Reader's Mail Archive
Issue #163 - July/August 2008
We welcome your letters; please limit them to one page.
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Readers' Mail, NHF, 820 N. Orleans, Suite 411,
Chicago, IL 60610-3132 or NHF1970@headaches.org.
Eyes Swell with Headaches
Q: Has anyone ever had swelling or pockets of fluid collect above the eye from a headache? Both my eyes are affected.
A: Yes, it is quite common to have swelling and puffy eyes during or after a migraine attack. However, I would recommend that you see a healthcare provider when the swelling occurs to be sure that it is not from something else, such as inflammation and allergy. Ptosis "droopy eye lids" can be a symptom of a headache disorder, but also of other neurological problems.
-George Urban, MD, Diamond Headache Clinic, Chicago, IL
Could Coma Cure Chronic Migraine?
Q: I have transformed migraines for the last forty-two years I have had a constant headache. I heard that German research indicated that an induced coma could be used to cure chronic pain by allowing the brain to reboot itself much like a computer.
A: I don't know much about the inducing of a coma for treatment of chronic headaches, but over the years, induced deep sleep for 24-48 hours has been used to help 'break up' a chronic headache. This procedure is not used as much now since there are other techniques and medications that can often breakup daily headaches. There is ongoing research with deep brain stimulation for chronic pain and chronic headache, but as far as I know, this is being used mostly in chronic cluster headache.
I assume you have been evaluated for medication overuse or 'rebound headaches' due to daily use of analgesics. The daily or near daily use of pain medications is the most common cause of chronic daily headaches. Certainly you should consult with a headache clinic or headache specialist if you haven't done so. Also, if not already done, a psychiatric evaluation for an individual with 42 years of constant headache would seem to be indicated.
-Robert Kunkel, MD, Cleveland Clinic, Cleveland, OH
Disturbing Symptoms May Be Migraine-Related
Q: I have a 40 year history of migraines, which started when I was a child. I still have occasional episodes when my hands feel big, my tongue feels like I'm going to swallow it, everything around me seems to be moving very fast and my heart feels like it's going to pound out of my chest.
Two weeks ago I started having pain around my right ear. My nurse practitioner told me that I had an ear infection and gave me an antibiotic, but after five days I still had severe pain. The nurse practitioner then said my ear infection was better and diagnosed me with trigeminal neuralgia. She prescribed pain medication and a muscle relaxant.
One week later, I had very severe pain on the right side of my head. I took aspirin and Tylenol®, but the headache got stronger. I decided to take a pain killer and lay down. My headache went away but I didn't feel normal when I woke up. My right side was very weak, I dragged my leg when I walked, my mouth drooped on my right side and I had very slurred speech. I was referred to a neurologist for a possible stroke, but tests showed no abnormalities and the neurologist determined that I had a very severe migraine and put me on verapamil.
I'm continuing to have stuttering in my speech and my right side is still weak. I'm also having problems with my memory, writing and typing. When I had breakthrough migraines in the past, I just had visual aura symptoms, nothing like this.
A: Migraine, as you have been experiencing, may certainly take on a variety of unusual and unexpected symptoms at times in some people. It is challenging to sort out these events from the myriad of other neurological issues that may also present with similar transient and disturbing symptoms. When the events are repetitive over time, it does increase the probability that they are migraine-related, but first occurrences of new symptoms are more troublesome and caution needs to be exercised to assure that the problems are not a reflection of something more serious.
There is only scattered information in the literature that suggests one treatment is superior than another when one has neurologic events as part of migraine. Typically, it is believed that the calcium channel blocking agents, such as verapamil or nimodipine, may be preferential. There is also limited evidence that suggests that two medications originally developed for seizure control lamotrigine and topiramate may be more effective in preventing migraine and aura.
-Frederick Freitag, DO, Diamond Headache Clinic, Chicago, IL
Migraine and Irritable Bowel Syndrome
Q: I am interested in the connection between migraine and irritable bowel syndrome (IBS). I have had migraine without aura for about 10 years, and have also had mild IBS for about the same length of time. I never made the connection between the two until recently and am very interested in finding out more.
A: There seems to be an association between migraine and IBS, but I don't think anyone knows the specific connection. Both are very common conditions and both occur more often in women, so there is bound to be an overlap with many persons having both conditions. Fibromyalgia also seems to be associated with IBS and migraine.
I have heard of recent reports of people with celiac disease and migraine who had improvement in both conditions when put on a gluten-free diet. This suggests that gluten sensitivity may be a factor in some migraineurs. There are tests for gluten sensitivity but as far as I know, none for IBS. It might be worthwhile getting checked for celiac disease.
-Robert Kunkel, MD, Cleveland Clinic, Cleveland, OH
Hemicrania Continua
Q: I have recently been diagnosed with hemicrania continua. I would like to know of any other treatments for it besides indomethacin.
A: Indomethacin is the most effective treatment for hemicrania continua. Indeed, the diagnosis is confirmed by responsiveness to indomethacin. If you do not respond to indomethacin, the diagnosis should be reconsidered. If you have responded well, but have side effects, celecoxib (Celebrex®) or aspirin may also help.
-George Urban, MD, Diamond Headache Clinic, Chicago, IL
Numbness in the Face
Q: I have been suffering from numbness of the scalp, forehead and around my eye and nose. The numbness is predominantly right-sided and more pronounced when I wear my glasses and wipe my head with a towel. These symptoms have been intermittent for years. They last for weeks and can go into remission for weeks at a time.
I have been diagnosed with migraine, trigeminal neuralgia, cranial syndrome, cervicalgia and occipital neuralgia. The symptoms still persist despite trials of a number of medications.
A: From the history that you have presented, it seems that the intermittent numbness sensation you describe may not be related to migraine. In order to meet the diagnostic criteria for migraine, there needs to be associated symptoms, including nausea and/or vomiting and light and/or sound sensitivity. The symptoms usually worsen with physical exertion. In order to meet the diagnostic criteria for trigeminal neuralgia, there should be brief electric shock-like pain that is limited to the distribution of one or more divisions of the trigeminal nerve. The pain is usually evoked by normal daily activities including washing, shaving, brushing the teeth, and smoking.
Sometimes, when a headache diagnosis is not completely discernible, it may be worthwhile to combine preventive medications including a tricyclic antidepressant and an antiseizure medication. Other alternative modalities of treatment include biofeedback and stress relaxation training, craniosacral therapy, acupuncture, and upper cervical massage. These are not scientifically proven treatments but may help when medication therapy fails.
-George Nissan, DO, Diamond Headache Clinic, Chicago, IL
