@arlene1958 you could try going down to 6 or 7 clicks on the adjustable pen, and over time move up. I was never able to take a full dose, staying at 7 clicks ultimately (6 clicks on a day I had something important to do) and still had a 20% gain in spine. For some reason I just could not tolerate the full dose even though it was only one click more than what I was doing,

Nausea with headaches sounds like migraine. Are you certain it comes from Tymlos? You could try skipping a day or two- my doctor always said that was okay. I did not have constipation from Tymlos.