugs was made for migraines, not one. These were created for other diseases.
Epilepsy, depression, high blood pressure, and were found to have an effect on migraine frequency. Rung three is the CGRP drugs. These are the first ones actually designed for migraine. So first we started with the monthly shots Amivig, A Jovi, Mgality, or an IV infusion every three months, Phi Epte. And pills you take daily or every other day, Culypta and Nertec, again doing double duty.
They're expensive. When the American College of Physicians looked at this in 2025, the old pills on rung two ran somewhere between $67 and about $400 a year. The CGRP drugs ran between about $7,000 and $23,000 a year. So very often, before your insurance will pay for one, you have to quote unquote fail the cheap.
Pills first, and usually two of them. Rung four is Botox. So once you hit 15 or more headache days a month, you've got what's called chronic migraine, and Botox comes into the picture or comes onto the table. It's about 30 injections around your forehead, your temples, the back of your head, your neck, and your shoulders every 12 weeks.
And very often it gets stacked on top of a CGRP drug or the other cheaper, rung two abortive medications. Not instead of it. Usually it's an add-on. And then rung five is everything else. Two or three preventatives stacked together. Nerve blocks, nummy medication injected into the back of your head, infusions in an infusion center or the ER.
inpatient headache programs where you leave your family and your work and check in for days or weeks. And Debacode. Dana has been on rung three for years and she's in daily pain despite all of that medication. And now she's been handed rung five. I call this the dead end road. You start with an abortive and it works. And after a while
it doesn't
So you need more. Then you need a different one. Then a daily preventative, then a second one. It just goes on and on. Because when we suppress the symptoms, the body fights that suppression. Now here's something about Depacode that surprised me. On paper, it's actually not the last rung. On paper, it's actually at the top of the list. It's on that second rung with propranolol and amatryptaline.
And Topamax. In the guidelines most neurologists in this country still use, Depacote is in the highest tier of evidence for migraine prevention, same tier as Topamax, same tier as papranolol. And in the newest guideline from the American College of Physicians, it is put in the very first group of drugs to try. So why do so many neurologists hold it back? Why is it the drug that they reach for after?
Literally everything else, everything else has failed. And I have seen this in my work.
When I see that the woman has been offered Depacote, is taking Depacote, I know they have tried everything. Because even though it's in that top tier, it's not prescribed very frequently. It really is prescribed as a last resort. Why is that? Why would that be the case?
Because of what's on the label. When Dana asked about side effects, her neurologist said, maybe you'll have a little bit of weight gain.
So when she got home, because again, this is not her first rodeo with medication, right? So certainly when she got home, she looked Epicode up, and what she found scared her. Let's look at what's on the label. Every prescription drug comes with a label approved by the FDA. And some drugs have a box at the very top of that label with a thick black.
border around it. It's what we call a black box warning. It's the strongest warning the FDA puts on a drug. It's there for the risks or the quote unquote side effects that can kill you. Depicode has one. The heading of that box reads Warning Life Threatening Adverse Reactions. There are three things in that box. The first is the liver.
Liver failure, including deaths. Now I want to be fair about this. Those deaths are rare. They usually happen in the first six months, and the people at the highest risk by far are very young children, especially children under two. But it's in the box. And it's why the label tells doctors to check your liver before you start depicting and to keep checking it. So hang on to that one.
The second is the pancreas, pancreatitis, including fatal cases. The third is pregnancy. Depicote can cause serious birth defects and lower IQ in children exposed to it in the womb. It's serious enough that the label says it cannot be used to prevent migraines if you're pregnant or if you could become pregnant and you're not using effective birth control.
So Dana's past that, so it doesn't apply to her. But if you're a younger woman and someone offers you Depacote, you need to know about this. Now, the everyday side effects, the ones that won't kill you, but that you have to live with. In the studies Depicote was approved on for migraine, here's what people taking it reported compared to people taking a placebo, like a like a sugar pill. So nausea. Almost one in three on Depacote.
Okay, one in ten on the sugar pill. So you know, with migraines, a lot of us are already nauseous. We don't need to take a medication that makes us more nauseous, right? And then one in three were nauseous. And a lot of migraine sufferers that have nausea as a symptom with their migraines, they'd rather have the head pain than the nausea, right? Nausea is a very, very difficult symptom to live with. It's it causes a lot of suffering.
vomiting, okay, eleven percent, okay, compared to one percent on the placebo. So, right, the noise is bad enough, right? How many of us will do everything we can not to actually vomit? you're taking a medication to prevent symptoms, but then the side effects are those symptoms. it's very frustrating.
weakness and fatigue. One in five, that's 20% on depicot. So remember, Dana is already exhausted. Um, fatigue was one of the main symptoms that she was experiencing, and one of the main reasons, in addition to her migraines, that she reached out. Dizziness, 17%. Okay, again, how common is dizziness as a migraine symptom? Is one of the more common migraine symptoms.
