When Inderal Meets Low Carb

I’ve commented before on how disturbing Inderal dreams can be.

Last night I dreamed I was eating in my college dining hall.  I had half an English muffin.  Then I went back for the second half.  Then I had a croissant.  Then a bagel.  Then another croissant.  You know where this is leading, don’t you?

I’m sure the “fat is all in your head” camp will say that this is because I miss these foods.  On the contrary, this was not a dream of desire.  It was a nightmare.  It was like I dreamed I was eating poison.

Neurology Appointment on Wednesday

Long-time readers of this blog may remember that about 3 months ago, I tried to make an appointment with a neurologist who specializes in migraine, and was told that he was booked until late October.  I made the appointment, my PCP prescribed Inderal, and I haven’t had a migraine since.

I’ve been wondering whether I should keep this appointment, since I’ve been completely migraine-free since starting Inderal, and perhaps I could free up the appointment for someone who really needed it.  I decided to call and describe the situation.  The receptionist talked me out of cancelling, saying that I should come in and be evaluated, because if I cancelled the appointment and later started having migraines again, it would be another 3 months before I could get an appointment.  “I see this happen all the time,” she said.  If the doctor had evaluated me and the migraines came back, he could consult with me by phone if necessary.

OK.  I did not cancel the appointment.  It’s probably for the best.  I want to ask if he’s heard anything about ketogenic diets for migraine (thanks to all my readers who have provided information sources, by the way).  I’m also more than a little concerned about Inderal’s affect on insulin levels, but it seems to be working so great against migraine that I’m reluctant to stop it without asking some questions.  I want to ask him exactly how Inderal works, and whether there are other drugs that affect the same brain pathways without raising insulin levels.  And of course, if there are other drugs, I want to know what side effects I could expect.  Finally, while this isn’t a problem at this time of year, Inderal is somewhat bothersome during hot weather, when my normal, non-drug-influenced BPs already run a little low; it would be nice if I could find an alternative before next summer – I felt limp for much of July and August.

I’ll confess that what I want to hear is:  ketogenic diets work extremely well for migraine; there’s a high likelihood that I won’t need Inderal as long as I stay on a low-carb regimen; and if low-carb does not completely resolve the migraine situation, there are other prophylactic drugs that do not raise insulin and have very few side effects.

Yeah, right, I can hear my fellow migraine sufferers say.  Well, a girl can dream, can’t she?

Ketogenic Diet for Migraine?

I started this blog many months ago as self-help for my migraines, and it has evolved into a blog about low-carb, with occasional migraine-related posts.  If you want a little more detail about this evolution, check out my About the Migraineur page.  If you want a lot more detail, read the archives. 

I have never claimed that there was any connection between migraine and a low-carb diet, but the thought has been nagging at the back of my mind.  So many other health problems clear up when I limit grain, other starches, and sugars – what if migraine were another?  What if I could get off Inderal, which has slowed, but not stopped, my weight loss?

Now, this new study from France has me wondering if low-carb could actually be a preventive measure for migraine.  Warning: extremely technical language.  If you’re not inclined to technical terms, (hey, I’m a bit of a nerd myself), try the layperson’s explanation on Jimmy Moore’s blog, where I originally found this.

Or, if even that’s too much, allow me to oversimplify even further.  A ketogenic diet is one that reduces carbohydrates and replaces them with fat, thereby leading the body to produce ketones and burn them for energy.  It’s long been known that a ketogenic diet can help control epilepsy in children – see this excellent article on Epilepsy Action’s website.  According to the new study, the ketogenic diet works by changing the balance of two neurotransmitters, GABA and glutamate, in the brain.  On a ketogenic diet, GABA increases, and glutamate decreases.  This is because burning glucose causes the body to make more glutamate, and burning fat causes the body to make less.

Call me gobsmacked.

GABA may not mean anything to the average migraineur, but anyone who has ever suffered from migraine should be very familiar with glutamate.  Glutamates in all their forms (mushrooms, parmesan cheese, soy products, MSG and its kin) show up frequently on lists of common migraine food triggers.  What I did not know what that glutamate acts as an excitatory neurotransmitter, which just means it causes neurotransmitters to fire.  I also didn’t know that glutamate is actually produced by our bodies, and I didn’t know that it often occurs in inverse ration to GABA, which is a neurotransmitter that inhibits the firing of neurons.

This suggests (but does not prove) that you can spend all the time you want avoiding all those glutamate-rich foods, but as along as you are feeding your brain a steady supply of glucose, it’s just gonna keep cranking out glutamate on its own.

Also note that one commonly prescribed migraine preventive is Topamax – an anti-seizure drug.  This also suggests (but does not prove) that treatments that are effective for epilepsy may also be effective for migraine.

