Migraine: Managing Migraine Misery (cont.)
Member: When I recently went to the ER for a migraine with nausea, I was given Nubain and Phenergan. This seemed to work better than the original Demerol and Phenergan recipe -- why?
Diamond: Well, different medications have a different effect in patients. Nubain has a longer half life, which means it hangs around in the system a bit longer, and because migraine is a longer headache, it may be helpful because of that.
Member: Is there anything I can do to treat a migraine besides prescription medicine? My insurance company won't pay for Imitrex, which works for me really well.
Diamond: First of all, I would have both your physician and yourself write a letter of appeal to your insurance company. It seems cruel to not allow a patient to have effective therapy, and sometimes a letter from your doctor can help get a medication approved. Other nondrug therapies include biofeedback, meditation, hot or cold packs, and lying in a dark room. But clearly, having an effective medication is your best weapon. Most of the companies that make the triptans have prescription programs for patients who don't have medication benefits. You would probably have to fill out paperwork, but it's likely you could get some medication from the companies in this manner.
Member: I have been a migraine patient all of my life. My concern is for my children. Are they hereditary? Also, I recently read that a child that gets car sick usually develops migraine headaches later in life. Do you have any knowledge of that statement? Thanks for your help!
Diamond: Motion sickness is probably an early migraine forerunner. Migraine is a genetic disorder and if you have one parent with it, you have a 50% likelihood of getting it. If both of your parents have it, you have an 80% chance of getting it. In saying that, migraine in a family will vary so that one person may have very severe attacks and other patients within the same family may not have as severe or as many attacks.
Member: Most of the time, during migraine attacks, I don't want to take any medicine, I just let it pass naturally, by taking a long sleep. Am I doing the right thing?
Diamond: No. The treatment for migraine with sleep is an old one and we've been using it for years. But the problem is are you sleeping much of the week or is it an infrequent occurrence? If it's once in a blue moon, no big deal, but if you are missing important occasions like work, school, and time with family, having an effective medication might be useful, too.
Member: I hear a lot of migraine sufferers have CT scans to see if the pain is caused by a tumor or other condition. Would you recommend that all migraine sufferers get a CT scan as a precaution?
Diamond: Good question. I don't think you need a CAT scan or MRI to diagnose migraine, but if your pattern is atypical (symptoms don't necessarily fit) or you have a changing pattern of headache, or neurologic symptoms, then a scan is very much in order. Most patients who have migraine will probably end up getting a scan at some point. But it isn't absolutely necessary. Some patients will want it for reassurance purposes.
Member: How do you treat adolescent (girl) migraines that are chronic and possibly related to sleep pattern (serotonin or melatonin?)?
Diamond: There are many treatments, depending on the patient. Melatonin has received some attention because of its usefulness in some patients with sleep disorders. There isn't enough evidence yet to show whether it is helpful in migraines.
Member: Can you explain what is actually happening, vascularly, when a migraine headache occurs?
Diamond: That's an area of controversy, but we do know that the migraine generator or control center is located in the brain stem. Which is the area just above the spinal cord, but below the cortex. That generator sends signals to the blood vessels that line the brain, causing them to dilate, or get bigger, get swollen, stretch, and send pain signals back to that control center. Our migraine abortive drugs, the triptans, DHE45, and even Midrin to some extent, help to prevent that from happening.
Member: But are there safe medications for adolescents to take who suffer from severe, chronic migraines that interfere with their daily living?
Diamond: Absolutely yes, but you need to see somebody who is interested in treating kids with chronic migraine who can put together not only the headaches but other contributing factors.
Member: I am 63 and have suffered from migraine for the last 25 years. The earliest attacks used to impair my sight. Now I control my suffering by taking Valium and Ponstel as soon as I get the inkling of the oncoming attack. Does chronic migraine and its medication cause any other serious ailments, such as strokes or cancer?
Diamond: Stroke is more common in patients with migraine. The increased risk is very small but is present. So it's very important for migraine patients to control other cardiovascular risk factors. Good control of blood pressure, cholesterol, diet, and smoking cessation are all helpful in limiting those risk factors. There is no data that migraine patients are at greater risk for cancer. We do know that migraine is often associated with depression and anxiety. There is also some greater risk of epilepsy or seizures.
Member: I read about the NTI dental device in USA Today. Do you have any more information about this?
Diamond: I am not a dentist. And when I have a patient with TMJ I send them to the dentist because that's a dental disorder. However, poorly managed TMJ may lead to more tension headaches. The NTI is a type of dental night guard. Traditional night guards for people who grind or have TMJ cover their front and back teeth. Many patients take them out while they are sleeping or find them difficult to sleep with. The NTI is a device that prevents grinding by preventing the occlusion (coming together) of the front four upper and lower teeth. The dentist who makes this device says that it cures migraines. I have been doing headache work for 14 years and I've seen lots of devices come and go as well as cures. While I'm sure the device might be helpful for some, there is not enough evidence, in my mind, to say people should run to get it. Not all migraine sufferers grind and have TMJ. Patients with migraines that are hard to control will often try anything and I'm concerned when people say they have a cure. That can do damage, too.
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