Living With Migraine And The Search For New Treatments
http://thedianerehmshow.org/shows/2012-08-16/living-migraine-and-search-new-treatments
For those who suffer from migraine headaches, the pain can be devastating. Intense throbbing and sensitivity to light or sound often keeps people from their normal lives for hours or even days on end. The World Health Organization ranks migraine as one of the most debilitating diseases, and more than 10 percent of the population suffers from it. Yet migraine is not widely understood and is often misdiagnosed. But patients can find relief with the right treatments. As scientists learn more about the cause of migraines, doctors and patients have their sights on better medication. Diane and her guests discuss living with migraines and the search for new treatments.
Guests
Dr. Perry Richardson
neurologist at George Washington University Hospital.
Teri Robert
author of "Living Well With Migraine Disease and Headache."
Dr. David Dodick
neurologist at the Mayo Clinic and chair of the American Migraine Foundation.
Dr. Story Landis
director of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.
Related Items
Web Extra: Dr. David Dodick Answers Audience Questions
Is there a correlation between migraine and epilepsy? How are migraines diagnosed in children? Dr. David Dodick of the Mayo Clinic responded to these listener questions and more. Some questions have been edited for space and clarity.
Q: Is it common for children to experience migraines during puberty and then grow out of them? -- From Twitter user @A_Fountain
A: Migraine tends to be begin during adolescence, peak in the 20’s-40’s, and diminish thereafter. While the clinical course is highly variable and migraine can go into remission at any time, it is not common for migraine to remit in adolescence. In addition, the predisposition to migraine is believed to be genetic and therefore, the predisposition is lifelong, though for a significant proportion of individuals, the attacks tend to diminish over time.
Q: What is the correlation between stroke, birth control and migraine? -- From Twitter user @MigraineLand
A: The risk of stroke, particularly in women less than age 45, is increased two-fold in those who have migraine with aura. That risk is increased by up to 8-fold in women who have migraine with aura who also use an oral contraceptive pill. This risk is increased even further if the woman smokes. Therefore, all women with migraine with aura should be encouraged to quit smoking (if they smoke). In regards to the oral contraceptive pill, recommendations vary from never using the OCP in a woman with migraine with aura to using if aura is infrequent and limited to visual symptoms only. In general, for those young women with frequent migraine with aura, or aura that is prolonged (lasting longer than 60 minutes), or in those whose aura started or worsened after starting the OCP, it is recommended that alternative means of birth control be explored to minimize the risk of stroke.
Also, please keep in mind that while the relative risk of stroke is increased by a factor of 2 in those with migraine with aura, the baseline risk of stroke in young women without migraine with aura is very low (approximately 4 per 100,000 women). That means that while the risk is double, the risk of stroke is still very small (8 per 100,000 women) and even when the OCP is added, the risk is approximately 60 per 100,000. Those individuals with a family or personal history of blood clotting disorder (deep venous thrombosis, pulmonary embolus, should certainly avoid the OCP)
Q: Are there any studies that establish a correlation between fibromyalgia and migraines? -- From Twitter user @araaajoooo
A: Yes, fibromyalgia and other chronic pain disorders are considered to be “comorbid” with migraine. That means that they are more often associated with migraine than one would expect to occur by change alone. This is likely due to abnormal function of the internal pain modulating networks in the brain in migraine, and this dysfunction leads migraine sufferers to be susceptible to other chronic pain conditions.
Q: I get cluster headaches which are often mistaken for migraines. Is it because I am female, or are they that similar? -- From Twitter user @MJnTJ
A: Cluster headache does share some features with migraine. For example, cluster headaches are almost always unilateral (migraine is unilateral about 50% of the time), and cluster headaches may be associated with sensitivity to light (photophobia) and noise (phonophobia), and, less commonly, with nausea. However, cluster headache can usually be distinguished easily from migraine because cluster headache is almost always unilateral, side-locked (which means they occur on the same side), last a shorter period of time (30minutes to 3 hours; compared to the 4-72 hours of migraine), are associated with prominent tearing, reddening of the eye and nasal congestion, on the same side as the pain, and patients with cluster often need to pace during an attack while migraine sufferers generally like to be at rest and still. Cluster usually occurs once to three times per day for a period of months and then go into remission for months to years (hence the name cluster). Finally, in those with cluster, attacks that awaken individuals from sleep are very common. While cluster used to be considered a disorder that affected men 20-times more commonly than women, we now know what the ratio is much smaller and while cluster is still more common in men, the ratio is more like 3:1.
