Headache treatment: trimetazidine nicely dissipates my 3-day headaches within 12 hours

[Hip]

SUMMARY: I find the drug trimetazidine 20 mg to 40 mg in a single dose an effective treatment for my recurrent headaches (which are probably cluster-type headaches).

Every few weeks I get a dull headache, which comes with a noticeable increase in tension in my neck muscles (especially the neck and shoulder part of the trapezius muscle), and tension in the eye sockets. This headache is located more on the left side of my head than the right.

When I have these headaches, if I engage any mild exertion which raises heart rate, I can feel the headache pain in my head and eye sockets pulse or throb to the rhythm of the heartbeat.

I don't find anti-inflammatories such as aspirin help much with this headache. My headache normally lasts for around 3 days before dispersing on its own. Fortunately the pain levels are not that high.

I am not sure if my headache would be classed as a tension headache, or a cluster headache. I would probably guess a cluster headache, because cluster headaches are recurrent, located on one side of the head, and affect the eyes, like my headaches.

The differences between headache types are described here:

Tension Headaches
Tension headaches are one of the most common types of headache. They can be caused by a tightening of the muscles of the neck and scalp. This muscle constriction may be triggered by physical or environmental factors, including stiffness or pain in the shoulder and neck muscles as a result of stress or poor posture.

Tension headaches can:

• result in mild-to-moderate pain and feel like a tight band of pressure around the head
• be felt equally on both sides of the head, and are normally short lived
• be uncomfortable and annoying. However, they are generally not severe enough to prevent daily activities such as walking.

Cluster Headaches
Cluster headaches are the least common type of headaches, but arguably the most intense, and men are more likely to suffer from them than women. The “cluster” in cluster headaches refers not to the location of the head pain, but rather to the grouping of the attacks over time. This is the main difference between cluster headaches and tension or migraine headaches – cluster headaches regularly recur over a certain period of time.

Cluster headaches can:

• bring intense pain, which is usually described as excruciating and localised to one eye
• affect one side of the head, around and behind the eye, then worsen and may last from 15 minutes to three hours
• include symptoms such as eye swelling, tearing and redness and blocked or runny nose only on the side of the head that is affected.

Migraine Headaches
Migraines differ from tension headaches in that the pain is usually restricted to one side of the head and may be described as throbbing, moderate or severe. Many migraine sufferers may become temporarily sensitive to light and noise, and may also experience nausea and vomiting.

Migraine headaches can:

• last from a few hours to a few days and attacks can be reoccurring
• be more common in women than men
• be caused by various triggers and vary from person to person.

Fortunately, identifying and managing these triggers can substantially reduce the number of migraines.

I actually used to get this headache before I developed ME/CFS, though I think it got worse and more frequent after I was hit with ME/CFS.



Anyway, about 8 years ago, by complete serendipitously, I found taking a single tablet of the drug trimetazidine (Vastarel) at a dose of 20 mg to 40 mg would clear this headache within 12 hours. And in fact if I take a trimetazidine tablet at the first signs that my headache is about to appear (usually an increase in neck and eye tension indicates it's coming on), then I can entirely prevent the headache from manifesting.

I originally tried trimetazidine after coming across a patent for its use as a fibromyalgia, ME/CFS and Gulf War Illness treatment. This drug unfortunately did not help my ME/CFS, but I noticed how it would nicely dissipate my headaches. So ever since then, I have been using this drug regularly as a headache treatment. I only take it when the headache comes on.

Whether trimetazidine will work for other people's headaches, or will work for migraine headaches, I am not sure.



Trimetazidine is a generally a pretty benign drug with a high safety and tolerability profile, according to Wikipedia. It's also an antioxidant, and protective of cells (cytoprotective). Trimetazidine is normally used to treat angina.

(This drug has been linked to reversible parkinsonism, which disappears after the drug is stopped. But I doubt this is anything to worry about if, like me, you are only taking 1 tablet of trimetazidine once every two weeks or so.)

