Brain Fog and Migraine
Source: “From Fatigued to Fantastic” by Jacob Teitelbaum, M.D.
Treatments for “Brain Fog” due to CFS and Fibromyalgia
___102. Ginkgo 60 mg - 1 capsule 2-3 times a day.
___ 103. Remember - Mental Sharpness Formula (Enzymatic Therapy) - Take 2 capsules daily. For mild memory problems associated with aging, this comprehensive formula is more powerful than ginkgo alone. It safely supports enhanced focus and brain function through its unique blend of powerful antioxidants, energizing B vitamins, high-potency alpha lipoic acid and clinically-studied herbal extracts.
___ 104. Niacin - (not niacinamide or “flush free niacin). Take 100-500 mg of niacin 3-4 times a day on an empty stomach as needed to cause a “flushing” feeling, which occurs within ~ 10-20 minutes. The Flushing feeling is often intense, but not dangerous. It opens the blood vessels to your brain and other areas that have been deprived of blood flow. You may choose to let the pill dissolve in your mouth, and follow it with a glass of cold water. The flush can significantly help brain fog and pain and niacin is very inexpensive. Try to keep the dose at 1000 mg a day or less if this is enough to cause flushing, as higher doses can rarely cause liver inflammation or unmask diabetes. This treatment also helps to lower cholesterol.
___ 105. Piracetam (Rx) - 1200 mg twice a day for 2 weeks, then take 2400 mg twice a day for 2 weeks. Then adjust to optimum dose (up to 4800 mg a day). Can be ordered from England. Take with Hydergine (#106) (www.antiaging-systems.com).
___ 106. Hydergine (Rx) - 4 to 6 mg each morning.
___ 107. DMAE - up to 400 mg a day.
For Migraines - prevention
For migraine prevention, Magnesium (see #1 plus take an extra 200 mg at bedtime) is very important. I would add vitamin B2 and butterbur (or feverfew if the butterbur is too expensive). It can take three months to see the effect of these preventive measures! If your migraines are predominately around your period or associated with taking estrogen, they can often be eliminated by adjusting estrogen dosing. Many medications which are elsewhere on this form can also be helpful for the prevention of migraines when taken regularly. These include Neurontin, Topamax, Elavil, and Doxepin. Inderal XL can also be helpful but may aggravate fatigue, asthma, or depression. Food allergies should also be addressed. Other medications can also be helpful. For more information see A Comprehensive Medicine Approach To Migraines.
___108.** Food allergies are also very important to consider in the production of migraines. To tell if foods are playing a role, it is helpful to do a food elimination diet. Although a very limited diet is needed for five days (eat only pear and lamb, and drink only bottled spring or distilled water), this kind of strict elimination diet for five days will make it easier to tell if true food allergies are present and triggering your migraines when you reintroduce the foods into your diet. In one study, by avoiding the ten most common food triggers, there was a dramatic reduction in the number of headaches per month, with 85% becoming headache free. The most common reactive foods were wheat in 78% of patients, orange in 65%, eggs in 45%, tea and coffee and 40% each, chocolate and milk and 37% each, beef in 35% and corn, cane sugar, and yeast in 33% each when the patients were challenged with these foods . If you have severe and frequent migraines, it is worth exploring this. You may find that instead of avoiding these foods for the rest of your life, you can eliminate the sensitivities/allergies using an acupressure technique called NAET (see http:///www.naet.com).
___ 109.* Vitamin B2 (riboflavin) - 400 mg each morning to prevent migraines.
___ 110.* Petadolex (butterbur) - 50 mg 3 times a day for 1 month and then twice a day to prevent migraines. Can take 2 every 3 hours up to 6 capsules for acute migraines. Use only Enzymatic Therapy or ITI brands - others often have impurities and do not contain the amount of Butterbur the label claims. This can be highly effective.
___ 111. Feverfew - 250 mg 1 to 3 times a day to prevent migraines.
___ 112. Zonegran (Rx) - 100 mg- An anti-seizure medication. Begin with 100 mg a day for two weeks and then increase to two tablets a day. The maximum dose is 400 mg daily, although most of the benefit occurs at the first 200 mg. Because there have been rare occurrences of a life threatening rash (most rashes caused by the medication are not however), stop the medication immediately if you get a rash.