Q: Are most migraines onset due to triggers? What are common triggers? -- From Twitter user @JoanneDavidhiza
A: The extent to which triggers are present varies considerably from one individual to another. It is certainly time well invested to keep a diary to determine which triggers may be relevant for you. Common triggers include stress, relief from stress, sleep deprivation, alcohol, certain medications (e.g. nitroglycerin), overuse of analgesics, triptans, narcotics, certain foods (processed meats, aged cheese, monosodium glutamate, aspartame, caffeine), menstruation, exercise, high altitude.
Q: Are the mental health issues mentioned by your guests also a concern for those who have aural migraines? -- From Twitter user @Tom_Godell
A: Yes, the mental health issues are equally a concern for those who have migraine with aura. For those who have chronic migraine (headache more than 15 days per month), mental health issues are even more common. Rates of depression and anxiety for example are higher in chronic migraine sufferers than in those with episodic migraine (less than 15 headache days per month). This association is very likely due to similar underlying biology – in other words, the altered chemistry in the brain in depression and anxiety may be similar in some ways to migraine. This may explain in part why some antidepressants are effective for the prevention of migraine.
Q: Is there a comorbidity or other correlation between migraine and epilepsy? -- From Twitter user @MmrghHmph
A: Yes, migraine sufferers are twice as likely to experience epilepsy and vice-versa. This is very likely due to a similar underlying biology. In other words, epilepsy and migraine are both due to abnormally excitable brain cells and networks in the brain. And, in fact, several of the most effective medications for the prevention of migraine are antiepileptic drugs.
Q: What research is being done regarding long term impact of migraine on the brain and long term (20+ years) exposure to daily meds? -- From Twitter user @nikki_d
A: There have been a number of studies that have evaluated the long-term neurological effects of migraine, particularly with respect to cognitive function. A very recent and large study that evaluated over 6,300 women over the age of 65 at the time of the evaluation, and who had migraine with and without aura throughout their lives, found that cognitive decline was no more significant or rapid in those with migraine (with or without aura) compared to those without migraine. However, there is evidence that migraine sufferers are at an increased risk of stroke and brain lesions, particular those with migraine with aura. These individuals are at double the risk of stroke and up to 15-times more likely to develop brain lesions. It is not clear whether these lesions have an effect on these particular migraine sufferers over time compared to those without these lesions.
With regard to the long-term effects of migraine medications that are taken daily, while there are adverse effects associated with all medications, and the type and severity of adverse effects vary between patients and depending on the particular medication, there is no definitive evidence that there are serious long-term effects of preventive migraine medications taken daily for migraine. All of the preventive drugs taken for migraine are used long-term for other disorders such as epilepsy, depression, high blood pressure, and other disorders, so there is extensive evidence that the long-term effects of these medications taken for other purposes appear to be relatively safe long-term.
Q: Biofeedback machines, watching my state of mind and breathing techniques changed my migraines substantially. I had been a serious sufferer from 12 until 21 years old and still get them, but not nearly as often. Please discuss application of meditation and breathing techniques. Was this my imagination? -- From Facebook user Kathleen Galt
A: Biofeedback has been demonstrated to be effective and is recommended for the preventive treatment of migraine. By becoming aware of your body’s automatic responses to pain and stress, and learning to control those responses, some individuals are able to lessen your pain. Biofeedback monitors and measures your body’s involuntary physical responses to pain and stress, such as breathing patterns, heart rate, body temperature, and muscle tension. The monitors provide feedback to the patient during a session and with this information, individuals can better understand how their body reacts in certain situations and how they can modify these responses to reduce pain. These techniques are felt to exert control over the autonomic (‘involuntary’) nervous system and engage the internal pain modulation system in the brain and in these, and potentially other ways, have a positive impact on migraine.
Q: Is there any relationship between the brain disorder that causes migraines and trigeminal neuralgia? -- From Facebook user Donna Mitchell MacKinney
A: No, trigeminal neuralgia and migraine are felt to be distinctly different disorders. They each have a unique biology and are treated differently.
Q: I was wondering if you can have migraines that do not manifest as headaches? I had ear pains that literally gave me vertigo so bad that I had to use my medical leave. We were never able to figure out what caused the ear pain. -- From Facebook user Valerie Garza Estes
A: Migraine is a neurological disorder that can cause a wide variety of different symptoms, of which headache is one. However, other symptoms of migraine may appear without pain. In particular, the aura of migraine (e.g. visual disturbance may occur without pain), vertigo, and other symptoms may occur in the absence of headache. In children, abdominal pain, vomiting, and other symptoms may also occur in the absence of pain. The presence of ear (especially inner ear pain) with vertigo may be due to disorders other than migraine.