Trimetazidine also modulates energy metabolism in a way that may be beneficial in ME/CFS: in ischemic heart muscle, trimetazidine increases the activity of pyruvate dehydrogenase (PDH) by 37%:

In hearts subjected to low-flow ischemia, trimetazidine resulted in a 210% increase in glucose oxidation rates. In both aerobic and ischemic hearts, glycolytic rates were unaltered by trimetazidine. The effects of trimetazidine on glucose oxidation were accompanied by a 37% increase in the active form of pyruvate dehydrogenase, the rate-limiting enzyme for glucose oxidation.

Source: here.

I am not sure if trimetazidine increases pyruvate dehydrogenase (PDH) in tissues other than the heart muscle, or if it increases PDH in the absence of ischemia (low oxygen).



The only two other treatments I found effective for my recurrent dull headaches were the supplement carnosine 1000 mg (which interestingly enough also stimulates PDH), and basil essential oil 10 drops taken internally or applied transdermally.

These two supplements are quite good, but not as good as trimetazidine. I sometimes take carnosine with trimetazidine for a synergistic effect if the headache is worse than normal.

 

[Wolfcub]

When you get headaches @Hip do you get them as part of a "crash package", or just on their own and at any time?
I still get the very mild right side eye/head "twinges" (I really am lucky because I can't call them more than that!)

But they are the one of the first symptoms I got at the very beginning of everything a year ago, and never got worse. I had very very rarely ever had headaches of any kind before.
They always come on as part of a relapse or "crash", together with the other symptoms and at other times aren't there. When the crash passes, they do too. And mostly ease anyway during the evening and night.

 

[Hip]

When you get headaches @Hip do you get them as part of a "crash package", or just on their own and at any time?

I have not noticed any link between my PEM and these headaches. I think they come more or less randomly. Though I've noticed that some medications have a tendency to trigger them.

 

[CCC]

@Hip

I also get three-day headaches of exactly the kind you describe from time to time (not on a schedule, though). The main thing that works for me is potassium gluconate stirred into coconut water. We discovered it by accident when my husband brought some coconuts home.

If I'm not able to do that, I'll take some aspro clear (normal aspirin doesn't work) to relax the muscles in my neck until I can get to the coconut water. Maybe your trimetazidine 20 mg to 40 mg wouldn't be a bad alternative, too.

It's improved recently as I've been on an antiviral for nerve pain from chronic shingles.

I can't find a consistent trigger. I have noticed that if I drink lots of tea at work I can get very thirsty and that can become a headache. (I don't drink much coffee - I grew up drinking tea).

I have never understood why it can suddenly lift on the three-day mark (if untreated). I'd love to hear an explanation for that.

 

[Hip]

The main thing that works for me is potassium gluconate stirred into coconut water.

Very interesting, does any form of potassium work do you know, and is the coconut water necessary, or might the potassium work on its own?

 

[CCC]

I use potassium gluconate because we have it for my son (he is the reason I am here on PR - potassium is one of the goto options for tiredness and irritability). We haven't tried other forms.

I have found the coconut water makes quite a big difference. The potassium can work on its own, but not as quickly and not as well. It is my preferred treatment, and I even have some coconut water in my work cupboard in case of emergency.

That said, i did try mixing in a little MgSo4 (one day, when no coconut water was available) and found that it slightly improved the efficacy of potassium + water. You wouldn't want too much Mg in that form though!

 

[hapl808]

Just bumping this thread as one of my most frustrating symptoms is very frequent headaches. I might start another thread as mine seem to be 'part' of my PEM, but not always concurrent. Any mental activity will trigger somewhat awful headaches and acid reflux. If I have no significant mental exertion (no phone calls, no difficult computer work, etc), then I don't get the awful headaches or acid reflux (although I still have baseline brain fog and maybe minor neck tightness and headache).