So again, we're taking a medication that is trying to prevent a symptom, but the side effect is the same symptom. Okay, I am I getting on my soapbox too much? My apologies. Hair loss, seven percent. this is a big deal, right? We don't like to lose our hair.
Right? We want to stay, we want to keep our hair as long as possible, right? So hair loss, it's not something that we really want to go through. A lot of people will stop a medication just with hair loss as a side effect, and who can blame them? And then we come to the weight gain, 8%. Okay. Now, again, 8% weight gain doesn't seem too much. Maybe I'll dodge the odds, right?
In those same studies, about one in six people on Depacote quit the medication because they couldn't tolerate it. The top reasons were hair loss, like I say, we don't want to lose our hair. Then nausea and vomiting, those two really, really tough symptoms. And those were short-term studies. Over time, the label lists more.
let's talk about the weight a little bit more because this is what Dana's neurologist told her was the side effect, a little bit of weight loss. In one small study that followed women on Depacote for a full year, 40% gained a meaningful amount of weight. Okay. Then we also have your bones, lower bone density, osteoporosis, fractures, Dana's past menopause, the time of life when women are already warned about their bones.
And then your brain. Some people have had their thinking decline or become apathetic or irritable. And in some cases, their brain scans looked like their brain had shrunk. That usually got better after they came off the drug. Depico carries a warning for suicidal thoughts. Let's take a look at your blood. It can lower your platelets.
The cells that help your blood clot. That's why the label tells doctors to check your platelets. Your hair, we're not just losing the hair, we are seeing changes in the texture and the color of the hair, too. you're taking a drug to prevent migraines and your hair color changes. And then there's what happens when you stack it. Remember rung five, stacking the drugs together?
Depicote raises the blood levels of amitriptyline and nortriptaline, two of the antidepressants from rung two, and taken together with Topamax, the label warns about high ammonia and swelling of the brain. Now, most people don't get most of these, I want to be fair about that, but it'll maybe do a little weight gain is not the whole story. You deserve to hear all of it before you decide whether to take it.
I actually asked the women in my Facebook group, Healing Migraines Naturally, with Leslie Caesar and D, look for us on Facebook. What happened? What did they experience when they were on Depakote? And here's what some of them told us in the group. One woman's liver enzymes went up so high they put her in the hospital right away. Liver failure is rare. Liver enzymes going up is not. Several reported the weight gain side effect.
One gained more than 20 pounds and said that it didn't really even work. Two of them described the same thing in different words. One said she felt unresponsive. The other said it made her feel disconnected. And she said, I didn't have a mood disorder. I was just miserable from the pain. That same woman told me her neurologist had put her on over 50 drugs, including Botox. Nothing helped.
And she said Depacote felt so horrible she'd rather feel the pain of the migraine. How many of you have said that to yourself? She'd rather have the migraine. And Dana was told it might cause a little weight gain. But I haven't told you the most ridiculous part yet. When I went through Dana's lab work, her liver enzymes were already elevated. Here's what that means.
Your liver cells have enzymes inside of them, the working parts of the cell. When liver cells are under stress, some of those enzymes leak out into your blood and we can measure them. So when a blood test shows them is higher than normal, it's a sign that your liver is under strain. Now Dana's were not dramatically high, they were a little elevated. Her doctor had flagged them and she was planning to follow up. And, you know, I
I wasn't surprised. I told her with the way you're feeling and the medication load that you've been under, I'm not terribly surprised that the liver enzymes are a little elevated. She's been taking something for head pain every day for years. her liver has been processing all of it. And the drug she was just offered has a black box warning at the very top of its label for liver failure, and a label that tells the doctor to check.
The liver before starting. I don't know what her neurologist was looking at when she wrote that prescription, but I know what I was looking at. A woman whose liver is already showing strain and a drug her liver would have to process every single day With a warning about the liver printed in the black box at the top of the label. And the only thing she was told about was a little bit awaking.
So I want to step back for a minute. The real question isn't what are Depacode's side effects? It's why does any drug have side effects at all? Why do we just assume that taking a medication means putting up with side effects? If your car's check engine light comes on and you take it to a mechanic, what do you expect? You expect them to find out what's wrong with the engine and fix the problem.
