The neurosurgeon required Tymlos prior to spinal fusion surgery because of severe osteoporosis. It's now 7 months since initial Tymlos. I skipped a month post-surgery because of all the other medications I was taking, but immediately back on daily Tymlos after post-surgery rehab. I am now in osteopenia category and believe this progress is due to Tymlos. Because of nausea and headache with Tymlos I went from full dosage to 6 clicks a few months after starting the Tymlos injections. The headache and nausea continued with lower dosage but with less intensity. This is why I take Tymlos just before bedtime--I fall asleep while Tymlos is doing its work. Additionally, I've been on progesterone as part of bio-identical hormone replacement therapy (BHRT). Evidently, progesterone is also a sleep aid which might be why I'm not conscious of the nausea and headache. I'm not advocating progesterone--just mentioning it for full disclosure as to its possible effect on my ability to sleep through the nausea and headache from Tymlos.