Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.

Do you have a question for Maarten and do you live in Thailand? Send this to the editor: www.thailandblog.nl/contact/ It is important that you provide the correct information such as:

  • Age
  • Complaints)
  • History
  • Medication use, including supplements, etc.
  • Smoking, alcohol
  • Overweight
  • Optional: laboratory results and other tests
  • Possible blood pressure

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Dear Martin,

I have been diagnosed with high blood pressure for 10 years, when I lived in Belgium. I have been living in Thailand for 2 years. Before discovering my high blood pressure, I suffered a lot from migraines. I took the medicine (Lisinopril 20 Mg) for years until 2 weeks ago (my GP had given me a supply). I presented the Thai substitute (Lispril 20 Mg) to my GP and she said it was good.

After switching from Lisinopril to Lispril, my blood pressure dropped dramatically. I contacted my doctor and she advised to halve the dose and maybe even stop it. Because, according to her, the different living situation (climate, no work stress) could be a cause of the decrease. I decided to stop the meds to see what would happen to my blood pressure. This rose to too high values ​​after 4 days. Then I started halving the old dose (so 10 Mg Lispril). My blood pressure dropped back to a constant and good value. Unfortunately, in 9 days I had 2 times 2 days of severe migraine (Nausea, vomiting, extreme fatigue).

My question now is, could the change of medication be a cause of these migraine attacks? Do you have any tips (other medication?) or advice that I could try?

Age; 49, female.
I don't smoke or drink.
Do not be overweight (1.77 m and 65 kilos).

  • i also take blood thinners Aspent-M 81mg. 1 per day.
  • Before the diagnosis of high blood pressure and taking the medication, I had frequent migraine attacks. From the start of taking the drugs, these attacks have been very sporadic. It seemed that the high blood pressure was the cause of these attacks.
  • sometimes I feel tired.
  • I certainly drink enough. Especially flat water.
  • I am sporty, walk a lot, sport and swim. Don't be overweight, don't drink or smoke.

Could the transition from lisinopril to lispril cause these complaints? Or could it be complaints that are part of an early menopause?

I have been taking lispril 9mg for 10 days now with good blood pressure, is your advice to continue or increase to 20mg?

Regards,

R.

*****

Dear R.

Unfortunately, migraines often return during and after menopause. Your blood pressure is good enough to try going up to 5mg Lispril.
Nowadays there are many medicines for migraine, which work quite well.
If the reduction in Lispril has no effect, I would try starting with primperan (Metoclopramide) half an hour later followed by 300mg Aspirin.
Sometimes that works. If not, Triptans qualify. Start with sumatriptan. That is cheaper and no worse than the others. If that doesn't work, you can try another one.
There are fast-acting triptans and long-acting ones. You and your doctor can determine what is right for you. That may take some time.
During the menopause, hormonal regularity is lost for a while. You can possibly try a low dose of estrogen, for example Estromon 0.625mg/day. Long-term hormone supplementation, especially with combination preparations, can have serious side effects,
including an increased risk of breast cancer. For a while, I thought that was not the case, but the latest publications show that connection again.
If you use the Aspent because of vascular problems, hormone supplementation is contraindicated.
I hope this is of some use to you. If you have any questions, you know how to reach me.
Sincerely,
Dr. Maarten

 

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