Q: I have suffered for over 30 years and now I am getting nocturnal migraines. Any idea why they are happening while I am sleeping? I have also suffered two episodes of cluster headaches in 1990 and 1996. Any input on what could have triggered my cluster headaches? -- From Facebook user Chris DeBottis
A: It's very common for cluster headache to occur during sleep and in fact, its also common for migraine to occur during sleep or upon awakening. While sleep sometimes provides relief of migraine, it can also sometimes trigger migraine. This may be due to inactivation of certain regions in the brain that may lead to activation of the pain pathways and other brain networks involved in generating a migraine attack. One should also beware that there may be sleep disordered breathing (sleep apnea), elevated blood pressure during sleep, and other disorders that can either trigger cluster headache or migraine during sleep. If patients whose attacks begin to occur during sleep, or occur exclusively or predominantly during sleep, a sleep evaluation, sometimes with overnight sleep studies (polysomnography) is recommended.
Q: My 5-year-old son has been suffering from weekly headaches for just over a year. They can be debilitating if we don't treat them with Tylenol or Ibuprofen immediately. His pediatrician has prescribed Periactin nightly. How are migraines diagnosed in children, and is there more we could be doing? -- From Marla via Website
A: Migraine is a clinical diagnosis, based on characteristics of the headache and associated symptoms. In other words, there is no blood test, x-ray, or brain scan that can make the diagnosis of migraine. These tests are used to exclude other disorders that can mimic migraine. While there may be some differences between migraine in children and adults (e.g headache may lasts shorter period of time), in general, the attacks are similar. Cyproheptadine (Periactin) is a commonly prescribed medication used in children to prevent attacks. There are a variety of treatment options, both pharmacological (drug) and non-drug treatments that can be used to effectively manage migraine in children. For those children who do are not responding to conventional treatment, and who are suffering from frequent and disabling headaches, one could consider a referral to a pediatric migraine specialist.
Q: I've heard that migraines are also associated with a higher incident of stroke. Does the latest research, which moves the disease from the vascular space to the neurological space, support that? -- From acdames via Website
A: Yes, there is now considerable evidence that women who have migraine with aura are at an increased risk of stroke. Even though the migraine aura and the migraine headache is now not considered to be due to constriction and dilation o f blood vessels, migraine may be triggered in some patients by alterations within the brain blood vessels (e.g. reduced blood flow, particles in the blood). Also, during migraine attacks, there may be secondary changes in the blood vessels that affect blood flow and increase the risk of stroke. For example, during migraine with aura attacks, there may be a reduction in brain blood flow as a result of changes in brain activity. Also, individuals with migraine, especially with aura, are also at an increased risk for other disorders (patent foramen ovale, arterial dissection) that may increase the risk of stroke.
Q: Could there be a correlation between gastrointestinal diseases and migraine headaches? You discussed in detail on the show the numerous neurological conditions that have a strong relationship to migraines, but is there any research being done about possible relationships between Inflammatory Bowel Diseases and migraines? -- From Schandra via Website
A: There is evidence of a relationship between migraine and irritable bowel syndrome. There is also evidence that gastric stasis (reduced movement or motility of the stomach) may be present during and in between migraine attacks. However, there is not yet convincing evidence that migraine is related to or more commonly associated with inflammatory bowel disorders that would occur by chance.
Q: What is the difference between migraine and Benign Paroxysmal Vertigo syndrome? If you have BPVS, will you become a migraine sufferer? -- From Facebook user Deborah Couch
A: Benign Paroxysmal Positioning Vertigo (BPPV) is an inner ear disorder and unrelated to migraine. However, paroxysmal vertigo (episodes of vertigo) may occur in association with migraine attacks, whether or not the migraine attack is accompanied by the headache. This has been termed migraine associated vertigo or vestibular migraine. In fact, in young women, migraine is one of the most common causes of unexplained episodes of vertigo.
