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Otter docs, I got new meds and want your advice...

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Otter docs, I got new meds and want your advice...

Old 02-26-05, 07:59 PM
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Otter docs, I got new meds and want your advice...

I get migranes. They suck. Convinced my doc to perscribe Torodol more than a year ago, but now he is concerned about how many shots I take. In about 14 months I have taken 19 shots. He worried about long term problems with scar tissue, etc.

Anyway, he decided he wants me to take Amitriptyline once a day. Personally, I hate the idea of medication every day. My doc takes this as well for the same reason. But I decide to look it up, and the uses are for depression (which I don't have, but wonder if it will somehow make me "happier" or something?), obsessive compulsive behavior, which is a plus for me because I am a little freakiy in the OCD department, and for bedwetters, which doesn't affect me.

But, the side affects are drowsiness, dizziness, blurred vision, etc. which seems to be why they say to take it at night. Other side effects are loss of appetite, heartburn, strange taste in mouth, anxiety, etc.

It also says to report immediately if you have: chest pain, difficulty urinating, nightmares (which I actually love), etc.


So.....what's this crap really like? Supposedly one a day keeps the migraine away, but I only suffer from them roughly 3 times every 2 months, anyway. Hate to take a regular pill for something like that.

Give me the lowdown.
Old 02-26-05, 08:15 PM
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My wife used to have bad migraines, and they put her on a once-a-day pill (she's not on Amitriptyline; I think she's on Lexapro), and she's had migraines much less often. Most people don't have side effects, or if they do, they only have one or two and they are minor, so you might want to give it a try to see if you have any side effects.

But if you're really set on not doing a once-a-day medication, my wife also has a prescription for Zomig, which is a pill she's supposed to take when she first gets a migraine. They used to work pretty well, but not 100% (though, like I said, she doesn't get the migraines any more, so it's a moot point).
Old 02-26-05, 08:16 PM
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Drinks lots and lots of alcohol!!!

(just kidding)

If you want some more technical info, they have a variety of online documentation for all sorts of pharma info. I know off hand it is a Tricyclic and is usually used to treat depression. (At least that is what I have seen)

http://www.mentalhealth.com/drug/p30-e01.html

In general, the above website is a great resource for a variety of mental health related information. I use it frequently when I don't have my DSM-IV around and I need an answer.

-pedagogue

Last edited by NotThatGuy; 02-26-05 at 08:19 PM.
Old 02-26-05, 08:35 PM
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dave wets the bed.
Old 02-26-05, 08:40 PM
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Dave is on meds?

yeah I'm not surprised







Old 02-26-05, 09:22 PM
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Originally Posted by pedagogue
I use it frequently when I don't have my DSM-IV around and I need an answer.

-pedagogue
Back in my day we had the DSM-IIIR and we got along just fine
Old 02-26-05, 09:25 PM
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Originally Posted by costanza
dave wets the bed.

<img src=http://images.usatoday.com/news/healthscience/health/_photos/2002-04-18-inside-enzyte.jpg>
"Not anymore, thanks to Amitriptyline"



I am more curious what an anti-depressent does to a person who is not depressed. Does it make me less prone to being in a bad mood?
Old 02-26-05, 10:32 PM
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Originally Posted by kvrdave
<img src=http://images.usatoday.com/news/healthscience/health/_photos/2002-04-18-inside-enzyte.jpg>
"Not anymore, thanks to Amitriptyline"

I am more curious what an anti-depressent does to a person who is not depressed. Does it make me less prone to being in a bad mood?
Antidepressants in general don't stop you from having moods. Depression is a condition in which there may be a chemical imbalance. The purpose of most antidepressants is to restore that balance. It doesn't really make you feel 'happy'. It's supposed to just make a depressed person feel normal. If you have no mood disorder, then it will probably not have much effect at all on your 'happiness'. It may even alleviate your OCD if you in fact really have it. Hell, it might even turn you into a liberal.

