Lifting & conditioning whist using Migraine Medication

Medical Q&A [Moderated]
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This is a new post created on a different device to replace the previous one that only displayed the first paragraph in this forum. Hopefully it will display all my text.

I’m going to go back to doing another NLP after a 4 month hiatus(non hernia) due to extensive travel and tennis elbow from actually playing tennis and badminton. Apparently a rare phenomenon.

12 years ago I have an ACDF & plate at C4 & C5. It doesn’t stop me lifting but since the injury and surgery I do suffer with migraine/headaches which radiate from the back on my neck forward, often behind one eye. No flashing, or aura, just debilitating pain, mild nausea & tiredness.

Sumatriptan if taken early enough prevents the headache development but I have for the past 8 years used a prophylaxis daily medication taken at night

I have used amitriptyline 20mg or the beta blocker nadolol 80mg, separately, both of which have been very effective as preventing headaches.

My typical BP is 140 / 90 (far from ideal) whilst not using the betablocker and so I can see the additional benefit of taking that for my longer term health. I’m relatively fit and healthy 45 year old male at 215lbs at 6’1" waist 39" but I would benefit from losing around 12lb of bodyfat for better health.

Conditioning training on Nadolol really reduces my maximum attainable HR by about 25bpm. Resting HR is around 55bmp rather than 75bpm without it.

I wonder which prophylaxis medication would be better for my long term heath and fitness and benefit my main training goal of getting stronger, or is there something else I could take that could be just as effective, with less side effects? I’m going to be living in Thailand from tomorrow.
If my max heart rate on a betablocker is restricted, does this affect my performance and ability to increase strength and improve my fitness?
If I do sprint interval training on a stationary bike, on the betablocker, it’s the aching leg muscles that stop me from pedaling any harder or faster at ~160 bmp without much breathlessness (presumably due to less oxygen getting to my muscles).
When I’m not using a beta blocker, my HR can get up to around 185 doing the same HIIT program and it’s more the breathlessness that makes it hard and makes me want to complete the sprint and ease off.

Whilst using one or the other medication I probably average 3-4 migraine headaches a month. Without using anything, typically 3-4 a week. Without it, life would be pretty miserable. If I miss a dose, bang, I get a headache the next day.

Deadlifts have certainly helped reduce the number of headaches I get. Any massage to my upper traps and back of neck triggers a headache quickly and so I avoid them.
I notice that when I have the migraine headaches I lose some flexibility when I bend forward from a standing position and try to touch my toes. My finger tips would be around 2-3 ’ higher from my toes with a headach.

Side effects of both medications are a reduced libido which is the biggest negative effect. Also being less mentally sharp and maybe some cognitive impairment and forgetfulness using the amitriptyline over the past 6 months or so.

I want to get the best out of my strength training programs and conditioning and most importantly benefit my long term health and I enjoy following BBM.

If at all possible, I’m seeking some medical advice from a medical practitioner. If Austin or Jordan had the time I’d really appreciate some advice from a combined Medical Doctor & coaches perspective.

Kind regards
Ian
England UK.

Austin, have removed the two phone created emojis from my previous post that failed and I hope that has solved the problem. Thanks.

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Hi Ian,

This is a bit of a complex situation (particularly with the surgical history, which makes me wonder about the migraine diagnosis).

How old are you?

While beta blockers are often effective for migraine prophylaxis, they would not be my first choice of therapy in someone with weight issues (as it slows metabolic rate), reduced libido, and are far from the first-line choice for treating hypertension. Similarly, it is not surprising that you report cognitive effects from amitriptyline, as it has significant anticholinergic and antihistaminergic effects.

Have you been evaluated by a neurologist? Have you ever tried / been on any other migraine prophylactic medications? There are several other options here that would likely cause less side effects for you, and I wonder whether you’ve discussed this with your prescribing physician. Topiramate, for example, can be used as a migraine prophylactic and actually promotes weight loss, rather than the weight gain that can be seen with beta blockers. Calcium channel blockers are an alternative that can be used, and would be beneficial for lowering blood pressure as well. And, from the non-prescription standpoint, there is actually evidence on Riboflavin (vitamin B2, at a dose of 400 mg/d, taken for at least 3 months) in reducing frequency of migraine headache.

