Migraine & Headache Q & A (cont.)

MEMBER QUESTION:
I get headaches in the back of my neck at least three to four times weekly. I notice I wake up with these headaches. I have been taking Fioricet for years, and have had migraines for about 20 years. Do you think a chiropractor would be of any help?

DIAMOND:
Headaches and migraine can be treated in many different ways by health care providers. An experienced chiropractor can sometimes be useful to help treat migraines. Anyone who suffers from migraine knows they have their own ideas about what treatment they're comfortable with. I have patients who see chiropractors very successfully. Always talk to people about their credentials and ask people for their experiences.

"The most important thing you can do is find a treating health care provider who is willing to stay the battle while you continue to search for an appropriate therapy that can help to normalize your life."

MEMBER QUESTION:
I was wondering if there is any way to stop or prevent the buildup of a tolerance to abortive medications. I'm very careful not to use my abortives more than twice a week. However, lately I notice that it takes at least two doses before I gain any relief from the migraine. Any suggestions?

DIAMOND:
People who commonly become adjusted or who become tolerant of their acute medicine will recognize that a medication will work for several months and then slowly you have to take more and more or you become resistant to it entirely. Usually patients in this situation will do better with a good preventative agent. Preventative agents will reduce the severity of migraines and will likely stop this cycle of what we in the medical community call tachyphalyxis.

MEMBER QUESTION:
I am about to lose my mind with this. I have chronic daily migraines without rebound, hemipelegic migraines, occipital neuralgia, and if they are real bad, I can't see out of my left eye. I am constantly nauseated or throwing up. I throw up at least once a day. I can be heard all over the house. I have been fired from all my jobs since graduating college. I haven't been able to work for two years now and am applying for SSDI. I also have fibromyalgia and CFS. I have had the headaches for 16 years and I have always been a complicated case. Each of my neuros has thrown up their hands and say they have exhausted all means, and then I get a letter telling me they won't treat me anymore. In fact I am expecting one from my current neuro this week. They all agree I need a pain clinic.

I have taken all the preventatives, abortives, and rescue meds. The best I have been was when seeing a doctor that had me on Wellbutrin, Celexa, Topomax, Xanax, Stadol NS, and Demerol pills. Every time something new comes out they try it on me. I get temporary relief with the pain meds, but when it wears off I am right back where I started. It is not rebound as I have been taken off all pain meds by two different doctors for about six weeks each.

DIAMOND:
Your story is one very typical of the types of patients we see in a headache clinic. I can say that six weeks off analgesic is not a long-enough period of time with someone as long a history of chronic daily headache as you to say that piece in your brain would have healed.

It is common for physicians, when patients are struggling, to say I can't help. It is also unusual for someone to say they can't care for you any more, unless something else has gone on in the relationship. The most important thing you can do is find a treating health care provider who is willing to stay the battle while you continue to search for an appropriate therapy that can help to normalize your life.

MEMBER QUESTION:
I want to know where I can find that. I have been to all the doctors around here.

DIAMOND:
I would refer you to the National Headache Foundation, www.headaches.org

MEMBER QUESTION:
My chiropractor told me that headaches are caused by certain vertebras and if you want them to go away for good then a chiropractor has to adjust those vertebras that are out of line. Is this true or not?

DIAMOND:
Not.

MEMBER QUESTION:
I started with migraines when I turned 45. It was scary. The headache does not bother me as much as the aura. It starts with numbness on one side of my body and then the zigzag lines with distorted vision. Most of the time the headache starts when the scintillating scotoma disappears, but sometimes the headache will emerge with the aura. Is the aura dangerous in any way and is it unusual not to have a real bad headache with it? I have had worse tension headaches, but it is different. The next day when I cough, my head is sore in one spot. I do have a history in the family of migraines. Does it need to be treated? Is there any way to spot the aura in midstream?

DIAMOND:
You have something we call acephalgic migraine. Because it started later in life (please don't shoot the messenger) we would normally recommend a thorough workup to rule out any organic problem, such as mild stroke or tumors, etc. Usually this workup will be normal.

Many patients who had migraine at a younger age will simply be left with aura once they hit their 50s and 60s. It is unusual to have started later in life with no history of migraine and I am curious if your "tension- type" headache might have some migraine flavor to it.

If you are a woman and you are on hormones, or hormone-replacement therapy, or oral contraceptive, it is important for you to call your health care provider and for you to let them know what's going on. New onset of aura that is associated with hormone therapy can sometimes predict a potential stroke, and I would normally recommend my patients stop the hormone.

Auras can be treated with preventative medicines we use for migraine, and your doctor can prescribe that for you if you are having frequent symptoms.

"New onset of aura that is associated with hormone therapy can sometimes predict a potential stroke, and I would normally recommend my patients stop the hormone."

MEMBER QUESTION:
How real is the risk of stroke for a migraine sufferer who is 36, on the pill, and has a mitral valve prolapse? The pill is the only thing that keeps my endometriosis at bay.

DIAMOND:
That's a great question. Historically, we used to tell our patients to avoid oral contraceptive because the oral high-dose estrogen compound made patients worse about 70% of the time. Patients with migraine, and especially patients with migraine with aura, are at a slightly increased risk of stroke than the general population. When you add an oral contraceptive to that mix it raises the risk just a little bit more. So it's really a risk/benefit ratio.

Is the endometriosis severe and is there any other option of treating it? When I discuss hormone treatment with my patients, I screen them for hypertension, smoking, and a family history of pulmonary emboli or early strokes. Individually, patients and their health care providers can decide the benefits of using this medication. I am absolutely opposed to the use of the pill in a migraine patient who smokes.

MODERATOR:
Dr. Diamond, we are almost out of time. Do you have any final words for us?

DIAMOND:
If you're having bad headaches please make sure you visit your doctor and get help. The National Headache Foundation is an excellent source and can help you with information about headaches and also give you information about people who can treat your headaches in your area. Thanks for your time.

MODERATOR:
We are out of time. Thanks to Merle Diamond, MD, for sharing her expertise with us.

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