Migraines w/no letup

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lobsterlew
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Date Joined Feb 2011
Total Posts : 6
   Posted 2/2/2011 5:40 PM (GMT -7)   
Hi - I am new to this but its my husband who has suddenly started having headaches since a fall in late Sept. He has never been sick or had any pain that didn't go away in a cpl of days with no meds.  Now he has this headache that just doesn't let up. He had just turned 71 and is getting very little help from Drs. He has had 1 visit w/a neurologist who put him on 20 mg of prednisone which really didn't help at all. He was taking aspirin for 2 mos and then had bleeding and became anemic from those and went to Tylenol which didn't really help much. The call to the neurologist stating the prednisone didn't help prompted the Dr to try Inderal 20mg 2x per day for 4 days and then up to 60mg per day after that for 1 mo. No refills w/out Dr writing a new RX. He has taken the 20mg 2x today and no change. Can anyone tell me if this has worked for them.
 
He has pain on one side of his head which goes down into his neck and shoulder on the left side. We have tried a heating pad, ice pack and nothing seems to work for long. The pain just does not let up. We can't seem to get our Primary Phys or the neurologist to realize how bad this pain really is and that is has been going on for 3 1/2 mos now. The neurologist did tell us it was a migraine but no other info was forthcoming. My husband has also tried massage therapy which made the pain worse not better. He has had a CT scan of the head and an MRI of the neck which were both negative. We are at our wits end trying to get some relief. Any ideas certainly would be welcome.
 

Post Edited (lobsterlew) : 2/3/2011 8:47:55 PM (GMT-7)


EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/2/2011 10:38 PM (GMT -7)   
Hi Lobsterlew,

I'm sorry to hear your husband is having such a hard time. It sounds like that he is having Post Traumatic Headache.

These can be more difficult to treat and so I would very strongly recommend getting him into a Headache Center or Clinic. When it comes to difficult to treat headaches, many (non-headache specialist) neurologists just lack sufficient training and experience (though there are exceptions).

I would also recommend getting him into a good physical therapist as well. If you can find one that is well versed in trigger point therapy, that could be beneficial.

here is a link that will hopefully be helpful:

http://www.headachedrugs.com/archives/post_traumatic.html


If the pain is too much, you can talk to your doctor about IV DHE (as is discussed in this article).

Make the appointment with your nearest headache clinic as soon as possible. They generally have waitlists. I would also show the article to your doctor in the meantime.

I hope your husband feels better soon.

lobsterlew
New Member


Date Joined Feb 2011
Total Posts : 6
   Posted 2/3/2011 9:29 AM (GMT -7)   
EvilFluorescents,
Thanks so much for the info in your post. I am quite impressed with this forum. We just felt so alone and it seems no one understands or can give us much info on this problem (Drs or massage therapies).
 
This is affecting a man that has hardly ever had a sick day in his life. Worked hard and is now retired but in so much pain. But after reading so many other peoples' posts, his has only been 3 and 1/2 mos. Some have been suffering for years. I have been so disappointed with the medical profession after calling Drs with these symptoms and being lucky if they call us back, never mind get to the bottom of what is happening.
 
I will ck with the phys therapist about trigger point therapy. My husband was ready to give up on them as his head and neck hurt ever so much more after a session. Also, maybe he did not give it enough time to show some improvement.
 
Also, thank you for the link. I will ck it out.

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/3/2011 11:45 AM (GMT -7)   
Hi LL,

Your are very welcome. Happy to help in any way I can.

First off, I'm not a healthcare professional, so you should consult your doctor.

With that out of the way...

Migraine and chronic headaches are really tough; especially when they begin for the first time, and you have no idea what is going on.

Please do look at that link. It sends you to book excerpt (written by a headache specialist) that offers advice on the best treatment options. The article is a little technical but not too bad. You can even show it to your current doctor and they can try the recommended meds until you see a headache specialist.

Read through it carefully, but essentially it tells you that the pain is not a figment of your husband's imagination (if your healthcare provider tells you differently... run and find a new doctor). Your husband will probably need a combination of the right medication(s) and physical therapy. The article discusses the best medications to stop the pain and medications that he can take long term to prevent the pain (The article was posted in 2000. There are some newer meds the article doesn't list, e.g. gabapentin and lyrica. Talk to your doctor. These may be options too).

