Beta Blockers

squired

I'd be interested in hearing about cycling experiences on beta blockers. I suffer from chronic migraines (current one has been going since late December) and these are almost a last swing of the bat by my GP to get them under control.

I started them yesterday and I can honestly say my 20km commute home was one of the most awful cycling experiences of my life. I had to freewheel chunks of the journey because I felt so bad. At the end of my commute there is a short 100m incline and I thought I'd have to walk it. Today my legs feel destroyed, which is not normal either.

Does it get better or is this the new reality if I keep taking these pills? My head feels no better so far and given other side effects I'm currently just inclined to stop taking them.

One little amusing note from when I collected my prescription... I asked the pharmacist if I'd be ok starting them immediately given that I would have a one hour cycle home. His response was, "well cycling doesn't increase your heart rate so you'll be fine".

Cheeseface22

First of all, I'm not a qualified medic. But I'm intrigued on your GP's decision to put you on beta blockers to manage your migraine.

Have you looked into what causes or triggers your migraine?
And also what eases your migraine?

Sounds like your symptoms are consistent with the initial response to starting on beta blockers:

BUPA: Beta-blockers

American Heart Association: How do beta blocker drugs affect exercise?

NHS: Beta blockers

You might want to back off your intensity down a notch until you get used to the beta blockers.
And monitor your symptoms and see if it matches with known side effects or something more.

tangled_metal

Good luck with your migraine treatment. I get humdingers when I get them but fortunately I don't get them that often nowadays.

I was offered the choice of beta blockers the gp wasn't allowed to prescribe I had to go to a pain clinic run by a consultant. He offered those drugs in half strength (for heart issues that is). I had no idea what they were so asked what he'd do. A bit of blather to avoid answering it he eventually admitted he'd take it. So I got the hospital prescription made out and went home. I read up on them and reached out to medical people I knew or met through joint friends. One consultant who suffered with migraines said she'd tried them and wouldn't advise it unless migraines were truly bad (I think that's like yours). I took them up my nearest pharmacist for disposal.

My gp had been given a backup prescription by the consultant so I got a serotonin antagonist I think it's called that's a wafer with evidence supporting faster absorption. My issue is tablets come back up before getting absorbed.

What I found out is there's problems with even half strength beta blockers. Coming off them isn't easy because you have to gradually reduce dosage to prevent issues. Cold turkey has consequences. I've read something about it being hard to get your BP up when on them. I suspect that's why you're struggling. Your BP can't get high enough for activity levels but I'm only guessing.

I'm not trying to tell you what to do but my opinion is that you might need a referral to a pain clinic or a migraine clinic. A hospital consultant (apart from having better, specialist knowledge) will be allowed to prescribe drugs that a gp isn't allowed to prescribe. Once the consultant prescribes a more restricted drug the gp can then take over the treatment and future prescription.

squired

Thanks for the comments guys.

Yes, I've done all sorts over the years for my migraines. I possibly have the most boring diet on the planet in order to avoid any triggers. The problem I have is that I get acute migraines, but also chronic ones, the latter lasting months at a time. Normally I can cope with the chronic ones, but lately they've been terrible (thankfully work have been understanding). In the past amitryptiline proved quite effective, but effects from a hiatus hernia mean taking it is no longer really an option.

The beta blockers are a last option before finally sending me to a migraine clinic. I've also been prescribed anti-psychotics as another thing that supposedly can help, but I've avoided taking them so far.

Things like the wafers can be useful for the acute migraines, but the real problem is the chronic ones.

I only started the beta blockers on Monday, but I'm already starting to tail off the dose. Even today my legs feel destroyed, which just isn't right after a 20km commute home on Monday evening. If there was a chance that things return to near normal after taking them for a few more days I might feel more positive, but I just don't get the impression that is likely. Today I've ended up taking the train because I couldn't face even trying the bike.

tangled_metal

I don't get chronic ones, I think. Well put it this way I only notice migraines when they start to impact on my life. I had this feeling a few years ago that my migraines changed in pattern. I stopped getting as many acute ones and then suspected I just plain hadn't been identifying an aura feeling as migraines. I also started to get less severe acute ones that came and went in a couple of hours (well I became incapacitated then fully capacitated in the space of 2 hours). Now I'm kind of don't know where I am with migraines.

Anyway, I don't understand why your gp isn't referring you to the migraine or pain clinic. The consultant I saw was pretty good and the level of understanding and ability to give more options was clear. I also don't understand why your gp could prescribe beta blockers for migraine. The consultant I saw said they could not be prescribed by primary care because they had a higher level of control to them. The same with some treatments for acute migraines.

I've never had migraines as bad as you have so I don't presume to know the answers, but I would suggest seeing the consultant in a migraine clinic ASAP. Beta blockers are serious medicine. I don't feel that the gp is best placed to prescribe such options. After my consultant visit my gp was given a list of possible treatments that she could prescribe with the secondary medic's backup / authorisation.

BTW there's other options. It seems that a lot of migraine treatments are derived from drugs developed for other purposes. One I got prescribed (by the gp but only after the consultant had confirmed it as a possible treatment) was a drug developed for depression. It wasn't the most effective at that but had positive effects on migraines. BTW never took those anti-depressants neither. I'm between the criteria for the two main treatment types. I got less than automatic daily treatment as prevention / reduction but a lot more than just treating the migraine event. Plus my attacks had all the symptoms a male migraine sufferer could get. They were like mini strokes at times.