Q: While going through peri-menopause, I started suffering from the most painful headaches that often came in the middle of the night and often induced vomiting. Is there a link between migraine and menopause? I have a younger sister who is now going through the same symptoms I had at about the same time in her life. -- From Facebook user Candy Allen-Smith
A: Yes, migraine is often affected by changes in hormonal cycles in women. For example, the onset of menstruation during adolescence, the menstrual cycle, pregnancy, hormone replacement therapy, oral contraceptive therapy, and menopause all may have a dramatic effect of migraine. However, there is considerable variation in the effect of each of these periods, including menopause, among individuals. Certainly, a significant number of women improve after menopause, but a substantial number of women worsen while going through menopause. The effect of fluctuating levels of female hormones during menopause appear to have an effect on the excitability of brain networks, including pain systems, that may adversely effect women with migraine and those genetically susceptible to migraine.
Q: Are ocular migraines related in any way to migraine headaches? Are they connected to any type of brain disorder, or something completely different? -- From Facebook user Suzanne Rose
A: The formal or accurate term for “Ocular migraine” is migraine aura without headache. The visual symptoms experienced by these individuals is the same as those who experience the visual symptoms associated with the headache. One can think of the visual symptoms and the headache as two of many symptoms of the migraine attack. Sometimes they occur together, sometimes they occur in isolation.
Q: I have had dizzy spells for months, which some doctors think are related to migraine. I have tried physical therapy with mixed success to "retrain" the brain. Do you think this approach makes sense? -- From Facebook user Barbara Carney-Coston
A: Yes, vestibular rehabilitation therapy is recommended for those with vesibular symtoms, whether related or unrelated to migraine. There are other potential approaches to treatment as well, and guidance from a neuro-otologist or migraine specialist may be useful if you do not make progress with physical/vestibular therapy.
Q: I still get the visual auras and as my migraines became less [severe], I began to have acute tinnitus. Is there a connection between tinnitus and migraines? I am 63. -- From Facebook user Virginia Ann Ullrich-Serna
A: Yes, there appears to be a relationship between tinnitus and migraine. A number of migraine sufferers report tinnitus during migraine attacks. However, age-related tinnitus can have other causes as well, the most common of which is sensori-neural hearing loss.
Q: I think I have visual migraine when I exercise vigorously or I'm dehydrated. I have jagged lines in my field of vision, but no pain or sensitivity. It happens one or two times a year. Is that a migraine? -- From Facebook user Janie Moretz
A: Yes, that is a migraine aura without headache. It has the same underlying biology as when these symptoms are associated with headache.
Q: My migraines seem to be triggered by hormones and seem to be getting worse as I approach menopause (I'm 45). Are there different approaches for hormonally-triggered migraines? Can I expect some relief after I go through menopause? -- From Facebook user Lisa Tait
A: As noted above, migraine may worsen while individuals are progressing through menopause and may improve after menopause. This of course is not true for all. While treatment approaches may be the same as for migraine that is not associated with hormonal changes, there may be very specific strategies for treatment that include hormonal replacement therapy. It is highly advisable however that you enlist your doctor’s advice and guidance regarding the pros and cons of hormonal therapy.
Q: Has marijuana shown any promise as a treatment for migraines? -- From Facebook user Lionel Hubbs
A: There is no evidence to support the use of marijuana for the treatment of migraine.
Q: If as much as 10% of the population suffers from migraines, why does the medical community lack basic knowledge of common symptoms and treatments? What will it take to put migraines on doctors' radars? -- From Erin via Website
A: That is an excellent question but complex to answer. A misunderstanding of the biological nature of migraine for centuries, an underestimation of the impact and suffering experienced by a substantial number of individuals with migraine, and the lack of education in undergraduate and post-graduate medical education of physicians and health care providers are certainly leading reasons. It’s also true that it takes approximately 15 years for advances in medical knowledge to make it into clinical practice. With the emergence of the internet and direct-to-consumer advertising, patients have and will continue to become more empowered and engaged in the management of their illness, and seek the most appropriate medical care for their condition. Also, as medicine moves toward reimbursement (“pay”) for performance rather than “pay-for-service”, physicians and health care providers will need to integrate evidence-based guidelines and best practices to ensure optimal patient outcomes.
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My aura (complex) migraines are triggered by stress, I've found that doing yoga and meditating helps to prevent them. People that suffer this debilitating problem should at least give Yoga and meditation at least a try.