Now imagine if the mechanic operated like conventional medicine, like your neurologist. The mechanic would take out a little pair of pliers and cut the wire to the dashboard light and say, There you go, check engine lights off, you're good to go. That's what most migraine medications are doing. A migraine is your body's
Check engine light. It's a signal. Your body is generating the migraine for a reason. And the medications are designed to cut that signal wire so you can't see the light. But the engine is still running rough and you've cut the wire to the one light that was warning you. So if something worse starts happening under the hood, you won't know about it. Not until something breaks. And on top of that, you've added something else to the car.
To understand what that does, you need to know how your body takes out the trash. Okay. Every cell in your body is working all day long. And every cell that's working is making waste material. I call it metabolic waste material. So just like your kitchen, right? When you're in your kitchen, you're always, you're always making trash, right? You're always having to throw something in the trash can. You cook, you eat, you're doing your dishes, right? You're you're putting trash in the trash can.
That's not a problem. It's just what happens when you're working in the kitchen. On top of the waste material that your own cells make, there's something that comes in from the outside, from the environment. What you eat, what you drink, what you breathe, and every medication that you take. All of it has to be dealt with every day in two steps. So step one is detoxification. Detoxification, it's known
Chemistry, known biochemistry. It's your cells taking a waste product or a toxin or a drug and changing it into something that your body can get rid of. It's like bagging up the trash. Your liver does the bulk of that work. So I'm going to reference the liver.
Every medication has to be detoxified or processed by your liver. But if there's a medication where they're like, you know what, we really got to make sure your liver's okay when you're taking this, what does that tell you? That tells you that this drug is really going to put a strain on your liver to detoxify it and get it out of your body. So step
Two is elimination. That's getting it out of your body. This is like taking the trash bag to the curb. This occurs through your urine, your stool, through your skin. We call the skin the largest organ of elimination, through your breath. Now picture a bucket with a drain at the bottom. Everything that has to be dealt with goes into that bucket. I call this like your toxin bucket, your trash can.
Detoxification and elimination are the drain at the bottom of the bucket. As long as the drain keeps up with what's going in, you're you're good. You're you're you're going to feel relatively well.
We want that drain to keep up with what's going in. You cannot put 10 pounds in and have a three-pound drain. When more goes in, then your body can detoxify and eliminate, the bucket fills up. That's what I call toxin overload. And when the bucket gets that full, your body starts making symptoms. They're called toxicity symptoms. In my view, a migraine is a toxicity symptom.
That's why a migraine feels so much like a hangover. A hangover is your body holding more of alcohol's byproducts than it can clear, and you're feeling it. So think about Dana's bucket.
Fifteen to twenty tryptins a month, etc. on the other days, a monthly migraine shot. This is in addition to all of the medications that she's tried over the years, and other medications that she's taking to suppress other symptoms that aren't migraine symptoms. Every one of those goes into that bucket, and her liver has to process every one of them. Remember her liver enzymes? That that that's
giving you some indication as to how full that bucket is. Her liver listen, her liver is working its heart out. That's why those enzymes are elevated. It's working, working, working so hard to drain that bucket. I've had clients ask me, you know, is my liver weak? Is what something wrong with my liver? Your liver is trying to keep up, but again, if we're putting 10 pounds in and the liver only has the capacity to clear three, we're not going to feel good. But that doesn't mean that your liver
Is defective. Trust me, it's trying its little heart out.
And what if we were to put the depicot into that bucket? Here's what's known about how the body handles it. The liver breaks almost all of it down. A big part of that happens inside the tiny energy-making parts of your liver cells. And to get the drug in there, your body uses up a nutrient called carnitine. And while your liver is busy with depicot, it can fall behind on clearing ammonia, a waste of
Material your body makes every day, right? We've all heard of ammonia. Our body makes ammonia as part of its normal metabolic processes. This is, you know, just one of the things that I'm talking about. When we hear the word toxins, toxicity symptoms, detoxification, our liver, we're always thinking about environmental toxins, usually man-made toxins. And I wish we didn't have those things in our environment. I'm not making an excuse for those things.
But we have to understand just how much waste material, toxins, our body makes all the time, just normally, just to function. And ammonia is one of those things. So in studies, somewhere between one in six and one in two, okay, so like that's up to half of the people on Depacode have a high amount of ammonia in their blood. And
usually without any specific symptoms.
So depicote isn't just going into the bucket, it works against the drain while it's in there. It uses up a nutrient to get processed and it slows down the clearing of another waste product. So for a woman whose bucket is already overflowing and whose liver is already showing strain, that's exactly the opposite of what she needs.
