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Suggest Treatment For Chronic Migraine
Question: My husband has suffered from severe chronic migraines for 4 years. He has had a CT scan, 4 MRIs, and recently a lumbar puncture we haven't received results on. He had to have a blood patch due to the lumbar puncture this past week but it didn't help. His pain has intensified. Do you have any suggestions on what could be causing this? Could it be something in our home? He has seen 4 different neurogist and no one can figure out what's causing him so much pain.
Brief Answer:
Preventive treatment important.
Detailed Answer:
I read your question carefully and I am sorry about what your husband is going through.
There are many types of headaches according to their cause, but they can be divided in two big groups, primary and secondary. Secondary are those for which a cause is determined (which can at times be corrected). Meanwhile the headaches involved in the primary group are headaches for which no cause can be determined (at times triggering factors, but no proper cause). Primary headaches are very common and migraine is a primary headache.
What I mean to say by this is that it is common for no cause to be found. To be honest unless there was some other factor (some other symptom or sign) involved, I am not even sure why your husband needed 4 MRIs really, one is usually enough, two at most. I am not sure what you mean by something in your home, if you mean certain situations, anxiety and depression can favor headache. If you mean some toxin then there would be other symptoms which would appear sooner or later in the course of these years, so I don't think so.
At this stage I would take comfort in the fact that MRIs do not show any threatening problem like stroke, inflammation etc, and really focus on preventive treatment for his headaches. The aim of preventive treatment is to reduce frequency and severity of headaches. There are several classes available for migraine like antidepressants (amitriptyline), anticonvulsants (valproic acid, topiramate), beta-blockers (propranolol), calcium channel blockers (flunnarizine).
If those fail there is now the option of botulinum toxin injections (botox) or electrical stimulation. You should talk with your doctors about those options. Keeping a headache diary (can find many online) can also help identify triggering/exacerbating factors.
I remain at your disposal for further questions.
Preventive treatment important.
Detailed Answer:
I read your question carefully and I am sorry about what your husband is going through.
There are many types of headaches according to their cause, but they can be divided in two big groups, primary and secondary. Secondary are those for which a cause is determined (which can at times be corrected). Meanwhile the headaches involved in the primary group are headaches for which no cause can be determined (at times triggering factors, but no proper cause). Primary headaches are very common and migraine is a primary headache.
What I mean to say by this is that it is common for no cause to be found. To be honest unless there was some other factor (some other symptom or sign) involved, I am not even sure why your husband needed 4 MRIs really, one is usually enough, two at most. I am not sure what you mean by something in your home, if you mean certain situations, anxiety and depression can favor headache. If you mean some toxin then there would be other symptoms which would appear sooner or later in the course of these years, so I don't think so.
At this stage I would take comfort in the fact that MRIs do not show any threatening problem like stroke, inflammation etc, and really focus on preventive treatment for his headaches. The aim of preventive treatment is to reduce frequency and severity of headaches. There are several classes available for migraine like antidepressants (amitriptyline), anticonvulsants (valproic acid, topiramate), beta-blockers (propranolol), calcium channel blockers (flunnarizine).
If those fail there is now the option of botulinum toxin injections (botox) or electrical stimulation. You should talk with your doctors about those options. Keeping a headache diary (can find many online) can also help identify triggering/exacerbating factors.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is it common with these types of headaches for it to be painful to wear a hat or press on your head? Also wanted to mention that these headaches started when he was deployed in Iraq in 2004. The headaches in Iraq would last a couple of days about once a month. Ever since August 2011 they have become a daily occurrence. The pain isn't always severe but at least once a week it is so intense that he is nauseous and occasionally vomits. Also I misled you about the MRIs. He had 2 standard MRIs, 1 MRA, and 1 MRV for a total of 4. All were no contrast. He has an appointment with his neurologist this Wednesday XXXXXXX 3rd. Do you have any suggestions on what we should discuss with her? Thank you for your time.
Brief Answer:
Read below
Detailed Answer:
Thank you for bringing some more info.