I was really hoping to call in, but couldn't get through. First of, thank you so much for covering this issue. I was diagnosed with migraine headaches when I was 9 years old, but can remember having them much earlier. Now at 21, no medication I've tried has helped and few doctors have taken my migraines seriously. When I was 17, I was diagnosed with Ulcerative Colitis. My mother encounted two coworkers, one with UC like me and the other with Crohn's Disease. Both suffered from chronic migraines. It got us both wondering if there could be a correlation between gastrointestinal diseases and migraine headaches. You discussed in detail in the show the numerous neurological conditions that have a strong relationship tobmigraines, but is there any research being done about possible relationships between Inflamatory Bowel Diseases and migraines?
I get migraines from msg and when low pressure systems are in the area. I have learned by accident that eating a huge piece of cold papaya or a frape help almost immediately. On the latest People's Pharmacy Radio program I heard that others have gotten relief from cold shakes, etc.
Dianne, could your panel discuss the difference between migraines and cluster headaches? I have been a long time sufferer of clusters and always been told they were vascular based.
Thanks,
Kevin
I can't seem to find Teri Robert on Facebook, has anyone found her?
My 11 year old son was recently diagnosed with Migraine. Fortunately, Verapamil has worked for him. While undergoing an MRI for an unrelated brain study a small, benign lesion was found located in the area between the two hemispheres of his brain. Could this be related? In addition, since he was a baby he has had regular, mysterious, terrible stomach pains that last for hours until he vomits several times. These always resolve in 24 hours. Could this have been abdominal migraines? What are those exactly?
Since taking the Verapamil he no longer has these symptoms.
Oh, so disappointed in this show, and many like it. Why? For proposing expensive and not-necessarily-valid research, focusing on drugs and surgery, and ignoring practical and inexpensive solutions. I'm a nationally certified Shiatsu therapist (that's Japanese medical bodywork for those not in the know), and have successfully treated a number of individuals suffering from migraines. What sort of success? The results have ranged from a great decrease in the intensity and frequency of the migraines to complete elimination of them. Simply by applying my palms and thumbs along meridians and acupressure points, treating the whole individual, restoring balance. Also, advising on individual triggers, and prescribing simple exercises, meditation and other behavioral changes. Oh, yes, I speak much in the language of Asian medicine, which sounds strange to Western medical doctors but is simply another paradigm with which to view health and wellness. Plus, yes, I would love to put my therapy up against other treatments with regard to results. But, no, I won't be constrained to a defined acupoint protocol in a "controlled experiment" because that does not reflect the nature of Asian medicine, which is based on the treatment of the individual. Anyone on the Western end willing to explore real solutions with me? Oh, wait, maybe there's no money in it for the medical establishment and the drug companies. Hmm.
Diane said several times that Dr. Dodick would answer questions for a bit after the show. Don't see anything here. Maybe on Diane's facebook page. Hope so
a question for Dr. Dodick: my roommate suffers with migraines and was particularly debilitated two nights ago. He was in tears, sweating and shivering, his imitrex (sp?) had no effect. I wonder if some headaches should cause a person to go to the emergency room (it was 3 am so could not go to a doctor's office) AND MOST IMPORTANTLY, what treatment would the ER doctors be able to use?
I'm writing for my husband, Jim, who is on permanent disability for chronic, complex migraines.
Would one of the doctors please comment on these subjects?
--Medicines for migraineurs with low blood pressure.
--Complicated migraines (with aphasia and hallucinations) and triptan use. Are triptans likely to put patient at higher risk of stroke? I've been told that blood vessels in the brain are spasming with these types of migraines and that the triptans might constrict the vessels further when the brain is already in a constricting phase. Does this sound right?
--Off-label use of Effexor and Klonopin for migraine prevention.
--Riding in a car as a migraine trigger.
--Ortho-static hypo-tension as a migraine trigger.
--Jim developed a chronic cough around the time he started having frequent migraines. Has any relation been noticed between the 2 symptoms.
--Why does his nose run after a migraine?
--Do you see a cause-and-effect relationship between head trauma and migraine?
--Do patients report increased anxiety or paranoia around the time of a migraine event?
I've had migraines since high school and am now in my 50s. It took years to find a doctor who knew much about migraines. Mostly, they just recommended codeine which was useless. One male doctor said to me during a multi-day migraine, "oh you women and your little headaches".
My 1st breakthrough came during a multi-day migraine. The first thing my new doc said to me was 'have you ever heard of Imitrex'. She gave me an injection and observed what happened. 20 minutes later the headache was gone. My then new (and current!) doctor suffers from migraines herself. She always seems up to date on info, is compassionate, has helpful treatments.
