Savage Citalopram/Celexa withdrawl headaches.

February 17, 2009 2:55 PM

I have recently stopped taking Citalopram over 10 days, since then I've had a permanent headache which has lasted 4 weeks to date and seen me visit A&E twice. Currently I have been prescribed and am taking : Morphine, Voltarol, CO-codomol and Sodium Valproate which are only providing limited relief. I am also seeing a Neurologist and Psychiatrist who as of yet have failed to diagnose the problem. Has anyone had similar effect ? If so, what was the diagnosis and resolution ?
posted by Suchos to health & fitness (22 comments total)

When I started my Citalopram regemin, I ended up with horrible headaches for about two weeks, but they went away after that time. The worst one got me sent home from work because I couldn't see straight.

I mentioned the headaches to my prescribing doctor and he didn't seem concerned, but I also mentioned they'd gone away. Citalopram is also the only medicine I'm on besides birth control. Are you taking anything besides the Citalopram? Is there a possible interaction? Have you tried asking your pharmacist for drug interaction advice?
posted by Verdandi at 3:30 PM on February 17

Can you clarify: You are currently taking morphine, voltarol, and co-codamol for this headache? Morphine is an extremely powerful painkiller. Voltarol is an NSAID, andco-codamol contains codeine.

How bad are these headaches?
posted by Justinian at 3:49 PM on February 17

Oh, I see the word "savage" in the title. Sorry.

What kind of headaches are they? In terms of type of pain, location, etc.
posted by Justinian at 3:52 PM on February 17

Firstly thanks for the responses, secondly yes I am taking all these painkillers :
Morphine, Voltarol, CO-codomol and Sodium Valproate, and yes I know what family they each come from, they have been prescribed by my Neurologist and a Pain team at the hospital, they have just seemed to combine them as none of them individually gave any relief.
I am currently not taking Citalopram, that is when I developed the headache, on the stopping of the Citalopram, I'm actually 4 & 1/2 weeks into this same headache with no relief.

At present, I have had a CT scan, X-rays, Blood tests, eye tests all of which revealed nothing, currently am awaiting the findings from an MRI scan, however all the specialists seem to be at a loss including : Neurologist, Psychiatrist, GP and Hospital, which is obviously quite concerning.

They have ruled out a drug interaction problem as when the headache developed, it was 3 days after the stopping of Citalopram, and at that point I was taking nothing else.
FYI I was taking 20Mg of Citalopram for 3 1/2 months.

The headache starts at the back of the head on both sides and goes across my head and stops at my forhead.

One final thing, to put things into perspective, I have broken my neck and had multiple surgeries, so I'm very used to pain, and this by far exceeds anything previously experienced.
posted by Suchos at 4:42 PM on February 17

May I ask you a couple of questions and then try and help?

1. How are you taking Morphine (it is not very effective orally)? If you are taking it as an injection then you are pretty much at the best analgesia money can buy.
2. Co-codamol prescribed with morphine should make you extremely constipated - which would limit the dose and effectiveness of the regemine.
3. What dose of voltarol are you taking?
4. Which country are you in?
posted by london302 at 4:43 PM on February 17

Some but not all of my questions are already answered.

Has your neurologist mentioned Lyrica (pregabalin) which is a lot better than Valproic Acid. Lyrica can be combined with Cimbalta for further benefit. This would have been considered if the pain is neurological (which is probably why Valproate was considered).
posted by london302 at 4:47 PM on February 17

Another complication is that using lots of pain meds for headache over time can cause rebound headache and you end up in an unending cycle.

I feel for you as a life-long migraineur and I hope things get resolved.
posted by thebrokedown at 4:50 PM on February 17

Again thanks for the response, and here is the answer to your questions :

Indeed I am taking the Morphine Orally, i.e. Oramorph and I agree with you, its more of a general numb than targeting the head, and yes the combination with codeine is making me horribly constipated and also now require a laxative as well.

The Voltarol does is 3 * 50Mg daily.
Sodium Valproate is 1000Mg Daily.

I'm in the UK,Reading

Again you are correct about the Sodium Valproate, this was suggested by the Neurologist and has just been stepped up to 1000Mg daily, with no apparent benefit.
To answer your question Pregabalin wasn't discussed and neither was Cimbalta, I'm due to see the Neurologist again soon to discuss the MRI (with contrast reagent) results and can discuss with him the drugs you suggested.
Hopefully the answer to your questions throws some more like on my problem.
posted by Suchos at 5:00 PM on February 17

Okay, that sounds absolutely nothing like the syndrome some people get when stopping SSRIs, which was my only thought. Beyond that I've never heard of anyone getting headaches so serious that they require this level of pain management. I think your own neurologist/psychologists are your best bet; this sounds beyond the pay grade of Ask Mefi if morphine and codeine aren't working.
posted by Justinian at 5:19 PM on February 17

(never heard of anyone getting headaches this significant from discontinuing SSRIs, I mean. )
posted by Justinian at 5:30 PM on February 17

Lol, I'm still sticking with the Neurologist and Psychiatrist, I was just hoping that someone else had hit a similar problem, and there was a silver bullet solution.
It looks like I've a few more long nights ahead of me....