As you're starting to discover, not all doctors are created equal; so go to the best that you can find (ie a good headache specialist). The same is true for physical therapists (PTs). Yelp is a good place to start looking for a good PT. I would talk to him/her about trigger point therapy to see if they think it is appropriate. It's a specialized/niche thing, so again if your husband decides to try it, find the best practitioner you can.

If you want to find a good headache specialist in your area, I'm sure many on the forum would be happy to offer recommendations. You can start a new thread and title it something like "Looking for good headache specialist in _____(state or metro area)"

Best of luck!

Post Edited (EvilFluorescents) : 2/3/2011 12:56:56 PM (GMT-7)


lobsterlew
New Member


Date Joined Feb 2011
Total Posts : 6
   Posted 2/3/2011 1:53 PM (GMT -7)   
Hi EvilFluorescents,

Thanks again for getting back to us. The first Dr we talked to about the headache said it might be something he would have to learn to live with. We couldn't believe it. There had been no investigating of something to help in any way. Granted, he was trying to get to the bottom of his bleeding which led to the anemia. At least we knew that that had been caused by the aspirin used to relieve the headaches. We knew if he got rid of the pain in his head all else would fall into place.
 
Definitely found that not all Drs are created equal.  Will ck out all avenues mentioned and hopefully get some relief for him.
 
Going to ck out that link now. Thanks again!!

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/4/2011 12:52 PM (GMT -7)   
It's too bad that the doctor wasn't any help in the headache department. It is great, however, that s/he was able to get to the bottom of the asprin/bleeding issue. That's certainly very, very important.

It sounds like s/he is a good GP, who is simply lacking some knowledge, training and exposure.

Best of luck to your husband!

lobsterlew
New Member


Date Joined Feb 2011
Total Posts : 6
   Posted 2/4/2011 8:59 PM (GMT -7)   
EF,
Talked w/Neurologist today and he tried an IV of Depacon 1000 units. Didn't seem to help. I guess we just keep trying. He also told us not to use Tylenol-can cause rebound headaches. We just can't seem to get ahead of this.

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/4/2011 9:40 PM (GMT -7)   
Sorry it didn't work. Treating migraine and headache can be a slow process. It's really full of lots of trial and error, but I'm confident you will find something. Just keep plugging away and don't give up.

I'm not completely surprised the Depacon (sodium valproate / depakote) didn't work, though it was certainly worth a shot. Based on the recommended treatments in that link, I would think treating it like a headache variant or maybe even a neuralgia (rather than classic migraine) would yield better results. These are small, but important distinctions.

He's right to worry about rebound headache (medication overuse headache / MOH). It's a nasty nasty road that you just don't want to go down. That being said, it usually takes a while to develop MOH. I would think a little bit here and there, once in a while, would not be the end of the world (as long as your husband does not have any conditions that would make taking tylenol dangerous). The general rule is not to use pain meds more than two times per week. I would talk to your neurologist again, or find another one.

Where are you located? Either myself or someone else may be able to recommend a good headache specialist.

Post Edited (EvilFluorescents) : 2/4/2011 11:44:30 PM (GMT-7)


EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/4/2011 10:09 PM (GMT -7)   
Go to that link (what I'm going to suggest is all included in the book excerpt), print off a copy and give it to your neurologist.

To stop the pain ask your doctor about an injection of toradol or an injection (or IV) of DHE. These are the "Big Boys", so s/he may want to try something like indocin (it's like a strong ibuprofen) first.

You can also suggest, as a short term solution, butalbital compounds (e.g. fiorinal). These can be addicting and eventually lead to rebound headache, so it's not a long term solution. But it could give your husband a respite from the pain while you try out preventative medications.

If this doesn't work, ask about muscle relaxants (again short term).

As for the preventatives, based on the book excerpt, your doctor was on the right track with inderol (aka propranolol). How long was your husband on it and at what dose? Other suggested avenues include tricyclic drugs: nortriptyline and amitriptyline. They each have their + and - 's (things to discuss with your doc). This was not in the excerpt, but gabapentin or lyrica could be particularly good choices as well.

Post Edited (EvilFluorescents) : 2/4/2011 10:27:05 PM (GMT-7)


lobsterlew
New Member


Date Joined Feb 2011
Total Posts : 6
   Posted 2/5/2011 8:01 AM (GMT -7)   
EF,
We are in Port St Lucie, Fl - Treasure Coast.
 