My migraines stayed about the same for years, only some had aura (zigzag flashing floaters). About 10 years ago they abruptly changed. I started getting scary neuro. symptoms with 1-sided numbness to hand and foot + speech disturbance (couldn't form or understand words). My doctor ordered an MRI (to rule out stroke) and a neurologist consult. Only things noted were abnormalities in/near my cervical spine. My meds were changed to incl. Topamax (greatly helped). My current meds include Fiorinal and Maxalt. If my neck starts to tense up then a migraine is likely. Taking a Fiorinal early often prevents the migraine from happening. I now wear a medical bracelet that says, "migraine accompaniment mimics stroke or TIA".
I also have a service dog who is extremely good in alerting me a migraine is coming--before the onset of aura. She changes her behavior, guides to me to safe places, and has saved me from serious injury. How she detects a migraine coming I don't know. Would be interested in hearing what your doctors have to say about this.
Btw, I started donating platelets and found after donating my migraines decreased and if I donated within a few days of a bad migraine that my platelet count spiked. I would be interested to hear your guests opinions of this.
I found Teri Robert at
http://www.facebook.com/TeriRobert1
Mainstream medical doctors seem to consistently claim "we don't understand", and those doctors who have been open in communication with me have noted the typical prescription drug side effects of anxiety and insomnia. It is not true, however, that Eastern Medicine and Alternative Medical knowledge and practice have no knowledge of the cause and process of migraines. In the process of treatment for the past 3 years I have come to understand the mechanisms and relationship between stress hormones, blood pH and blood flow, the smooth muscle spasm of the colon and brain blood vessels etc.. Bringing this syndrome under control, without prescription drugs and without Botox, has required a complete and total lifestyle change that may very well save my life by preventing other major deadly disease in the future. Unfortunately, mainstream medicine does not want to address the facts of pH, of the acidic body chemistry and the American diet because first of all most Americans' seem to choose the deadly unhealthy lifestyle of a mostly processed food, meat and dairy diet, and secondly, because the rigid training and philosophy of mainstream medicine can not leave room for either the art of medicine in our legalistic age nor for the realities of success through alternative - not complementary - alternative medicine.
Several of the Doctors' comments, plus listeners comments, questions, and answers, point that ISCHEMIA (low blood-flow, and/or vaso-constriction) and MUSCULAR TENSION (also restricts circulation) are involved in many cases.
Like many other patients, it took several years to find under-lying cause, and effective treatment for my case.
My FIBROMYALGIA is, undeniably, the cause: musc. spasm, chronic, in my neck, trapezius (shoulders), along spine; make every muscle-strand in my neck "tight as a violin-string", and that "clamping-down" causes indescribable headache, BY ISCHEMIA. (Verified by CAT scan, later MRI.)
"BOTOX" treatment (injected) was mentioned, as effective for some. This PROVES that spasm was a primary cause.
A "cascade" was also mentioned. As in Sports Med., and some acute trauma, this "vicious cycle" of : pain > spasm > more pain > more spasm >worse pain > worse spasm... etc, etc.
If that pain is "headache", without treatment, there are verified cases of patients taking their own lives, as a result of the unbearable pain.
Diazepam, (i.e."Valium") was, literally, "invented" to be an anti-spasmodic. The "minor tranquilizer" effect immediately observed in the first human trials. Because of mis-use, it has gotten a "bad name".
Having tried dozens of other drugs, for fibromyalgia and migraine, a wise, very experienced Prof. of Pharmacology here at Mich. State Univ. prescribed Valium, as “muscle relaxant”.
It worked, “like a charm” when first-needed, with only over-counter pain med.
I thus credit Valium (Diazepam) as muscle relaxant, in "synergy” with analgesic (pain med) at “lowest effective dose”, APPROPRIATELY USED, with SAVING MY LIFE.
I took Diazepam and Morphine “ER” at 4AM. today, awakened by migraine. I will spend my afternoon WORKING.
I am a 64 yr old woman who had migrane from age 19 thru surgical suppression of estrogen production because of cancer at age 60. The most helpful treatment was a course of bio-feedback trying to learn to control blood flow to finger which decreased episode frequency. This was during the vascular cause model era. Main useful treatment was codine and sleep in the quiet dark. Now my headaches are milder, still one sided, and generally associated with any decrease in caffeine ingestion a day earlier.