Things it would be nice to know:

1.  How much glutamate occurs in the brain on the 300 g of carb a day recommended by the USDA?
2.  How much glutamate occurs in the brain on the 20 g to 50 g of carb a day recommended by many low-carb diet plans?
3.  How do these numbers compare to the glutamate in a reasonable-sized serving of Parmesan cheese or mushrooms?
4.  When is someone going to do a study of the effect of a ketogenic diet on migraine?  (Geez, I wish I were a scientist right now …)

Still, I find this very exciting – it really would be nice to get off Inderal!

Flickering

After the alarm clocks went off this morning, but before we actually got up, I asked my husband if he could see flickering light.  (We live on a busy street, and there’s a tree outside our bedroom window, so sometimes the combination of reflections on moving cars and light filtering through moving tree leaves creates an impression of flickering.)

“No,” he said.

“It’s weird,” I said.  “I don’t see it either, unless I hold my head at a specific angle.  Then it’s like there’s a slight flickering light on the bridge of my nose.  It’s almost like the sensation you get when you’re in a room with a ceiling fan, and the fan is at the very edge of your peripheral vision.”

Actually, I thought, it just like the last stages of migraine aura, where the little dot of disturbed vision has expanded to a ring of disturbed vision, and the ring has expanded and expanded until it’s mostly out of your field of vision, and then it’s gone.

It wasn’t aura, at least not as I usually experience them.  First of all, I had been awake for at least 10 minutes, and had not noticed the usual progression of aura described above, just flickering on the bridge of my nose.  Second, it went away when I closed my eyes, which aura never does.  And third, no headache followed.

Even though Inderal seems to be a godsend in preventing my migraines, I still live in fear and vigilance.  My husband’s parents are visiting and took lots of photos yesterday.  I monitored the flashbulb afterimage carefully, because these afterimages are bit like aura.  I still occasionally get very minor headaches that may or may not be sinus headaches, and I wonder if each headache is going to be a mere annoyance, like a fly buzzing around, or if it’s going to send me running to a dark, quiet room to hide.

I didn’t feel this way when I was a teenager and had a handful of migraines a year, mostly clustered in the spring.  And I didn’t feel this way when, in my twenties, I started to realize that my last migraine had been at the age of 18.  And I didn’t feel this way during the 19 years when I was completely migraine-free.  But something about my recent experience of having several migraines a month, combined with the fussy nature of Imitrex (“take at first sign of migraine” means “pay attention, dammit, because if you dick around too long waiting to see if it really IS a migraine, you might be too late”), combined with having adult responsibilities like a job, and operating a motor vehicle safely, and doing my fair share of the work to manage a household, has made me very, very twitchy when it comes to migraines.

Inderal Dreams

Saturday night I dreamed I woke up with an aura.  It looked just like the aura shown in my user pic, which means it was kind of abstract, but not too much so.  In the dream, I immediately got up and stumbled down the two flights of stairs to the kitchen, where (in the dream) I kept my Imitrex.  Then I went back up stairs to bed, and thought, “Oh, wait, I have to call in sick.”  I turned, and there on my bedside table was my laptop, already booted up and logged into the network.  I pinged J., my project manager, on IRC, and asked him to tell everyone else.

Then I woke up and couldn’t remember if I had taken my Inderal the night before.  Still can’t, actually.  Given my low blood pressure, I thought it was better to risk skipping a dose than to risk doubling up on one.

No actual migraine ensued, by the way.

This is the third or fourth time I’ve awakened to wonder, Did I take my inderal last night?  I think I’m going to have to put it in one of those 7-day pill counters (even though I only take one daily med).

Inderal, it is said, can cause vivid dreams – in fact, on Friday night I had a rather disturbing dream about my cat.  But vivid dreams about migraines?  How self-referential!

4 Weeks

Just a quick one.

 My weight is still at 155, where it’s been for two weeks.  In spite of sticking very closely to the low-carb diet.  (I solemnly swear that the highest carb food I’ve eaten in the last two weeks was a tomato.)  In spite of my daily 4 to 5 miles of walking.

Is it the bloody Inderal?

It’s hard to avoid being discouraged, so here’s my list of good things about the  low-carb diet:

• I haven’t regained any of the weight I lost.
• My waist is down an inch, from 33 inches to 32.  (Maybe someday my waist will be under 30 inches again!)
• Those jeans that Land’s End sent that were a little too small fit a bit loosely now.
• Those jeans that Land’s End sent that fit just right are rather loose now.
• Those jeans that Land’s End sent that were a little loose are almost embarrassingly loose now (think plumber butt). 
• I think the neuropathy in my hands is totally gone now.  At least, I don’t find my hands falling asleep for no apparent reason.
• My knees hardly hurt at all.