This is what I mean when I say the worst side effects are the ones that directly block the very things your body needs to do in order to get well again. Getting nutrients to your cells, clearing out waste material, having the resiliency and vitality to withstand stressors or what we call migraine triggers. So a side effect isn't random bad luck. It's the drug adding to the load.
So let's take a look at what the scolding did. Let's go back to that appointment. Because something happened after it that matters. She goes into the neurologist. They say, You're in rebound, right? Why are you taking all this abortive medication? You're gonna have to go cold turkey. Here's some prednisone to help out. She goes through all of that.
The migraines come back. She goes back to the neurologist and they scold her. They get mad at her. Why did you go back on that medication? Why did you start taking Imotrex again? We told you you can't take so much, right? What what is Dana supposed to do? She's try she's got to get through her day. So after that appointment where they scolded her, they weren't very empathic, they acted like nobody understood what a migraine was, and told her, You need to take Depacode and the only thing you need to worry about is a little bit of weight gain.
And after she got home and, you know, went on Dr. Google to look up the side effects of Depacote because, like I say, she'd been burned before. After all of that, Dana had one of her worst migraines that night. After that whole experience, it came on earlier than normal, and it was one of the worst that she had had in a long time. It was bad enough.
That she needed extra medication just to hold herself together. So think about what that day was like for her. She went to her doctor for help, she got scolded, then she got handed a drug and told it might cause a little weight gain. Then she had to go home and sit down with Dr. Google to find out the rest of the story. And what she found made her feel like the thing that was supposed to help her was going to hurt her even more.
She started to feel hopeless, like is this really all that's left for me? Am I at the end of the end of the rope? The appointment itself set off a migraine. Stress isn't just something that happens in your head. Fear, hopelessness, feeling like nobody's on your side. Your body feels all of it. It hits your body as hard as a physical stressor does. And Dana walked out of her neurologist office, carrying all three.
And there's something else. Her neurologist scolded her for taking too much medication. It didn't work. She didn't take less medication. She she took the same amount of medication and she hid it.
she stopped telling her doctor the real number. Nine is what she says. Fifteen to twenty is what she takes. Shaming someone about how much medication she's taking doesn't make her take less. It makes her stop telling you. When the price of telling the truth is getting in trouble.
You don't get the truth. And then nobody knows what's really going on, including the people trying to help her. On that call, all I did was take the trouble off the table. I don't care if it's more than nine. I I won't call the police. I won't call your doctor. Just tell me what you're doing. And she told me. And I needed that number because going into that call with her from what I had on paper.
I thought we were going to be working on primarily an excedrin rebound. About nine tryptins a month, an Excedrine the rest of the time. That's mostly Excedrin. But once she told me the truth, 15 to 20 tryptins a month, the picture flipped. She's mostly on tryptins, and that matters because it's usually easier to get someone out of a tryptin rebound than an excedrin rebound. Now
Her neurologist doesn't think like that, but I know that to be true from my work. So the truth was actually good news for her. If she'd stuck with the insurance number, I would have been gearing up for the harder road with her, planning for the wrong thing. And it's funny, for her neurologist, that number wouldn't have changed a thing. Triptins, etcedron, it doesn't matter. Just stop and hear some prednisome.
The numbers matter to me because I'm not just pulling the medication out from under her. I'm helping her restore her health and then she will naturally wean down on those abortive medications on her own at a pace her body can handle without the prednisome. And how I do that actually does depend on what she's taking.
If you're taking pills from your daughter, ordering from an online pharmacy, borrowing from your sister, stockpiling, I want you to hear this. You are not the only one. You're not even close to the only one. It doesn't mean that there's something wrong with you. It means that you're in pain and the medication is the only thing getting you through the day and giving you a shot at a reasonable life. And you've been made to feel ashamed of it.
Remember what Dana said about the pills? I'm not proud, but that's what I do. So did Dana do something wrong? No. She was prescribed a medication for her migraines. She took it. When it stopped working as well, she took more of it because she was in pain. When she was told to stop, she tried. And and she did it more carefully than she was told to do. And when the migraines came right back, exactly the same, she went back to the only thing that had ever given her relief.
At every step she did what she was told, or the most reasonable thing a person in that much pain would do. I feel for my clients because they were only doing what they were told to do. And the system she's in can only go in one direction up the ladder, another drug, a stronger drug, because not one of those drugs does anything to restore the health that's generating the migraines.