But there are still issues, especially frequent extremely poor sense of balance upon standing without obvious med cause, sleep apnea, and sudden hot sweats that having been going on for over 20 yrs. I can't tolerate crowds or other loud places. Both my brothers are dislexic and I have the milder version of inability to block out voices I recognize but do not want to listen to and poor spelling/use of wrong word that sounds like the right one. Plus I need to learn my environment in detail to feel safe in it so notice things others do not. I hear and recognize voices well but can't mimic accents. One of the brothers (78, lives near NIH) has sleep apnea so badly he sleeps 20 hr a day and has been told he has TIA events.
I was very interested in the doctors comments about how migrane may be connected by over sensitivity of the brain to sensory input and that it may be part of a constellation of problems. Is a correlation to sleep apnea and dislexia known? What is the connection to the inflammitory indicator that has be seen in blood work for about 30 yr but most doctors dont know how to interpret and thus ignore? I was extraodinarially high on that in my 30's.
I would be interested in being subject in functional MRI/PET study in DC area. Brother might also.
I experience migraine headaches monthly and they usually happen around my menstral cycle-- a few days before and sometimes right after. I have limited the dairy foods in my diet due to milk allergies and switched to Almond Milk. I also started to take all natural GMO Free GNC Soy protein and North Coast Naturals Hemp Protein powder in the mornings. I'm not sure what helped but since I have been taking the protein supplements, my headaches have been less severe and less frequent. If I feel a one coming on early enough I can take 2 advil and that usually helps. I also drink lots of water and try to stay away from processed foods. Hope this will help someone.
I had hoped that my migraines would improve through menapause because it did with my mother. Sadly, that has not been the case with me. They are not as intense as they were when I would in my twenties, but I think that has more to do with pain management and medication strategies. You are similar to me in that I often will have more than one or two a week. I wish you the best.
My headache / vertigo problems started within an hour of a regular teeth cleaning and checkup (including TMJ), over 7 years ago now. They have never gone away. Dizziness, tinnitus, brain fog, and endless headache, usually related to movement but also sounds, lights, and stressful situations, are the makeup of every day for me. Just walking around in a supermarket or mall is a nightmare.
I have tried every drug known to the 3 neurologists I have been to, had 3 or 4 MRI/ MRAs, a spinal tap, Botox treatments, acupuncture, and everything else anyone can think of. Diet adjustments, no caffeine, extra caffeine, no salt, etc. -- nothing helps.
I am a 63 year old male, in otherwise pretty good health, but this is ruining my live. Only one (!) of my doctors seriously thinks this was caused by the dental visit, but I KNOW it was. ( I like my dentist, still see him, and do not blame him. He was mystified, too.)
There is an excellent web forum, for Migraine Associated Vertigo, at mvertigo.org, where people share their stories, and medical experiences. It has given me a lot of consolation and advice. So far, nothing has worked for me, but I haven't given up hope, yet.
I want to say "Thank You" to Teri Robert for being there 10 years ago when I was sidelined by chronic/complex migraine & stroke. I found her on About.com and the information she shared really helped me when I needed it the most. Because of the support of the her and the About.com migraine community, I persevered until I finally found a neurologist who understood both migraines and serotonin syndrome. On the right meds, I improved dramatically.
Diet's made a big difference, too. I wish the NIH would ask the patient community what kind of research we'd like to see. I think there are definite connections between sensitivities to corn, gluten & soy and migraine. Could it be GMO?
I suffered ocassional severe migraines throughout my early childhood. The pain was nearly always centered over my right eyebrow and was often accompanied by nausea. My only relief was to take an aspirin (I'm 57 years old!) and try to go to sleep in a dark room; I nearly always awoke pain free. I outgrew these around puberty but would still get a milder headache from time to time that usually lasted only a few hours. One particularly stressful day (my fiance and I broke up) in my early thirties I developed a fairly mild headache that never went away. The headache usually stayed around a 2-3 on a ten-scale (my baseline headache) with ocassional spikes to 8-10. Five or six years ago the baseline increased to 4-6 with more frequent high spikes. I began seeking specialized care with local neurologists and undergoing various treatments with the usual array of drugs, vitamins, diet and lifestyle changes, even accupunture and accupressure. None of these had more than minimal, short term benefits. I was referred to specialists at the University of North Carolina-Chapel Hill and Duke University Hospitals, but no particulary effective treatments were found. One specialist recommended trying a regimen of botox treatments but my insurance would not cover it and the treatments were very expensive. I would greatly appreciate if anyone could recommend any course of action I could take to try to help with my condition.