I experienced a problem printing out the article in the link you gave. It prints out 1st and 3rd pg but not the 2nd which has a lot of info. Tried 3x and @ 1 point just highlighted the 2nd pg info and tried to print that way. No go.
 
I am tempted to go to Barnes & Noble and buy his book. May well be worth it. We are now trying ice packs & then heating pad - vice versa.
 
While these headaches have been so debilitating, he has now developed hip and knee pain which after xrays, show he has considerable arthritis of the hip. He never has had any problem with this joint before.  A nurse at our primary Dr's offc mentioned it almost sounds like an auto-immune response. Makes me wonder. She just said it in passing and it was not a Dr's opinion, but what if?? Another thing I could do is give the link to the Neurologist, just hope he would take a look.
 
I did read the whole excerpt and it seems there are quite a few things he (the neurologist) could try, but when he called and I asked about the Inderal, he said it could take 3 wks to start working. Other than the Inderal, he said there wasn't much else. I read about the injection of the IV of DHE but I think he is holding off. I will ask about Indocin. I guess I will be learning about a lot of meds that I have never heard of. I am willing.
 
Thanks for all your info and help with this frustrating set of events.

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/5/2011 10:00 AM (GMT -7)   
Hmmm... I know there are headache specialists down there, I'm just not too familiar with them. I'm more familiar with specialists in the the west, mid west and northeast. Hopefully someone will chime in here with their recommendation. With "super specialists", if you are able, it can be worth it to travel to them.

Can you convert the document into a PDF file and print that? It not, it would be worth it to pick up the book from BN or Amazon. You could bring it with you to appts. I've found that the best (open minded and intellectually curious) neurologists are always willing to learn from a recognized specialist.

That's an interesting observation the nurse made. It does sound very autoimmune like. The timing of the headaches (ie post fall) is just too coincidental though. I would still put my money on the Post Traumatic Headache. ( If you feel like you're not getting anywhere you can always consult a reumatologist. A team based approach to medicine certainly isn't a bad thing. When doctors take your husbands medical history, certainly mention it.).

There are two groups of medications that your husband will likely need to take:

1)Abortives/rescue meds -these stop the pain in it's tracks for anywhere from a day to a couple of weeks. Examples: DHE, toradol, fiorinal, indocin (to be taken sparingly/short term).

2)preventatives- these prevent the pain from occurring. These take anywhere from a few weeks to a few months to really kick in.
Examples: inderol (propranolol), nortriptyline, lyrica. (taken every day/long term).

The indocin is certainly worth a try. It's part of a class of drugs called NSAIDS (just like ibuprofen, though much stronger). I've used it before when ibuprofen just doesn't cut it. Toradol is like a super super strong indocin. All the migrainuers I know (including myself) loves the stuff. You can't take it too often, but it really puts my migraines to bed. There are certain risk factors that would preclude your husband from taking it. Talk to your doctor.

I know it's a lot to take in. But it's fantastic that you're taking such a proactive approach. Keep going!

Best of Luck!

lobsterlew
New Member


Date Joined Feb 2011
Total Posts : 6
   Posted 2/5/2011 11:21 AM (GMT -7)   
EF - Success finally in printing article from your link. To answer your ?... He has only been on Inderal 20mg 2X/day for 4 days now. He increases his dose to 60mg 1x/day tomorrow. Maybe we did not give either Inderal and/or Depacon long enough. His headache is somewhat less painful today - maybe from the Depacon, which is a wonderful whichever it is from. Even a small break from the pain is helpful.

You have been a big help in giving us info for this particular problem and I only hope your problems are all small ones now too.

EvilFluorescents
Regular Member


Date Joined Jan 2011
Total Posts : 224
   Posted 2/5/2011 5:44 PM (GMT -7)   
Fantastic! Glad to hear he finally has some pain relief.

You're right, it could definitely be the depacon or the propranalol (or both) kicking in. Given that he had the IV Depacon treatment yesterday, and that he has been on the propranolol for a short time, I would guess the Depacon did it.

Either way, he has pain relief!

Best of Luck!

Post Edited (EvilFluorescents) : 2/5/2011 8:15:11 PM (GMT-7)

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