Acute Migraines
___ 113.* Petadolex (butterbur) - 50 mg - 2 every 3 hours up to 6 capsules for acute migraines
___ 114.* Imitrex (Rx) - For the treatment of acute migraines, medications in the Imitrex family still remain the first choice. Imitrex comes and 25, 50, and 100 milligram tablets, and up to 100 mg may be taken at a time. If pain persists at two hours, another dose of up to 100 mg can be taken. In addition, it is also available by nasal spray, using a dose of up to 20 mg initially, followed by one more spray of up to 20 mg 2 hours later if needed. Another alternative is a 6 mg subcutaneous injection which can also be repeated one-hour later if needed. It is reasonable to try these different forms to see what works best for your migraines. You may also want to try a newer cousin called Amerge. Use 2.5 milligrams initially. This dose may be repeated four hours later if needed. #114A below is more effective than Imitrex 50 mg in a head to head study, however, and much cheaper.
___ 114A.* Acetaminophen 500 mg, aspirin 500 mg, and caffeine 130 mg is more effective than Imitrex 50 mg in a head to head study, however, and much cheaper.
___ 115. Axert (Rx, Almotriptan) - 6.5 or 12.5 mg. Can repeat after 2 hours. A cousin to Imitrex but less expensive.
___ 116. Magnesium 1-2 grams intravenously over 15-30 minutes will usually knock out acute migraine attacks.
___ 117. Midrin. (Rx) - Two capsules are taken immediately followed by one capsule every hour until the headache is relieved (to a maximum of five capsules within a 12 hour period). It can also be helpful for tension headaches in a dose of two capsules four times a day as needed.
___ 118. Metoclopramide 10 mg plus lysine acetylsalicylate (Rx) (compounded) - 1620 mg or aspirin 900-1200 mg (chewed). Metoclopramide returns the absorption of aspirin to normal during migraine attacks and also combats nausea and vomiting. In 2 placebo-controlled studies, this combination (using lysine acetylsalicylate) was more effective then 100 mg of Imitrex by mouth and was better tolerated.
OR
___ 119. Indomethacin (a “super-aspirin”), prochlorperazine (for nausea), and caffeine in suppository form (also compounded) eliminates an acute migraine in 49% of patients.
___ 120. ACTIQ (Rx, Fentanyl Lollipops) - 200-1600 mcg. This powerful narcotic should only be used for breakthrough pain that is not relieved by other medications (i.e., used instead of going to the emergency room). Fentanyl lollipops should be sucked on, not chewed or swallowed. In between being sucked on, it should be left between the cheek and lower gum. Time it so that it takes approximately 15 minutes to be absorbed into your cheek. In doing it this way, it is most effective. It begins working within 5 to 10 minutes with pain relief lasting approximately three hours. Its effectiveness is similar to 2-16 mg of intravenous morphine. The most commonly used doses are 400 & 800 mcg. Because these medications are only approved by the FDA for use in patients who are on chronic narcotics, it is reasonable to have you (if you are not on chronic narcotic pain medications) take the first dose in a doctor’s office to make sure that it does not cause excessive sedation. Like other narcotics, this medication can be highly addictive. Because of this, it should only be used as a rescue medication when other medications have failed. Once you have tried the 200 and 400 mcg doses and know that they are not too sedating, begin with a 400 mcg dose over 15 minutes. If adequate pain relief is not achieved 10 minutes later (25 minutes after beginning the first lollipop), use another 200 or 400 mcg unit each 25 minutes until adequate pain control is achieved or you reach 1200 mcg. The average dose needed is 800 mcg.
___ 121. Phenergan Rectal Suppositories (Rx) - For nausea, 25 mg- 1 every 4 hours as needed for nausea (up to 5 a day).
___ 122. Diamox (Rx) - (a diuretic) 125-500 milligrams once or twice daily may decrease severe pressure headaches. Carbonated beverages will taste funny while you’re on this medication.
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