It's an interesting choice of med your doc made. I assume you've already tried triptan meds for aborting the migraines and they didn't work? Or was he just searching for a preventative drug for you to take on a regular basis? Toridol's a good pain med, but it's usually used short-term for post-surgical patients due to long-term side effects on the GI tract. If you're not really getting migraines that often, I would think he would try you on one of the abortive meds. Triptans have seemingly revolutionized migraine treatments since they were introduced, which was not too long ago.

Last edited by hahn; 02-26-05 at 10:36 PM.
Old 02-26-05, 10:59 PM
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Originally Posted by hahn
Antidepressants in general don't stop you from having moods. Depression is a condition in which there may be a chemical imbalance. The purpose of most antidepressants is to restore that balance. It doesn't really make you feel 'happy'. It's supposed to just make a depressed person feel normal. If you have no mood disorder, then it will probably not have much effect at all on your 'happiness'. It may even alleviate your OCD if you in fact really have it. Hell, it might even turn you into a liberal.

It's an interesting choice of med your doc made. I assume you've already tried triptan meds for aborting the migraines and they didn't work? Or was he just searching for a preventative drug for you to take on a regular basis? Toridol's a good pain med, but it's usually used short-term for post-surgical patients due to long-term side effects on the GI tract. If you're not really getting migraines that often, I would think he would try you on one of the abortive meds. Triptans have seemingly revolutionized migraine treatments since they were introduced, which was not too long ago.
My OCD doesn't affect my life....unless my wife puts the thermostat on an odd number that is not prime nor a multiple of five.

Anyway, I am not sure I have tried any triptan meds. I was on Maxalt (if that is a triptan med), and it didn't do much. Rarely worked, and when it did, it took awhile, had to take two pills after waiting, etc. I generally need fairly quick relief because I love my job so much.

Long ago I use to take, iirc, ergotamine and caffeine pills. They worked quite well, but I understand they quit making it. That would be good stuff to have again. Worked well, relatively inexpensive, etc.

I just really hate the idea of "taking medication for life" and tend to think that he perscribed this because he uses it as a preventative for migraines as well. He also suggested trying an aspirin a day, which I might try first.

Personally, I though Torodol was a wonder drug. Got rid of pain, but was not addictive, etc. But I don't want to end up with arm ulcers, etc. from injecting it, nor do I want my stomach to suddenly start bleeding. But I figured at 34, that wasn't a worry for a few decades.
Old 02-26-05, 11:03 PM
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Originally Posted by kvrdave
But, the side affects are drowsiness, dizziness, blurred vision, etc. which seems to be why they say to take it at night. Other side effects are loss of appetite, heartburn, strange taste in mouth, anxiety, etc.
My drug side effects beat the crap out of yours mister.
Old 02-26-05, 11:08 PM
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Munchies, lack of short term memory.....yeah, I suppose
Old 02-26-05, 11:13 PM
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I've taken Amitrip for depression and all it did was put me to sleep. I have a very low tolerance for meds and it made me sleepy and drowsy all the time.
Old 02-26-05, 11:29 PM
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Originally Posted by kvrdave
Anyway, I am not sure I have tried any triptan meds. I was on Maxalt (if that is a triptan med), and it didn't do much. Rarely worked, and when it did, it took awhile, had to take two pills after waiting, etc. I generally need fairly quick relief because I love my job so much.

Long ago I use to take, iirc, ergotamine and caffeine pills. They worked quite well, but I understand they quit making it. That would be good stuff to have again. Worked well, relatively inexpensive, etc.

I just really hate the idea of "taking medication for life" and tend to think that he perscribed this because he uses it as a preventative for migraines as well. He also suggested trying an aspirin a day, which I might try first.

Personally, I though Torodol was a wonder drug. Got rid of pain, but was not addictive, etc. But I don't want to end up with arm ulcers, etc. from injecting it, nor do I want my stomach to suddenly start bleeding. But I figured at 34, that wasn't a worry for a few decades.
Maxalt is a triptan drug. I guess it didn't work for you, though if I recall, you have to make sure you take it REALLY early on during the migraine attack or it's not effective at all.

