Just stopped working? Migraines?

[Cgraham]

I didn't really know whether to type this in GAD, IBS or a migraine section on this forum but every time I try to pinpoint something I end up back at my citalopram.

This last year has been wacky and awful on my citalopram. I've been on citalopram for around 15 years and steadily had to increase from 20mg to 30mg and then since last march I was upped to 40mg which I believe is the maximum dose a person can be on with citalopram.

Early last year I went through a stage of constant migraines with aura but the weird thing is that the actual headache isn't the blinding pain you would normally associate with a migraine. It's more of a constant dull pain but I also get the other symptoms. Nausea, dizziness, sensitivity to light and sound. It eventually went but then came back again a few months later. I spoke to the GP and I thought it could be down to changing brands of citalopram from one chemist to another. I did the old Dr Google and imbalances of serotonin can affect and cause migraine so is the higher dose causing all of this??

But even though I've upped my dose to the maximum my anxiety seems worse than it was on say 20mg or 30mg in the past. Can it just stop working? Could this be causing my migraines? If it was would they just switch me to a different SSRI or would they all be the same?

I'm really frustrated and down with it all and especially the migraines. Constant dull headache and it really affects my mood. And advice or experience would be greatly appreciated

[Carys]

Hi there, I can't comment on the citalopram and if it can 'just stop working' but your migraines sound very like what is referred to nowadays as 'silent migraines' or acephalgic migraine (all the symptoms bar the terrible headache). You can look it up and find lots of information regarding silent migraine. The migraine trust is a good starting place to start thinking about those potential triggers, I know that you have citalopram as your number one candidate, but there are other things worth exploring too. Some antidepressants are used to treat migraine/silent migraine, amongst a variety of other meds of course, but I think venlafaxine and amitriptaline are the most used. Often they are 'end stage/nothing else has worked' meds used it seems, when all the standard prophylactics have been tried. It can be a nightmare pinpointing the triggers for migraine, of any variety - and I speak as someone who started having them very regularly indeed after stopping an SSRI (and menopause starting) so there are known relationships for some people between serotonin and migraine, but of course in my case also hormone changes. I get barely any headache at all, but plenty of other symptoms leading up to and after the aura. Sorry, I can't be much help, but I will say that if there has been a period where they have disappeared then maybe start looking at what changed during that period - I've been through and checked triggers, of so many types and kept diaries and lists galore, and can relate to the frustration with not being able to find the cause and therefore control it. It could be that you were incredibly anxious and that triggered them......and unrelated to the citalopram.....

https://www.webmd.com/migraines-head...lent-migraines

[panic_down_under]

Early last year I went through a stage of constant migraines with aura but the weird thing is that the actual headache isn't the blinding pain you would normally associate with a migraine. It's more of a constant dull pain but I also get the other symptoms. Nausea, dizziness, sensitivity to light and sound. It eventually went but then came back again a few months later.

Migraine with aura, but no, or only moderate headache pain is relatively common. I have them 3-4 times a year. If you're experiencing them only occasionally then the citalopram is less likely to be the cause, although it might be adding to whatever is triggering them.

I spoke to the GP and I thought it could be down to changing brands of citalopram from one chemist to another. I did the old Dr Google and imbalances of serotonin can affect and cause migraine so is the higher dose causing all of this??

Citalopram might be exacerbating them by a different mechanism. Serotonin isn't just a brain neurotransmitter. In fact this is only a minor function. It has many other roles in the body including in mediating blood vessel tone, constriction and dilation. Serotonergic antidepressants (ADs) can effect this so if the migraines occur often that could be the reason, though I suspect it won't be the only factor.

But even though I've upped my dose to the maximum my anxiety seems worse than it was on say 20mg or 30mg in the past. Can it just stop working?

Antidepressant 'poop-out' does happen and the SSRIs are more prone to quitting than the others.

If it was would they just switch me to a different SSRI or would they all be the same?

Failure of one SSRI doesn't necessarily mean the others won't work either. Switching to another SSRI can be the easiest and quickest route to regaining control of the anxiety as in most cases it can be done overnight. However, as with everything AD related, there are no guarantees. I suggest you discuss your options with your GP asap as the heightened anxiety and pain is counterproductive.

[Carys]

Citalopram might be exacerbating them by a different mechanism. Serotonin isn't just a brain neurotransmitter. In fact this is only a minor function. It has many other roles in the body including in mediating blood vessel tone, constriction and dilation. Serotonergic antidepressants (ADs) can effect this so if the migraines occur often that could be the reason, though I suspect it won't be the only factor.

Excuse me adding to your information PDU : Though there is much evidence now, somewhat debated though I believe, that 'cortical spreading depression' (rather than any vascular changes) are the cause of silent migraine - so the blood vessel constriction and dilation are less relevant/not relevant for this type of migraine. Would that make the SSRI more or less likely the potential cause ? I agree with you though , that even if it was part of the trigger it isn't the only 'cause'. I restarted my SSRI only to tackle silent migraine and it has reduced them by half in total each month, and made them less intense - but they are not gone and there are clearly other triggers within my body that I'm not aware of.