Not sure if this is somehow related to cortisol or digestion or dopamine or what. I've noticed that a phone call late at night is more likely to trigger it than one during the day. Usually the acid reflux starts within a few hours of the call, then the headache starts within 12-18 hours and continues for 1-2 days. I feel headache, eye pressure, neck and back of head pain and tightness, a bit dizzy, sometimes nauseous, etc.

I've tried various probiotics, zinc carnosine, mastic gum, butterbur with feverfew, fenugreek, OKG, curcumin, boswellia, NAC, passion flower, rhodiola, magnesiums, oral rehydrating salts, vitamin C, kudzu, charcoal, and on and on.

Things that help the most: strong caffeinated tea or coca cola with an ibuprofen (which I really don't like to take so I try to avoid if possible). That implies to me that the headache part is inflammatory? But the linked acid reflux baffles me.

Open to any suggestions.

 

[hapl808]

Ideally looking for something to stop the headaches from occurring. They're too frequent to take something like trimetazidine because if I talk on the phone daily, I get the headaches daily.

Oh, I've also noticed with my Garmin that it seems to tank my HRV as well, which is interesting. Then if I take 2-3 days of total rest, it slowly improves. One long phone conversation can set me back again, though.

 

[Hip]

Ideally looking for something to stop the headaches from occurring. They're too frequent to take something like trimetazidine because if I talk on the phone daily, I get the headaches daily.

You can take trimetazidine daily, and indeed it is intended for daily use. That I believe would prevent headaches manifesting in the first place (if you are responder to trimetazidine).

Pharmacies which sell trimetazidine include:

Buy Pharma • United Pharmacies UK • Safe Generic Pharmacy • Cheap Medicine Shop • RU Pharma • Over The Counter

 

[hapl808]

You can take trimetazidine daily, and indeed it is intended for daily use. That I believe would prevent headaches manifesting in the first place (if you are responder to trimetazidine).

Interesting. I wonder if I would have a similar experience as I find ibuprofen helps quite a bit and it sounds like you didn't find that result?

Do you think there is any way to get at the underlying cause(s) of the headaches? Is trimetazidine's success likely due to vascular issues? I wonder at the weird acid reflux connection as well.

 

[Hip]

I wonder if I would have a similar experience as I find ibuprofen helps quite a bit and it sounds like you didn't find that result?

I don't actually remember my results with NSAIDs like ibuprofen, because it was about 10 or 15 years ago when I started observing things which helped dissipate headaches. It's not good to take NSAIDs all the time, in any case, due to the risk of stomach perforation.

Do you think there is any way to get at the underlying cause(s) of the headaches? Is trimetazidine's success likely due to vascular issues? I wonder at the weird acid reflux connection as well.

I don't know the mechanism by which trimetazidine dissipates and prevents my headaches, but trimetazidine is a well tolerated drug.

I also observed that the supplement carnosine (not to be confused with carnitine) at doses of around 1000 mg or more worked well to dissipate my headaches. Unfortunately this supplement is not one of the cheapest.

Sometimes I will take both trimetazidine 40 mg and carnosine 1000 mg together, if the headache is stronger than usual.

 

[hapl808]

I also observed that the supplement carnosine (not to be confused with carnitine) at doses of around 1000 mg or more worked well to dissipate my headaches. Unfortunately this supplement is not one of the cheapest.

I trialed this supplement - is that the same carnosine? I think I was taking a much lower dose than you're describing (just two pills in a day). I took it for the acid reflux rather than specifically for the headache, but I didn't notice much benefit.

I don't know the mechanism by which trimetazidine dissipates and prevents my headaches, but trimetazidine is a well tolerated drug.

Thanks again. I'll look into it more. I always worry about a drug that I'd have to take daily (without really knowing the potential mechanism) as I feel there are so many unknown long term effects.

 

[Hip]

I trialed this supplement - is that the same carnosine?

No, that is zinc carnosine, a different supplement which is beneficial for leaky gut. And one capsule only contains 75 mg of zinc carnosine.

Whereas I use carnosine doses of 1000 to 1500 mg for treating headaches.