I lived with severe incapacitating migraines all my life (I am 60)... as did my mother. Each would last 3-5 days... I sometimes slept on the bathroom floor due to the frequent vomiting. I did finally find a medication that helped somewhat. However, a few years ago, I found a true cure.
Four years ago, I was told I had high cholesterol; medication was prescribed. I decided I did not wish to take the medication and began searching for a dietary solution. I became a strict vegan following advice in the book, Eat to Live by Dr. Joel Fuhrman. Within 30 days, my cholesterol issue resolved. However, in addition to the cholesterol issue, my migraines disappeared! For me, this is a miracle.
I eat fruits, vegetables, beans, nuts. I do not eat processed foods, oil, salt, animal products. I have never loved food more. The change of eating style was drastic and abrupt... but the benefits have been astounding. I would never consider going back to my previous diet.
I take no medications, I am now a perfect weight and I have never felt better.
My lifelong battle with severe migraines ended when I began a vegan lifestyle.
I have had migraine headaches since I was a young child. I have memories of my primary school principal coming into the classroom to carry me to the nurse's office. My headache site is very specific: I can draw a border around the pain site, located around the parietal region of the left side of my head., and included my left forehead and eye. Until the age of 30 I was told my headaches were due to alleriges or stress. I never fully accepted these explanations but it wasn't until the weeks after the birth of my 2nd child that I took action. I experienced two extreme headaches that were painful and caused one-sided paralysis and numbness in my face. I lived in Topeka KS at that time, the location of the Menninger Foundation, which had a headache research program facilitated by Joseph Sargent, MD. My initial treatment began in 1984.
The diagnosis of migraine, use of biofeedback and medication put me on a path toward getting better control of these debilitating headaches. My mother had a history of optical migraine, though never experienced the head pain. I became a research subject for the sumatriptan drugs for a number of years. I dislike using the triptan drugs because, although they abort the headache, I always get a rebound headache. I remember Dr. Sargent telling me that migraine triggers are like recipes: it usually takes more than one thing to get one going.
Now that I am post-menopausal my incidence of headache is diminished. I have two distinctive types of migraines. I am very thankful for the ongoing research leading to effective treatment modalities.
Unfortunately, two of my three daughters inherited migraine headaches. At least we know what the headaches are and have access to more tools to treat them.
Thank you for bringing a fresh indepth coverage to very complex and often misunderstood topic. I've been a suffer of migraines since my teen years. At 28 I developed and was diagnosed with chronic intractable migraines. I'm now 36. Its been a long and challanging process to gain my life back. I'm proud to say with the help of Dr.Herzog and his staff at Texas Neurology's, headach clinic, I've been able to retrun to a full-time career. Still suffer from the diaese but now able to manage.
I've kept myself very well informed of the migraine subject. Often acting as a resource to family, friends and aqatances. I found your discussion to be very enlightening and informative. Many new concepts were presented that I had not been aware of. I've forwarded your podcast onto many eager ears.
Thank you!
Thank you for this show - I learned a lot. I have had chronic migraines (at least 6 days/week) for about 2.5 years. Starting about 1.5 years before that, I would get migraines every month, then every three weeks, then every two weeks, until they eventually became daily. I have tried preventatives and abortives, and I was hospitalized for 8 days with an IV of DHE. Nothing worked. I am currently battling with my insurance company over Botox (you'd think it would be easier to get than an 8-day hospital stay?), which I have paid out of pocket for twice because my neurologists have such high hopes for it.
Question: Has anyone had significant help using the FL-41 tinted glasses for migraine? I have had mine for about a week and they seem to help a little but I'm not sure. I am not as sensitive to light in general, but very sensitive to any kind of flashing light or small lights in dark situations (TV, night driving).
Andrea,
"Complex" Migraine isn't one of the types of Migraine recognized by the International Headache Society's International Classification of Headache Disorders. So, when the term is used, we're never quite sure what's meant. It could be Migraine with aura, hemiplegic Migraine, basilar-type Migraine, or another form or Migraine. This is the problem when doctors don't follow the ICHD-II.
Sorry, Shelly,
Here's a link http://www.facebook.com/TeriRobert1
Hi, Cinder,
Awwww, you're very welcome. It's so nice to know that you're doing better.
Foods can be big triggers for some people, but not at all for others. I don't know about GMO. It's a good thought that it would be great to check out!
David,
I'm not sure where you got your information about Europe, but from talking with European Migraine specialists at conferences, I have to say that it's inaccurate.
TMJ can be a trigger for Migraines.