Ergotamine/caffeine pills are no longer made? That's news to me. If this worked for you, I'd check on it. My pharmacopoeia book still has it listed under the trade name Cafergot. It even comes in a handy dandy rectal suppository form for your added pleasure and to further constrict your blood vessels for added anti-migraine effectiveness. (Plus, it takes your mind off the migraine pain.)

I'm kind of anti-medication unless absolutely necessary so I'm with you on the not wanting to take the everyday medication. And it really doesn't seem like you need to since you get them infrequently. But I'm not your doc, and I cannot assess your medication needs adequately online (there, that's my disclaimer). If the caffeine/ergotamine combination worked for you, then why change? Check with your doctor again - I haven't heard anything about it not being produced anymore (a quick Google check doesn't show anything either).

Toradol is great stuff. It's an NSAID that works as strongly as narcotics for analgesia. I thought it was administered intramuscularly though. In which case, I don't see why you couldn't get injected in other locations to avoid scarring. Interesting that you were getting it preventively for migraines. I'd never heard of it used in that way, but I'm not a migraine expert.

Last edited by hahn; 02-26-05 at 11:35 PM.
Old 02-26-05, 11:36 PM
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Taken from the cd-rom for Davis's Drug Guide, here's probably more than you'd ever need to know about it:

AMITRIPTYLINE
(a-mee-trip-ti-leen)
Apo-Amitriptyline, Elavil, Endep, Levate, Novotriptyn

CLASSIFICATION(S):
Ther. Class: antidepressants
Pharm. Class: tricyclic antidepressants

Pregnancy Category D


--------------------------------------------------------------------------------

Copyright © 2003 by F.A. Davis Company
INDICATIONS
Treatment of depression, often in conjunction with psychotherapy.
Unlabelled Uses:
Chronic pain syndromes.
ACTION
Potentiates the effect of serotonin and norepinephrine in the CNS
Has significant anticholinergic properties.
Therapeutic Effects:
Antidepressant action.
PHARMACOKINETICS
Absorption: Well absorbed from the GI tract.
Distribution: Widely distributed.
Protein Binding: 95% bound to plasma proteins.
Metabolism and Excretion: Extensively metabolized by the liver. Some metabolites have antidepressant activity. Undergoes enterohepatic recirculation and secretion into gastric juices. Probably crosses the placenta and enters breast milk.
Half-life: 10–50 hr.


CONTRAINDICATIONS AND PRECAUTIONS
Contraindicated in:

Narrow-angle glaucoma
Pregnancy and lactation.
Use Cautiously in:

Geriatric patients (increased risk of adverse reactions)
Patients with pre-existing cardiovascular disease
Prostatic hypertrophy (increased risk of urinary retention)
History of seizures (threshold may be lowered).
ADVERSE REACTIONS AND SIDE EFFECTS*
*CAPITALS indicate life threatening; underlines indicate most frequent.

CNS: lethargy, sedation.
EENT: blurred vision, dry eyes, dry mouth.
CV: ARRHYTHMIAS, hypotension, ECG changes.
GI: constipation, hepatitis, paralytic ileus.
GU: urinary retention.
Derm: photosensitivity.
Endo: changes in blood glucose, gynecomastia.
Hemat: blood dyscrasias.
Misc: increased appetite, weight gain.
INTERACTIONS
Drug-Drug:

Amitriptyline is metabolized in the liver by the cytochrome P450 2D6 enzyme, and its action may be affected by drugs that compete for metabolism by this enzyme, including other antidepressants, phenothiazines, carbamazepine, class 1C antiarrhythmics including propafenone, and flecainide; when these drugs are used concurrently with amitriptyline, dosage reduction of one or the other or both may be necessary. Concurrent use of other drugs that inhibit the activity of the enzyme, including cimetidine, quinidine, amiodarone, and ritonavir, may result in increased effects of amitriptyline.
May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors (avoid concurrent use—discontinue 2 wk before starting amitriptyline)
Concurrent use with SSRI antidepressants may result in increased toxicity and should be avoided ( fluoxetine should be stopped 5 wk before starting amitriptyline)
May prevent the therapeutic response to guanethidine
Concurrent use with clonidine may result in hypertensive crisis and should be avoided
Concurrent use with levodopa may result in delayed or decreased absorption of levodopa or hypertension
Blood levels and effects may be decreased byrifamycins ( rifampin, rifapentine, and rifabutin)
Concurrent use with moxifloxaxin or sparfloxacin increases the risk of adverse cardiovascular reactions
Additive CNS depression with other CNS depressants including alcohol, antihistamines, clonidine, opioids, and sedative/hypnotics
Barbiturates may alter blood levels and effects
Adrenergic and anticholinergic side effects may be additive with other agents having anticholinergic properties
Phenothiazines or oral contraceptives increase levels and may cause toxicity
Cigarette smoking may increase metabolism and alter effects.
Drug—Natural:

