Headache Expert Question and Answer
Tuesday, June 9, 2009
Medication to treat Nausea and Vomiting
Q: I often experience nausea and vomiting with my migraine attacks, so much so that I sometimes end up in the Emergency Department. Pills taken by mouth are obviously not the best choice for me, but that’s all my doctor has prescribed. What else can I ask him for?
A: Nausea and vomiting are common among migraine sufferers, thus non-oral medications are often important parts of an effective treatment plan. I believe that all migraine sufferers should have at least two acute drugs at their disposal and, ideally, one of these drugs should be something other than a pill.
The Emergency Department is expensive, time-consuming, and usually causes additional suffering during a migraine attack due to the bright lights, loud sounds, and other offending items. You are clearly a candidate for a non-oral drug and you have several options. An injection in one choice, although this requires that you learn how to inject yourself with a needle, which can cause some discomfort at the injection site. In my experience, patients quickly learn how to properly give themselves injections, overcome any injection-related fears, and ultimately are pleased with the results. Furthermore, there are many effective injectable migraine medications available, for example, dihydroergotamine, sumatriptan, and droperidol, among others.
A nasal spray medication is also an option, although only a few migraine medications are manufactured in a nasal formulation, for example, zolmitriptan, sumatriptan, and dihydroergotamine. Learning how to utilize the nasal device is typically not difficult. Lastly, a suppository medication, given either rectally or vaginally, is yet another option to bypass your stomach. Several suppository medications can be prescribed for sufferers to relieve migraine pain or to treat nausea, including promethazine and trimethobenzamide.
Please talk to your physician about which non-oral route would be best for your circumstances.
Richard Wenzel, Pharm.D.
Diamond Inpatient Headache Unit
Chicago, IL
Botox for Migraine Headache
Q: A lot has been said about using Botox for migraines. My doctor has suggested since I get such severe neck pain with my migraines that Botox injections in the neck might help. Because of things I have read about the danger of Botox traveling, I am not sure this is wise, but I am miserable enough that I might consider this. Should I consider this form of treatment?
A: Botox has not been approved yet by the FDA for the prevention of migraine, but most of us who treat headaches use Botox. It has been discovered that the Botox travels along the nerve into the nervous system; but we don’t know the significance of this, at this point. Stay tuned.
Mark Green, M.D.
Columbia Univ. College of Physicians
New York, NY
Cluster Headache
Q: Has any progress been made to determine the cause of cluster headache?
Specifically, I suffer from vasodilatation type migraine approximately every two years for about two months. This pattern has repeated more or less since 1977. The only pharmaceutical medications that have provided consistent relief have been the triptans. I currently use Zomig (Zolmitriptan); I have also used Amerge (Naratriptan) and Imitrex (Sumatriptan).
A: Cluster headache is thought to be caused by dysfunction of the hypothalamus which is part of the brain. Cluster headache is characterized by severe headaches often referred to as “suicide” headaches which occur in clusters of days or weeks often separated by long periods of being headache free. This pattern fits your history of two month headaches every two years with the remainder of the months being headache-free. The only triptan that is FDA-approved for cluster headache is Imitrex injection (Sumatriptan) although some cluster headaches may respond to oral triptans such as you mention. A characteristic that can help differentiate cluster from migraine headache is behavior; an individual suffering from a migraine usually prefers to rest in a quiet dark room in contrast to the cluster headache individual who is pacing around; boring his fist into his eye and often banging his head against the wall.
Susan Hutchinson, M.D.
Director
Orange County Migraine & Headache Center
Irvine, CA
Compact Fluorescent Light Bulb (CFL) and Migraine
Q: I have had hormonal migraines for twenty years and recently have noticed that the new CFL (compact fluorescent light) bulbs are triggering my migraines. I heard that Congress has passed a law to stop the sale of regular light bulbs in the next year or two. I can’t use the CFL’s in my house because they trigger my migraine. I am very concerned about this new law because I'm not sure what I will do if I can’t purchase regular light bulbs.
A: In 2007 Congress approved an energy law that will see the incandescent light bulb begin to be phased out of the U.S. market beginning in 2012. The main reason for this move to more efficient lighting is that the CFL is one of the lowest-cost ways for the country to reduce electricity use and will have the added benefit of lowering utility bills.
Studies in children especially and clinical observation amongst my patients suggest that the blue wave lengths of light are the portion of the visual spectrum associated with triggering migraine. Fluorescent bulbs emit a higher proportion of blue wavelength light than do ordinary incandescent lights. A couple of options to consider and still be environmentally friendly would be: 1. To use daylight spectrum fluorescent bulbs at home (they are available). The relative amount of the different wavelengths of light approximate that of good old Mr. Sun, and have less blue wave length light. 2. Consider light emitting diode (LED) bulbs. These should help to lessen the lighting spectrum issue as a contributor to your migraines.
Fred Freitag, D.O.
Diamond Headache Clinic
Chicago, IL