But at least I have hopefully ruled out SSRI's withdrawal symptoms, and am now armed with a couple more drugs to try, as the current drug cocktail isn't working :(

Thanks for everyones input.
posted by Suchos at 5:30 PM on February 17

Oh, SSRIs.

What dose of morphine and co-codamol are you taking?

So far as I can decipher, you are taking morphine (pain), diclofenac (irritation), co-codamol (codeine phosphate and paracetamol, pain) and sodium valproate (anticonvulsant).

Ask your doctor why he's prescribed diclofenac and sodium valproate. Did they tell you precisely why they suspected the need for these drugs?

I had a period of time when I stopped taking Celexa (which I currently take) and during that time I didn't experience any headaches. The description from what I know of SSRI withdrawal headaches doesn't line up with a major severe headache.

Wait for the MRI scan.
posted by kldickson at 6:01 PM on February 17

Morphine is 2 * 10 Mg Daily
Co-Codomol 4 * 2 30/500 Daily

The hospital prescribed these to along with the diclofenac to control the pain, and it just seemed like a mud slinging operation with the hope that something would work.

The Neurologist prescribed the Sodium Valproate as a much more targeted approach, and I agree about the withdrawal not lining up with the severity of the headaches.

At the moment they have ruled out multiple things such as tumour, cancer and Trauma with the CT, X-rays, blood and eye tests.

My only thoughts, are long the lines of a chemical imbalance after the stopping of Citalopram, the only problem is, the headaches did occur near enough immediately after the cessation and apart from that there has been no other defining issues.

As you say all I can do is wait for the MRI results and as London302 suggested talk about the other drug options.

TX.
posted by Suchos at 6:18 PM on February 17

Why don't you try a slow taper of the citalopram? If re-starting it stops the headache, you'll know the cause and then you can slowly taper off or just stay on it. Why did you stop it in the first place?

Sudden cessation of things can cause weird, wildly individually varying problems: tapering usually minimizes theses if anything will.
posted by Maias at 7:18 PM on February 17 [2 favorites]

I am reminded of this insane thread on the drugs.com community site. They are talking about withdrawal from Lexapro (escitalopram) which is a nearly identical drug to Celexa. Notice that the first comment was written 1/31/2005 and the latest one was today. When I ran across this thread about a year ago, they were talking about tapering ridiculously gradually - shaving off tiny amounts of each pill so that they were taking a microscopically smaller amount with each day. I'm a pharmacist and speaking as a professional, I think these people are nutter butters. Tapering that slowly shouldn't matter in the slightest and some people are ascribing withdrawal symptoms to Lexapro that don't sound like they could possibly be from the drug. But I can't get over the fact that the thread has so much traffic. Obviously a lot of people think that withdrawal from this drug is a big deal.
posted by selfmedicating at 7:34 PM on February 17

I'd personally talk to your doctor about stopping the morphine and codeine, I know from experience that it will not stop the pain of a headache. Also a common side effect is constipation and a tendency to forget to eat and drink both of which trigger repeat headaches in a lot of people. Be careful of NSAIDS too: when they wear off they can trigger rebound headache which can rapidly turn into perma-headache if you keep taking them.

Honestly, I've tried everything for headache pain and good old aspirin + caffeine is about the best thing for my vaso headaches- Excedrin Plus works better than anything else. If you suspect its a vaso headache (throbbing pain, one sided pain, localized pain, sensitivity to bright lights) and your doctor agrees I'd give it a shot. And drink lots of water. Lots!
posted by fshgrl at 10:01 PM on February 17

I will try to answer all the questions again.
So I stopped taking Citalopram because the Phyciatrist told me too, as they didn't believe it was the correct medication for, and I followed there instructions about coming off of it, none of this solution was self-prescribed.
Re going back on it, this isnt really a viable option, as it was the wrong medication and secondly it such horrible side effects that I'd never consider it.

RE. The point about stopping the Morphine and Codine, also isn't really an option at the moment, as without these the pain is so bad I cant function, I have ended twice in the Emergency Ward where a Pain team has been assigned to me and supplied this cocktail of drugs I'm currently taking.

A couple of further points to note, is that Alcohol makes it worse, even like an inch of wine,
a secondly I get good relief for a couple of hours after training at the gymn ?
Endorphins or blood flow ?
Finally just before anyone asks about my blood pressure, this has been checked many times and is 118/65 with a resting pulse of 53.
posted by Suchos at 1:09 AM on February 18

This regime sounds a little excessive, and aspirational to me.