St. John's wort may decrease serum concentrations and efficacy
Concomitant use of kava, valerian, skullcap, chamomile, or hops can increase CNS depression
Increased anticholinergic effects with angel's trumpet, jimson weed, and scopolia.
ROUTE AND DOSAGE
PO (Adults): 75 mg/day in divided doses; may be increased up to 150 mg/dayor 50–100 mg at bedtime, may increase by 25–50 mg up to 150 mg (in hospitalized patients, may initiate with 100 mg/day, increasing total daily dose up to 300 mg).
PO (Geriatric Patients and Adolescents): 10 mg tid and 20 mg at bedtimeor 25 mg at bedtime initially, slowly increased to 100 mg/day as a single bedtime dose or divided doses.
IM (Adults): 20–30 mg 4 times daily.
AVAILABILITY
Tablets: 10 mgRx, 25 mgRx, 50 mgRx, 75 mgRx, 100 mgRx, 150 mgRx
Cost: 10 mg $17.90/100, 25 mg $35.75/100, 75 mg $85.25/100, 100 mg $108.00/100, 150 mg $108.86/100
Syrup: 10 mg/5 mlRx
Injection: 10 mg/mlRx.
TIME/ACTION PROFILE (antidepressant effect)


--------------------------------------------------------------------------------
ONSET PEAK DURATION

--------------------------------------------------------------------------------
PO 2–3 wk (up to 30 days) 2–6 wk days–wks
IM 2–3 wk 2–6 wk days–wks

--------------------------------------------------------------------------------

NURSING IMPLICATIONS
ASSESSMENT

General Info: Monitor blood pressure and pulse before and during initial therapy. Notify physician or other health care professional of decreases in blood pressure (10–20 mmHg) or sudden increase in pulse rate. Patients taking high doses or with a history of cardiovascular disease should have ECG monitored before and periodically throughout therapy.
Geriatric patients started on amitriptyline may be at an increased risk for falls; start with low dose and monitor closely.
Depression: Monitor mental status and affect. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.
Pain:: Assess intensity, quality, and location of pain periodically during therapy. May require several weeks for effects to be seen.
Lab Test Considerations: Assess leukocyte and differential blood counts, liver function, and serum glucose before and periodically during therapy. May cause an elevated serum bilirubin and alkaline phosphatase. May cause bone marrow depression. Serum glucose may be increased or decreased.
POTENTIAL NURSING DIAGNOSES

Coping, individual, ineffective (Indications).
Injury, risk for (Side Effects).
Knowledge deficit, related to medication regimen (Patient/Family Teaching).
IMPLEMENTATION

General Info: Dose increases should be made at bedtime because of sedation. Dose titration is a slow process; may take weeks to months. May give entire dose at bedtime. Sedative effect may be apparent before antidepressant effect is noted.
PO: Administer medication with or immediately after a meal to minimize gastric upset. Tablet may be crushed and given with food or fluids.
IM: For short-term IM administration only. Do not administer IV.
PATIENT/FAMILY TEACHING