That's not her failure. That's the dead end road. So what do we do instead? First, I'm not telling you to cold turkey your medication. Do not make any medication changes based on what you hear on this podcast. Discuss any medication changes with the prescribing doctor.
What I do is I work with my clients to help them restore their health first. and when people are taking abortive medications, they're only taking that medication as needed. And that's how the prescription is written. Take this Immatrex as needed for migraine pain or symptoms. So when we restore the body back to a state of health, it generates
fewer and fewer migraines. And so you would naturally take less and less abortives. Here's how that works with an abortive like Sumatriptin or Excedrin. When we start, the medication schedule doesn't change. You keep doing what you're doing, right? You're taking the abortive as needed. Meanwhile, we're working on what's generating the migraines in the first place. Then at some point a client will tell me something like
normally when an excedrine wears off, hour five is agony. But this week I got to hour six, and I was okay until then. That's the opening. Six hours becomes seven hours. Seven becomes eight. If you can take an excedron every eight hours instead of every six, you're taking it three times a day instead of four.
Then nine hours, week over week, until you don't need it. Your body tells us when it's ready for the next step. Not a calendar, not a two-week taper somebody wrote on a prescription pad. Same thing with the daily preventatives. You have to restore your health first. You have to lower the migraine frequency and severity first. And then step down slowly at the pace that your body can adapt to.
Because when you pull a medication out too fast, your body has to restart everything that the drug was suppressing. And if your health hasn't been restored, you crash, you feel terrible, and you think, well, I guess I need this drug. As you know, no one has an amatryptaline deficiency. Nobody has a Topamax deficiency. No one has a sumatriptin deficiency.
But that's what it feels like when you discontinue it or pull the rug out from under your body too quickly. My goal with my clients is that they don't go through a withdrawal at all. About half my clients have daily head pain. Dana's picture, unfortunately, is very typical. And I actually love working with women with daily head pain because we can get you out of rebound and we can get you feeling better.
I want to read you a message that a client sent me recently. When she came to me, she was taking something for her head every single day. On about four days a week, she needed two doses, usually an Excedrin and then some Imotrex on top of it. Every couple of weeks, a third. And she tried every preventative you can name, including Botox. That's how far up the ladder she was.
This is the message she sent to me two weeks into her plan. She wrote, I'm starting to see a break in my pattern. And then she gave me her week. Monday, no headache, no medicine. Tuesday, one accedrin. Wednesday, great until seven, then one accedrin and a small dose of imitrax, half of what she used to take. Thursday, no headache, no medicine. Friday, one accedron after a really stressful morning.
Saturday, good all day, one dose of Imatrex that night. So two days with no headache and no medicine, most days one dose instead of two, and when she needed an Imatrex, half the dose. And she said, I'm pleased, I'm seeing some improvement. I can't tell you that every woman sees this that fast. Everybody moves at its own pace. But this is what the start of getting out of rebound looks like.
It doesn't go from every day to never overnight. It goes day by day. And the days off start showing up. So let me go back to where we started. Don't call my doctor, right? Dana said that because she didn't want to get in trouble again, right? Afraid of being scolded, afraid of being handed another drug with a black box at the top of the label and being told that it might cause, you know, a little bit of weight gain.
If you've ever given your doctor the insurance number instead of the real number, I want you to know something. You're not a bad patient. You're not weak. And you are not out of options just because you've climbed to the top of the ladder. The ladder only goes in one direction, up. More drugs, stronger drugs, until you're so far up in the air you can't imagine ever getting back to solid ground. I'm here to tell you there's a way back down. You don't jump.
You climb down one rung at a time at a pace your body can handle. And you don't have to do it alone. You need a guide. Someone who knows how scary it is up there. I've walked a lot of women down that ladder. I know which rung to step on next and when you're ready for it. It starts with restoring your health. I'm telling you, I know everybody is telling you that you have a chronic genetic condition, you have a migraine brain.
This is a chronic, incurable condition that only gets worse. I'm telling you that's not true. If it were true, I would be laying in bed right now and not recording this podcast in front of all these bright lights. I know that.
It starts with someone being able to tell somebody the truth about what they're taking without getting in trouble for it. And if you're living with chronic migraines and you're ready to understand what's actually driving them and what you can do about it, I would love to talk. I offer a free consultation call. The link to that is in the description. We'll talk about your migraines, any other health conditions you have, and we'll put together a game plan to get you feeling better.
It's going to be the best 30 minutes you've spent on your health in a long time. So thank you so much for being here today. And thank you to Dana, Pseudonym, for allowing me to share this part of her story. I will see you guys soon.