You have the sympathies of a fellow sufferer (although one who's, touch wood, doing well at the moment).

tangled_metal

One more thing, it's good your employer is sympathetic. Mine got the letter from my consultant about the lighting issues and had to change lighting in the shared office I worked in. They did that by listening to an electrician with no knowledge of migraines. He thought they were like epilepsy so took the tube lighting away and replaced with spotlights against my pleadings. All they had to do was change the tube lights to ones in those gridded boxes. They prevent direct reflection from pc screens which was my issue. Instead I got a spot that reflected even more strongly on my screen and I got more days off due to migraines as a result. Until I rearranged the whole office to suit me better.

A sympathetic employer is a good thing. One positive you do have right now I think.

squired

Thanks Tangledmetal. I'm guessing the antidepressants you mentioned were Amitryptiline. For me they were effective while I used them. However I have problems with acid reflux due to a hiatus hernia and given that the amitryptiline dries my mouth completely I can't really use them now.

For whatever reason my GP is painful when it comes to getting referred. For my acid reflux I think they put on about 5 or 6 different types of pills before I even got an endoscopy. My dentist referred me separately but they wouldn't even do tests on my because I am slim, don't drink and don't smoke, so had no risk factors.... For my head I've never even had a scan despite this being an issue for over 20 years.

Although I do get the acute ones, especially when I fly, my main problem is the chronic ones. The longest ever lasted 14 weeks, but then this one is now around the 12 week mark. My GP did say that if these pills don't work he will send me to the migraine clinic, which only came up because I pulled up a webpage on my phone and said it was about time I saw someone who could help.

I am now stopping the beta blockers without speaking to my GP. Funnily enough the other pills he prescribed me (anti-psychotics) have plenty of warnings about taking them with beta blockers. As much as anything my cycling is one of my greatest pleasures in life and taking pills that albeit on only a couple of day's evidence have not touched my head (I think I'll be leaving work early today because it is dreadful) but destroy my ability to ride my bike just doesn't seem worth it.

tangled_metal

Don't BBs take a while to build up in your system and start to work? It could be you haven't given enough time.

Having said that it might trigger your gp to refer you. Personally I think he/she should have done that earlier. They are only gatekeepers to the specialists who can actually give the full range of possible treatments.

My biggest lesson in life WRT my health is to try and take more control of my medical treatment. Learn about your condition on the various respected medical websites. There's several that even GPs use. For long term conditions like migraine there is certainly good information online. Self help groups and specialist forums linked to condition charities. Then armed with knowledge you can tell the gp what you want. It's hard for me to do and I've not done it well yet. Migraines were one. I slightly played up my condition to get the referral I should have had earlier. Bear in mind at my worst level of acute attacks my gp then (I was at school) told me I read making up my symptoms. Why? Because her husband gets migraine but doesn't get the symptoms I got so I was making it up. You could not credit it. If a gp told me that now I'd calmly give them a piece of my mind. Then ask them if there is a practise complaint form and how to complain to the relevant gp standards body (is it GMC?). Certainly with age and experience comes confidence to confront authority. GPs are just one type of authority you sometimes need to confront to n get the outcomes you need.

Seriously, do what you need to do to get your clinic referral. Go in with prepared notes and arguments to cover possible counter arguments from the gp. Get past the gatekeeper. You have a debilitating condition that the gp is obstructing your path to the help you need.

Migraines affect more people than iirc asthma and epilepsy combined i believe I read somewhere. Or cost the economy more than both of those conditions. It's serious. It's more than just a headache. We're seeing billions of pounds of lost revenue / income every year.

That's before you consider the human effects. The sufferer feels the pain of migraines but families are put through it too. I know in my case I've scared my young son quite a few times when I've had an attack. I try hard to shield him from it but that's my possible always. You try to act normal with a full blown migraine that's knocking you down, banging your head in and making you throw up so violently you burst blood vessels in the whites of your eyes, eyelids and around the eyes! It disyresses adult family members let alone a 6 year old boy!

Sorry! I think I do rant on a bit about GPs and the service you have to fight for. They're really only doing their job but I've had enough bad help from them to not have much respect left.

johngti

Tangled Metal wrote:

That's before you consider the human effects. The sufferer feels the pain of migraines but families are put through it too. I know in my case I've scared my young son quite a few times when I've had an attack. I try hard to shield him from it but that's my possible always. You try to act normal with a full blown migraine that's knocking you down, banging your head in and making you throw up so violently you burst blood vessels in the whites of your eyes, eyelids and around the eyes! It disyresses adult family members let alone a 6 year old boy!

This (and the other migraine thread) is really interesting but this comment resonated really powerfully with me. I get pretty bad migraines, brought on by tiredness and stress generally, and my two sons clearly worry about me when they're bad. It doesn't help you to feel better! Rizatriptan in the form of Maxalt Melt wafers are my choice; they work well if taken early on, less so if the migraine is established.

I sometimes get migraines when I finish riding, a couple of hours after getting home. Stuffing my face with carbs pretty much always limits the impact - I only ever eat crisps when suffering and always ready salted. It's just nice to know I'm not the only one.