Instruct patient to take medication exactly as directed. If a dose is missed, take as soon as possible unless almost time for next dose; if regimen is a single dose at bedtime, do not take in the morning because of side effects. Advise patient that drug effects may not be noticed for at least 2 wk. Abrupt discontinuation may cause nausea, vomiting, diarrhea, headache, trouble sleeping with vivid dreams, and irritability.
May cause drowsiness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to drug is known.
Orthostatic hypotension, sedation, and confusion are common during early therapy, especially in geriatric patients. Protect patient from falls and advise patient to make position changes slowly.
Advise patient to avoid alcohol or other CNS depressant drugs during and for 3–7 days after therapy has been discontinued.
Instruct patient to notify health care professional if urinary retention occurs or if dry mouth or constipation persists. Sugarless candy or gum may diminish dry mouth, and an increase in fluid intake or bulk may prevent constipation. If symptoms persist, dose reduction or discontinuation may be necessary. Consult health care professional if dry mouth persists for more than 2 wk.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Inform patient of need to monitor dietary intake. Increase in appetite may lead to undesired weight gain.
Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Advise patient to notify health care professional of medication regimen before treatment or surgery. Medication should be discontinued as long as possible before surgery.
Therapy for depression is usually prolonged and should be continued for at least 3 months to prevent relapse. Emphasize the importance of follow-up exams to monitor effectiveness and side effects.
EVALUATION

Effectiveness of therapy can be demonstrated by:

Increased sense of well-being
Renewed interest in surroundings
Increased appetite
Improved energy level
Improved sleep
Decrease in chronic pain symptoms
Full therapeutic effects may be seen 2–6 wk after initiating therapy.
Old 02-26-05, 11:39 PM
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Good point - make sure you don't get pregnant or breast feed if you choose to go on Amitriptyline.
Old 02-26-05, 11:56 PM
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Originally Posted by hahn
Toradol is great stuff. It's an NSAID that works as strongly as narcotics for analgesia. I thought it was administered intramuscularly though. In which case, I don't see why you couldn't get injected in other locations to avoid scarring. Interesting that you were getting it preventively for migraines. I'd never heard of it used in that way, but I'm not a migraine expert.
Torodol is what they use to give me when I would have to go to the ER because it was really bad. Wiped it out quick. My Doc was resistant to give me torodol as a perscription, but my mother was an RN and I assured him that I would have her give them to me. He wanted to just have some at the clinic in case I needed it, but I generally needed it at night, so that didn't do me much good.

Anyway, I tend to give them to myself, which means they tend to go in the same place....so I need my wife to nut up and start giving me a hand.

And I don't think it was for prevention. I would take 2 doses of Excederin Migraine (which does work on occasion) and if it just couldn't do anything, I'd go for the Torodol. I tend to go in cycles. I will get 3 in 10 days, then not have one for 3 months.

Anyway, he also told me to cut way back on caffeine. My father also has the same migraines but had to quit drinking pop (the only source of caffeine for either of us) and hasn't had one since. May be the same for me. But damn, I had the "change of lifestyle" stuff. I want miracles.
Old 02-26-05, 11:57 PM
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I'll check on the ergotamine. Thanks.

Oh, and I won't breastfeed.
Old 02-27-05, 12:28 AM
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Originally Posted by kvrdave

Oh, and I won't breastfeed.

I might if that Proscar (finasteride) provides the side-effects it's supposed to.
Old 03-07-05, 07:26 AM
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OKay, got one this morning so I thought I would bump. This is actually the second in about 10 days, but they can come in waves at times.

Now this one, I know the exact cause of. I was working out last night, doing the bench press. I went to the edge of insanity, and pushed hard. I put up the weight and it I could barely get it up (this was on the 11th our of 12 times), but I decide I will get the full 12 in no matter what, so I go for 12. I feel something pop in my head (not really pop, but I am not sure how to describe it), and could feel that I just did something that was going to lead to a headache. It did. Felt it a little all through the night, and finally got up this morning and took the trusty torodol shot. I'll be fine in about 15 minutes. Now it wasn't incredibly bad, but I know from experience that it wasn't going to get any better.

