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What Causes Rare Migraine Headache In A Patient Suffering From Adrenal Insufficiency?

Posted on Sat, 19 Mar 2016

Question: Hi. I had a very rare migraine today...it could be due to one doctor increasing my gamma globulin dose for CVID, or the other one decreasing my ramipril dose because of episodes of low blood pressure as a result of adrenal insufficiency, or my neighbor out there spraying herbicides and other toxic chemicals today (I didn't see him until noon, had the migraine aura by 8:30). What do you think is most likely cause? I only have migraines every five to ten years, and this one is classic migraine. I have subq IgG infusions, dose increased from 4 gm to 5 recently, and this is two days post-infusion when the cytokines are at their highest.

Answered by Dr. Neeraj Kumar (55 minutes later)

Brief Answer:
Take pain killers and rest

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Migraine headache, episodic with aura can be diagnosed based on previous history and present headache characters.
Migraine headache is precipitated by stress, decreased sleep, skipped meals, some specific food like coffee, chocolate, scent, smell.
In your case it may be due to herbicides smell, post ivig and less likely due to decreased blood pressure.
If you don't have fever, vomiting, visual complains, loss of consciousness then you can take pain killers like Naproxen, paracetamol
for improvement and take rest too.
No continous medication for episodic migraine.
Consult a neurologist if not releived on pain medication.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Neeraj Kumar (13 hours later)

Thank you, Dr. XXXXXXX I appreciate your thoughtful reply. However, I have been having visual aura type eye symptoms that come and go, what has been called "fortification syndrome" in the same quadrant of both eyes. I have called my immune deficiency specialist about my dose of IgG, and my doctor about a slower reduction of ramipril. Nothing I can do about the herbicides but not go outside. I was nauseated last night but didn't vomit. I was better briefly this morning but then after getting up, got worse again. NSAIDs like ibuprofen actually give me a meningitis type headache, as they do to many lupus patients (although my SLE is mostly in remission), and acetomenophen gives me generalized itching. My primary care physician gives me several little codeine pills/year for episodes of acute pain, so I guess I will take one of those. If you have any other ideas or suggestions please let me know. I haven't used any codeine for months before yesterday.

Answered by Dr. Neeraj Kumar (8 minutes later)

Brief Answer:
Take medications and rest

Detailed Answer:
Hello,
For acute migraine any pain killers may be sufficient which suits you.
Take opioid if you get relief.
Also rest and sleep will help.
Nothing to worry about.
Regards
Dr N Kumar
Neurologist

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Above answer was peer-reviewed by : Dr. Naveen Kumar