OK, so it’s still a pretty good thing, isn’t it, this low-carb lifestyle?  And the food is amazing!

How Do I Make This Decision?

The Dilemma:

On the one hand, I have a dozen or so health problems, major and minor, that seem to be related to a futzed-up insulin/endocrine system:  PCOS, excess weight (though with a BMI of 27.5, I am not clinically obese), neuropathy, joint pain, acne, and apparently even my cracked heels.

On the other hand, Inderal, that fabulous, fabulous drug that has kept my migraines completely in check for the last 99 days (99 migraine-free days!  after having a migraine 2 to 6 times a month for several months, this is like a miracle) has as one of its side effects increased insulin resistance.

I know that insulin resistance that is induced by a high-carb diet can be treated with a low-carb diet.  I wonder – can insulin resistance that is induced by a drug also be trated with a low-carb diet?  Because if it can, there’s no dilemma – keep taking the Inderal, keep avoiding sugars and starches, and all will be well.

But if it cannot, how on earth do I decide between the misery of migraine and the misery of insulin-related disease?  Diabetes is rampant in my family, and I have seen first hand its ravages.  Truthfully, I’d rather have migraine, even several attacks a month, than lose a foot, a finger, or a kidney.

I hope it won’t come to that, though.

Why Women Have More Migraine Than Men

Check out this post on The Daily Headache, and make sure you follow the links to all the articles that Kerrie references there.

Very interesting.  I wonder if the cortical spreading depression explains why inderal – which supposedly makes the adrenalin receptors in the brain less excitable – prevents migraine.

By the way, I’ve been on inderal for 77 days now, and no migraine.  It’s supposed to be hot and muggy this weekend, though – not looking forward to the washed-out inderal feeling.  At least I know enough to stay away from booze now, or at least limit myself to one drink, and my husband and I have plans for a movie with a friend, so there’s a couple of hours of air-conditioned bliss in our weekend.

In any case, if the choice is between feeling a little slow and tired for a few days during the summer (it’s seldom unbearable in Boston) and skipping alcohol, or losing at least half a day twice a week to migraine, it’s pretty much a no-brainer, isn’t it?

All Quiet Here

Well, actually things are not quiet, exactly – we bought a house and moved all our stuff over the course of 36 hours, then I headed off to god-forsaken Orlando (yes, in August) for a conference that is a total waste of my company’s time and money to send me too.  Now it’s budget time at work, which is a huge pain in the ass, and I’m trying to paint, and … and … and …

But it’s quiet in the sense of, no migraines.  Hooray!  More than 60 days on inderal, and it still seems to be working.  I’m a little tired and weak in the heat, but hey, this is Boston – it was actually chilly this morning when I woke up.

I’m seeing the endocrinologist on Thursday; maybe I’ll have news to report then.

Inderal + Alcohol + Heat = Bad News

Yesterday I went out for drinks after work to send my coworker J. off on her way to graduate school (jealous!).  When I got there, someone was drinking a Rocket Pop, a layered drink with Chambord on the bottom, a mix of lemonade and pear vodka in the middle, and blue curacao on top.  It looks just like those red-white-and-blue popsicles my mother would never buy for me because they were more expensive than the plain grape ones.

That looks good, I thought, so I ordered one.  A few minutes later I noticed that this place also serves champagne cocktails.  You don’t see those very much any more, and although I had planned to only have one drink, I couldn’t leave the bar without having a champagne cocktail.  (It was very tasty, too.  I used to drink them a lot when I was younger, made with cheap Spanish cava instead of the real thing.)

I didn’t feel tipsy at all, probably due to the huge plate of French fries I’d been sharing.  When it was time to leave, I got up, walked through the air-conditioned bar, feeling fine, and then stepped out into the 90 degree street.

Suddenly I felt as though my spine was made of wet towels, limp and heavy at the same time.  I made it to the T, waited in the sweltering station hoping I wasn’t gonna pass out, and then got on the air-conditioned train.  Much better.

Then, of course, I had to walk the three blocks home from the T station.  I stopped at the air-conditioned drug store on my way home to take my blood pressure.  93 over 60, pulse 101.  Ugh.  I have certainly had BPs in that range before, but combined with the elevated pulse and the terrible weakness/tiredness, it suggested that I wasn’t getting enough blood to my brain.

When I got home, I drank lots of ice water, ate dinner, and went upstairs to pack up my air-conditioned study for the move.  Within an hour or two, I felt better.

The moral of the story seems to be, pick your drink wisely, because you only get to have one.