You need to be referred to a proper NHS Pain clinic. This is normally run by an anaesthetist, with an additional specialty in chronic &/or acute pain. I keep one at home (a pain specialist that is). I'll Memail you and you can talk to him later.

But, first, why did no-one suggest you go back on the citalopram for a few weeks to see if the pain resolved and then taper it off over a much longer period?
posted by Wilder at 1:11 AM on February 18

OK I see now why you don't go back on the citalopram. Have Memailed you.
posted by Wilder at 1:20 AM on February 18

Indeed please mail me the Pain Clinic info.
I think the reason they've not sent me to one already is because I'm already seeing 4 entities, i.e. Neurologist, Psychiatrist, GP and Hospital and they dont want any more people in the mix, and obviously the pain clinic doesn't get to the root of the problem, though if I dont get relief soon, I will push for this option.

The Citalopram option is not viable now, as they took me off it because it is the wrong medication for me, and am also reluctant to go back on it because of the side effects, and secondly we're still not sure it is the source of the problem, or that the damage is already done and going back on it wont resolve the issue.
posted by Suchos at 1:26 AM on February 18

I think one of the main problems is that you've been seen on an emergency basis for the pain, so basically treat and send home.

Many hospital consultants will cross-refer so presumably your Psych referred you to the Neuro. He/She can also refer you to the pain clinic operating at that trust. A word of warning though, they are differently developed across the UK. Some trusts have zip, others have a full service. It tends to depend a lot on the sub-specialty interests of individual anaesthetists.

The gateway in the UK for any elective health services is normally your GP as I'm sure you're aware. So do keep him/her up to date with what's been happening (the letters from your recent hospital experiences can sometimes take weeks if not months to get to your GP practice) as he/she may know more about the local options.
posted by Wilder at 5:24 AM on February 18

Several points, Suchos: (1) The BNF (British National Formulary) lists headaches as a well-known adverse effect of SSRI (serotonin reuptake inhibitor, the class of antidepressants that citalopram belongs to) withdrawal or sudden significant dose reduction, and recommends that such drugs be tapered off over a period of several weeks. I'm interested to know why your GP (or psychiatrist) concluded that citalopram was the wrong medication for you - and do they propose to prescribe a different SSRI or tricyclic instead? Was it because of other side effects (you mention this in passing) - if so, it may help to know what they were? I would be disappointed, but not necessarily surprised, if neither your GP nor your psychiatrist or neurologist are aware of this potential side effect - but sudden stoppage of a drug of this kind, taken for over 3 months, is not something most doctors would recommend, so it sounds a bit odd to me (I'm an anaesthetist, intensive care physician and pain specialist). (2) You assume that the onset of your headaches has a single cause, namely stopping the citalopram abruptly. Neither of these 2 assumptions need necessarily be correct - the drug withdrawal may only have coincided accidentally, or may be one of several contributing causes. Headache is an extremely complex subject, and the list of potential causes is very long indeed. (3) You are awaiting the outcome of tests to establish a pathophysiological cause/explanation, but of course you also need to alleviate the horrible suffering in the meantime. Drugs for headache generally fall into three distinct categories: Analgesics (whose side-effects are directly related to their strength), vasoactive agents such as the triptan group (by far the most effective for migraine), and neuronal dampeners such as valproate, gabapentin and pregabalin (originally developed and mainly prescribed as anti-epileptics). While these (and the analgesic subgroups) can be co-prescribed, to do so in an ad-hoc/unplanned fashion really invites disaster. It is interesting that you say a physical work-out relieves the pain - this would suggest that this works either by distracting you, or by inducing vascular changes (or a bit of both). You say alcohol makes things worse. This, and also cheese, are often bad news in migraine - which is fundamentally caused by vascular dysfunction. So perhaps trying a triptan would be worthwhile, as a diagnostic trial (they are available as tablets, nasal spray and injectables); you'd likely know straightaway after a single dose if it works or not. Otherwise I would really recommend looking at serious stress reduction measures and restarting citalopram, with a view to phasing it out gradually a few weeks later. I wouldn't be keen on dosing you up with a combination of opioid narcotics, simple analgesics and neuronal dampeners unless you are under close medical supervision, such as in a community hospital - but then I'm not the one suffering unmitigated pain every day. (4) One last thought: There is an uncommon condition called idiopathic intracranial hypertension whereby the fluid in which your brain and spinal cord are suspended builds up under pressure. This (and certain other neurological causes of headache) can be detected/excluded by having a spinal tap/lumbar puncture. This is a test you may want to have done. Of course the MRI will also help to clear up this blurred picture. (5) It is generally acknowledged that psychology (in the sense of tension and stress) can play a major role in headache, and (psychological or physical) treatments addressing this point, such as relaxation, massage, acupuncture, hypnosis, etc., can be surprisingly effective. Good luck.
posted by kairab at 12:40 PM on February 19