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Suggest Treatment For Severe Migraine Headaches
Question: Yesterday my husband was prescribed sumatriptan succinate 50mg tablets to take 1 or 2 daily for migraine headaches. He took 1 tablet and lay down for a few hours and his headache was better. Today he has had 2 headaches, probably just the same one, but after taking 2 tablets 2 hours apart, his headache is worse. His neck is also hurting and it is painful to lie down. What options do we have at this point? Should he take any pain relievers in addition to the sumatriptan succinate?
Brief Answer:
Can take Advil.
Detailed Answer:
I read your question carefully and I understand your concern.
If your husband hasn't had such headache in the past then I do not agree with the PA saying straight away it's migraine. Migraine typically starts at a much younger age not at 76. So I would be hesitant to prescribe a medication like sumatriptan which is specific to migraine and may have more side effects at that age. You can take Advil for today, he can take it in addition to sumatriptan.
That being said if he's had headache every day for 2 weeks, in particular if no prior history of headache, I would say that more attention is needed as more serious conditions like tumor, stroke etc should be considered. For that reason I would advise a neurological exam for the possibility of other signs you might have missed and some tests. Personally in a a new headache persisting over 2 weeks in an elderly individual I would prescribe head imaging even in the absence of other signs and some routine blood tests like blood count with erythrocyte sedimentation rate (to check for anemia, infection or inflammation indicators).
Apart from brain lesions other possibilities to be considered would be neck arthritis or high blood pressure (though you or the PA perhaps checked blood pressure already).
I remain at your disposal for other questions.
Can take Advil.
Detailed Answer:
I read your question carefully and I understand your concern.
If your husband hasn't had such headache in the past then I do not agree with the PA saying straight away it's migraine. Migraine typically starts at a much younger age not at 76. So I would be hesitant to prescribe a medication like sumatriptan which is specific to migraine and may have more side effects at that age. You can take Advil for today, he can take it in addition to sumatriptan.
That being said if he's had headache every day for 2 weeks, in particular if no prior history of headache, I would say that more attention is needed as more serious conditions like tumor, stroke etc should be considered. For that reason I would advise a neurological exam for the possibility of other signs you might have missed and some tests. Personally in a a new headache persisting over 2 weeks in an elderly individual I would prescribe head imaging even in the absence of other signs and some routine blood tests like blood count with erythrocyte sedimentation rate (to check for anemia, infection or inflammation indicators).
Apart from brain lesions other possibilities to be considered would be neck arthritis or high blood pressure (though you or the PA perhaps checked blood pressure already).
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr. Taka, for your reply. I realize I could have given a little more information. XXXXXXX does have a history of migraine headaches, but has not had one for quite a while.....many years. He did have them, although not frequently, as a young man and into his late 40's. He is quite active, is a backpacker and a mountain biker. I do not believe he has had any serious falls, a couple while biking, but not bad wrecks, except for hand, arm and leg bruises.
So last night about 3 AM he had not been able to sleep and finally did take an Aleve rather than Advil. He was finally able to sleep and woke up around 9:30 AM without the headache. So far so good today.
I too question whether all the recent headaches were migraines. Maybe more so tension headaches. He does have a regular doctor's appointment in mid April so if all goes okay between now and then he will not use the migraine medication if a headache occurs again. Thank you again for your very helpful reply. XXXXXX
So last night about 3 AM he had not been able to sleep and finally did take an Aleve rather than Advil. He was finally able to sleep and woke up around 9:30 AM without the headache. So far so good today.
I too question whether all the recent headaches were migraines. Maybe more so tension headaches. He does have a regular doctor's appointment in mid April so if all goes okay between now and then he will not use the migraine medication if a headache occurs again. Thank you again for your very helpful reply. XXXXXX
Brief Answer:
Thank you for the update.
Detailed Answer:
Thank you for the update. Glad he is feeling better now. Judging from your description I would again say that migraine is unlikely. Perhaps the initial headache 2 weeks again might have been a migraine episode, but then it was more likely tension type headache (may coexist in the same person). Migraine attacks do not last for 2 weeks, in some patients may become chronic, but that happens progressively, not all of a sudden after not having a migraine attack for that many years.
Anyway important thing is he's feeling better. If headaches reoccur I would use Aleve again.
Wishing you good health.
Thank you for the update.
Detailed Answer:
Thank you for the update. Glad he is feeling better now. Judging from your description I would again say that migraine is unlikely. Perhaps the initial headache 2 weeks again might have been a migraine episode, but then it was more likely tension type headache (may coexist in the same person). Migraine attacks do not last for 2 weeks, in some patients may become chronic, but that happens progressively, not all of a sudden after not having a migraine attack for that many years.
Anyway important thing is he's feeling better. If headaches reoccur I would use Aleve again.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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