migraine prescription

[dennisg]

I have an experienced diver/client who has been taking 'imigraine' for over 14 plus years prescribed to treat migraine headaches. He has now been prescribed 'epilim' (2x500mg per day) which he reports has reduced his migraines by about 70%.

Can anyone please advise whether these are safe to use whilst diving? He is not an epilieptic, just gets seriously bad headaches very frequently. I know this is a serious question that should require diving medical approval for, but in the first instance I'd appreciate any comments regarding the usage of this drug during diving activities, and whether it may have any precursive effect on decompression illness or oxygen toxicity. Any thoughts appreciated...


with thanks
Dennis Guichard
London, England

 

[DocVikingo]

To the extent that Epilim (sodium valproate) inhibits the breakdown and reuptake of an inhibitory neurotransmitter (GABA), and/or impedes the uptake of sodium by nerve cells, its activity might be expected to reduce rather than raise the likelihood of oxygen toxicity.

There is no apparent reason to suspect that the drug itself would affect the risk of DCI one way or the other. Be aware, however, that migraine with aura may be associated with increased risk of DCI, e.g., http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10331688&dopt=Abstract.

Reported side effects of significance for scuba include drowsiness, confusion, tremor, ataxia, aggression & transient GI disturbances, and these could be evaluated with an appropriate topside trial. To the extent that the adverse reactions are dose-dependent, 2x500mg per day falls at the lower end of the recommended maintenance range.

Be aware that sodium valproate seems not to mix well with a wide variety of other drugs. Be well informed about possible drug interactions, including with "imigraine."

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

 

[dennisg]

Doc,

Thank you very much for your advice and comments, I will pass these on. This question has been raised by the diver in question who is concerned by the medications he has been prescribed, so good on him for asking I think. As I'd have expected, it is a serious question which I will advise he discuss individually with a hyperbaric specialist diving doctor who can evaluate his specific history and circumstances.

Thank you for your rapid and thorough reply.


kind regards
Dennis

 

[lragsac]

Doc,

Thank you very much for your advice and comments, I will pass these on. This question has been raised by the diver in question who is concerned by the medications he has been prescribed, so good on him for asking I think. As I'd have expected, it is a serious question which I will advise he discuss individually with a hyperbaric specialist diving doctor who can evaluate his specific history and circumstances.

Thank you for your rapid and thorough reply.

kind regards
Dennis

I will tell you that I have been taking sodium valproate (500 mg/day) for migraine prophylaxis for as long as I've been diving (5+ years) and have never had a problem. I have also had to complete dive physicals (for AAUS cert and other things) in the past, indicated that I took this medication and was never told it was an issue. As I am on a low dose I experience no side effects. Granted, I am only one patient, so this is strictly anecdotal. Just thought I'd share my personal experience anyway.

 

[underwater daphne]

so i understand this right, there are ppl taking imigraine (imigran in german) while! diving without any problems? so it is safe to take imigraine while diving?
will make an appointment with a dive doc next week, but i've been searching the net on this, as i suffer from migraines without aura and feel quite fit after taking imigran and hope to be able to dive even on migraine days (i have been having migraines daily for over 2 weeks now after diving. seeing doctors, not dive doc yet, but worried about diving in future, could it be anything else than a migraine?).
and i understand that advice on this forum is no substitute for seeing a doctor, but i'm looking for information as i'm losing my mind due to the daily pain and would be grateful for a bit of light in the situation.

 

[pharmguy]

so i understand this right, there are ppl taking imigraine (imigran in german) while! diving without any problems? so it is safe to take imigraine while diving?

That would be a relative statement. Imgraine (=sumatriptan) is a vasoconstrictor and as such it can raise a person's blood pressure. It may not have cardiac effects in most people that take it but there is no definitive method of determining who will experience that cardiac effects.

Increased blood pressure has numerous ill effects and risks while diving (see any previous post on this topic). The hypertensive effect is supposed to be short-lived (15 to 30 minutes) and is less potent with the tablets and nasal spray compared to the injection. Half-life of the drug is short so after 12 hours most (>95%) of the drug would be out of your system.

I would treat imigraine like alcohol. Fine to have on a dive trip but once taken the diving for that day is over. Check with the dive doc for what minimum surface interval would be required after using the imigraine.

Statements are provided for information only and should not be taken in place of proper physician advice.

Jason

 

[underwater daphne]

thanks for the info. my blood pressure is perfect. it's probably best i ask a doctor next week to deeper discuss the matter.