[Standard disclaimers (written above) apply here, and as usual, you should speak with your physician prior to stopping or starting any new medications they have been managing with you.]

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Hi Austin and thanks for your reply.

I’m 45.

The only neurologist I have had contact with post surgery, that was in late 2006 was my neurosurgeon.

I complained about the headaches and he gave me occipital nerve injections of a local anesthetic and then I think some kind of steroid(from memory I think I said the substance was similar to a bee venom?? ).
This treatment seemed to prevent the headaches for a few months and then they returned. I had the procedure carried out for a second time with no benefit experienced.

Since then I have travelled around a fair bit but spent at least 6 months of the last 10 years in New Zealand and I’ve only seen GP’s

The GP’s that I saw in NZ issued either the nadolol or the amitriptyline, that was after the Maxalt Melt and other triptans had to be used so frequently and they seemed to lose their effects.

Upon returning to my home country UK back in May 2018 I saw a local GP and discussed the amitriptyline and its libido loss and weight gain side effects. He suggested that I try Nortriptyline but this didn’t seem to work for me at all so I returned to the Amitriptyline as I can depend on it.

I’m writing this reply on a plane that will shortly be leaving Birmingham Airport, England, to Chiang Mai, Thailand where I will be living for the next 9 months.

I’ve read about topiramate being good for migraine prophylaxis but I also read that there was a potential risk of vision being effected so I didn’t pursue that. Now that you have suggested it, I will explore that option as well as the calcium channel blockers in Thailand and take your advice and go and see a neurologist to get an evaluation.

I will also go to a pharmacist and get some B12 and take that in the dose my that you suggested for the next few months. I note the disclaimers and thank you again for the advice.

Best regards

Ian

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I would agree with the plan to get a neurologist evaluation on this.

And note that I said B2 (Riboflavin), not B12 (cobalamin).

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Noted B2. Thanks Austin.

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I’ve now in Chiang Mai Northern Thailand and yesterday whilst out and about I called into 3 different pharmacies.

Topiramate could not be obtained from the pharmacies.

They did have Madiplot, a Calcium Channel Blocker (dihydropyridine type).

2 pharmacies only did B2 in a multi b vitamin container at 15mg dosage of B2 and one could get B2 (Riboflavin) in 50mg for 1.5 baht (0.04USD) each.

Perhaps Topiramate could be prescribed and dispensed at a hospital.
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I’m still using the amitriptyline 20mg/d which is also available here until I find and make a consultation with a good English speaking Neurologist.

If I miss a dose I can pretty much guarantee I will get a headache the next day.

At the moment I can function and live with some cognitive impairment and a dry mouth in the morning but cannot with the often daily headaches I experience without medication.

Regarding conginitive impairment that we discussed from the use of amitriptyline, are the effects likely to be permanent, even once I come off it or will their cognitive effects dissipate over time ?

Are there any other potential adverse risks or side effects, short and long term that would make you very reluctant to prescribe 20mg of amitriptyline daily to me as a 45 year old male with an estimated body fat percentage currently of 23% doing strength and conditioning 5 days a week, despite them being highly effective at preventing my migraine headaches?

Also will it have any impairment on the training effect and recovery, assuming I’m training optimally on the NLP and post NLP programs and answering yes to Rip’s 3 questions? I’m certaining having very good sleep whilst using amitriptyline.

I am aware of the medical disclaimers to any advice given.

​​​​​​​Thanks Austin.
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This may provide some benefit, although sometimes tolerance is observed over time.

Riboflavin is easily obtained at the recommended dose range over-the-counter or online (e.g., Amazon).

No idea. Would be a question for a local neurologist.
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I wonder how much of an expectancy effect is at play here.

Cognitive effects should reverse in the short term when you stop the medicine, though there is some long-term risk of cognitive effects down the road from long-term use of anticholinergic medicines.

It should not compromise your training effect. And if you’re otherwise tolerating the medicine well, I’m reluctant to point out other side effects (which you presumably are not experiencing right now), at the risk of inducing a nocebo-type effect. This is well-documented in the literature (e.g., warning patients about potential side effects increasing their risk of experiencing and reporting said effects, compared to groups not advised of those effects).

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Thank you so much for the time you have given me Austin. It’s much appreciated and you are most welcome to close the thread. I wish you success in your future comps.