The increased sensitivity to touch that you describe, called allodynia, is a common occurrence in chronic migraine where pain structures have become oversensitive with time.
Otherwise my suggestion remains the same, keep a headache diary to identify possible triggering factors and since the episodes are frequent, start treatment with the regular preventive treatment I mentioned above, not only treatment for the pain.
Also regarding the treatment for pain, unfortunately you don't mention if he's taken any and how often, but you should be aware that in people who take painkillers too frequently for a long period of time there is also the possibility of developing what is called "medication overuse headache". The diary is useful for that purpose too, to keep track of the medication use.
I hope things will work out for the best.
Read below
Detailed Answer:
Thank you for bringing some more info.
The increased sensitivity to touch that you describe, called allodynia, is a common occurrence in chronic migraine where pain structures have become oversensitive with time.
Otherwise my suggestion remains the same, keep a headache diary to identify possible triggering factors and since the episodes are frequent, start treatment with the regular preventive treatment I mentioned above, not only treatment for the pain.
Also regarding the treatment for pain, unfortunately you don't mention if he's taken any and how often, but you should be aware that in people who take painkillers too frequently for a long period of time there is also the possibility of developing what is called "medication overuse headache". The diary is useful for that purpose too, to keep track of the medication use.
I hope things will work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My husband thinks it could be overuse of medication. The pain management doctor has him on the following medications:
Fentanyl 75mcg transdermal patch-changed every 72 hours
Hydracodon 10/325 as needed
Fioricet as needed
His neurologist has him taking the following:
Lamictal 200mg-two tablets twice daily
Wellbutrin 75-two tablets twice daily
He also takes Allegra 180mg daily and aleve as needed.
He has an allergy to aspirin so any over the counter medication with aspirin is off limits. I hope this helps.
Fentanyl 75mcg transdermal patch-changed every 72 hours
Hydracodon 10/325 as needed
Fioricet as needed
His neurologist has him taking the following:
Lamictal 200mg-two tablets twice daily
Wellbutrin 75-two tablets twice daily
He also takes Allegra 180mg daily and aleve as needed.
He has an allergy to aspirin so any over the counter medication with aspirin is off limits. I hope this helps.
Brief Answer:
Overuse is possible
Detailed Answer:
That's a long list I must say, fentanyl, hydrocodone, fioricet, aleve can all develop medication overuse headache, so now I would say that's a pretty strong possibility.
The definition of overuse depends on frequency and duration of treatment. For opioids like hydrocodone, fentanyl it is the use for at least 10 days or more a month for 3 months, while for others 15 days or more a month for at least 3 months. So if he's close to those figures and headache has worsened in the meantime, medication overuse is certainly a possibility.
If that is the case that withdrawal of the drugs is necessary. Since there are opioids and barbiturates involved their interruption should be gradual. It won't be an easy process as it may have a temporary worsening of the headache for usually 2-10 days during the detoxification procedure. At times this process is done in a hospital setting aided by infusions, antiemetics and corticosteroids for some days. Of course the possibility should be discussed with the neurologist in tomorrow's appointment.
Overuse is possible
Detailed Answer:
That's a long list I must say, fentanyl, hydrocodone, fioricet, aleve can all develop medication overuse headache, so now I would say that's a pretty strong possibility.
The definition of overuse depends on frequency and duration of treatment. For opioids like hydrocodone, fentanyl it is the use for at least 10 days or more a month for 3 months, while for others 15 days or more a month for at least 3 months. So if he's close to those figures and headache has worsened in the meantime, medication overuse is certainly a possibility.
If that is the case that withdrawal of the drugs is necessary. Since there are opioids and barbiturates involved their interruption should be gradual. It won't be an easy process as it may have a temporary worsening of the headache for usually 2-10 days during the detoxification procedure. At times this process is done in a hospital setting aided by infusions, antiemetics and corticosteroids for some days. Of course the possibility should be discussed with the neurologist in tomorrow's appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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