Now...I have decided against any medication that I have to take on a daily bases (other than aspirin). So I went to a bunch of online pharmacies just to look at the prices of Ergotomine, and none of them show it in stock. I will probably call my doc and see if he can get it, though.
Old 03-07-05, 04:38 PM
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Is this daily med something your doc was going to have you on forever? Because I used to have migraines very similar to what you're describing, and my doc put me on depakote for only about 6 months. At the end of 6 months, I was off the depakote, and my migraines have decreased to about 1 every 6 months instead of one almost every week. I can't remember what the primary use for depakote (and I don't think I'm spelling that right) is, I think it's normally for depression or bi-polar or something like that, but it does something to basically break the cycle of migraines and get you back in balance so you don't have to take it forever.
Also, you might try finding a good chiropracter, since that "pop" in your head is very very similar to what I have gotten, which is related to my neck and spine being out of alignment and putting pressure on nerves, which causes my migraines.
Old 03-07-05, 05:21 PM
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Originally Posted by kvrdave

Oh, and I won't breastfeed.
I would if that blond preggo from the TV show Lost was around.
Old 03-07-05, 05:23 PM
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Ok, sorry, but I missed this thread when it was originally posted.
Anyway, Yes I have prescribed Amitriptyline many times for migraine prophylaxis. It does work, however, it takes a while, it doesn't just happen overnight. It can take up to several weeks for antidepressant meds to build up in your system to the level where they will be effective.
No you are not depressed, this is an off-label use of this drug.
I wouldn't worry about the side effects unless you get one, they are rare and you will know it if you get them.
Maxalt is a triptan, however, I don't like it as much as Imitrex. These drugs are not for prophylaxis but more like rescue drugs to be used when you feel like you are getting a HA. Imitrex is the only one that can be taken orally, injected, or as a nasal spray (the latter two options work faster than pills) And yes, the earlier you take them the better. Don't try to wait it out or see if it goes away. And don't take them if you have had heart trouble or previous heart attacks.

Now this pop in your head, was it in your head or the base of your head / top of your neck? If this caused you to have a headache, your HAs may be more musculoskeletal and not vasodilatation.

This leads me to... where are your HAs?(front of your head, in back, both sides, in a band like pattern across your head) What do they feel like?(pounding, stabbing) Anything make them better or worse (like sitting in a dark room)? Any family history of migraines? Do you get carsick? Any vision changes?

And two things for future reference, if a doctor prescribes you something, do not alter the dose or stop taking it without talking with the doctor. This really kills me, when people stop taking a drug because of a side effect they read about or a friend of theirs is a nurse and said it was bad. Then they complain that they are not getting any better.
And the second thing is, as you get older, you will be required to take more once daily or even more than daily drugs to remain healthy or fight diseases.
So get used to it, its unavoidable.

Hope this helps.
Old 03-07-05, 05:35 PM
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Originally Posted by Bubba
I wouldn't worry about the side effects unless you get one,
Sage advice

Now this pop in your head, was it in your head or the base of your head / top of your neck? If this caused you to have a headache, your HAs may be more musculoskeletal and not vasodilatation.
It was just like a headache suddenly starting, not really a "pop" at all.

This leads me to... where are your HAs?(front of your head, in back, both sides, in a band like pattern across your head) What do they feel like?(pounding, stabbing) Anything make them better or worse (like sitting in a dark room)? Any family history of migraines? Do you get carsick? Any vision changes?
It is like an icepick behind the eye. Can be either eye. My father gets them as does my sister. I don't get carsick, or have vision problems. Sounds, smells, lights, etc. don't seem to bother me particularly when I have one (though naturally I prefer a quiet dark room to try to sleep or something, but sleep rarely helps....however, throwing up seems to).

And two things for future reference, if a doctor prescribes you something, do not alter the dose or stop taking it without talking with the doctor. This really kills me, when people stop taking a drug because of a side effect they read about or a friend of theirs is a nurse and said it was bad. Then they complain that they are not getting any better.
And the second thing is, as you get older, you will be required to take more once daily or even more than daily drugs to remain healthy or fight diseases.
So get used to it, its unavoidable.

Hope this helps.
I don't change my dosage at all. I just sit back and decide if what he gave me is something I want to mess with. So I have not even started the pill yet. Not sure I want to take something every day already. When I am 50, I can deal with it, but not yet. And I don't know that I want something that knocks me out. I like the night.

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