Causes Of Migraine Headaches
by Devin T.
(Mandeville, LA)
Exercise Migraine
I am a 39 yr old female with chronic migraines. Onset at age 24 y/o. I have had MRI's and CT scans that were unremarkable. The 4 neurologists I have seen said "yes, you have Migraines" and put me on Imitrex or other Triptans.
Recently they have been triggered by vigorous cardiovascular exercise which I do 5-7 x per wk. I am a personal trainer and work at a local gym.
The latest experience I have had has been Vertigo, according to my Family Practitioner it was triggered by motion sickness on a cruise.
I have never had Vertigo..but hear that it is incapacitating for some people...I manage my migraines well, with Imitrex 2-3 times a week but I am not dealing well with the Vertigo.
1) Do you think the vertigo and migraines are related or do you think it The Vertigo is from the extreme motion(sea)sickness I experienced on the cruise.
2) I take 100mg of imitrex 2-3 times a week more or less at times. Are there any issues I should be worried about with the frequent and long term use of this triptan?
Devin
Answer:
Hi Devin,
Excellent questions! You have a couple of things going on here so I will address them one at a time.
First of all, migraineurs can be at risk for episodes of vertigo and yes, a cruise can indeed set it off. It can take several weeks for the vertigo to settle down, but generally it does resolve. Migraineurs tend to have over sensitized nervous systems due to chronic pain, so other conditions can occur if triggered by certain events. Many migraine sufferers have a history of car sickness in childhood and/or adulthood which is a form of vertigo induced by motion.
A different form of migraine is exercise migraine. These can occur just as exercise starts or right after. Cardiovascular exercise is one of the causes of migraine headaches. Treatment of this could include a low dose of a beta-blocker such as propranolol 10mg about an hour before you exercise. A low dose like this most probably will not reduce your cardiovascular ability to work out.
What is of concern here is your frequency of headaches. You say you get a headache from exercise several times a week, but only use the Imitrex 2-3 times. I believe you are having chronic migraines that wax and wane between being mild to severe enough for Imitrex.
You meet the criteria for daily treatment which is one severe disabling migraine per month (you are in bed) or more than 2-3 headaches per week.
I would suggest you return to a neurologist, preferably one who specializes in headache, and discuss treatments. You might do well with alternative therapies for headaches, in addition to a review of your medications. Try to avoid over the counter meds until you see the neurologist.
Why do I say you need treatment? Your frequency of migraines may increase your risk of stroke symptoms over your lifetime, so it is important to get them under better control.
Best of luck!
Mary Kay Betz MS RPA-C
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Causes Of Migraine Headaches
by Lorrie
(ft. collins, co. u.s.a.)
my doctor says that i have blood vessels that have narrowed and i am not getting enough blood to my brain.
i also have occipital neuralgia and arthritis in 4 disks in my neck.
should i be concerned about the first question?
Lorrie
Answer
Hi Lorrie,
You don't mention which arteries are narrowed. The carotids, in the front of the neck, carry 90% of blood and therefore oxygen, to the brain. Narrowing here is most commonly caused by stenosis due to plaque. Doctors generally don't start worrying unless the stenosis starts getting over 75%.
The arteries up the back of the neck to the head are the vertebral arteries which join into the basilar artery. These carry the other 10% of blood to the brain and narrowing here can be due to plaque or can be something you were born with.
Treatment usually involves either a small dose of a beta-blocker, such as propranalol or a calcium-channel blocker, verapamil. Both would open the arteries allowing more blood and may treat your migraines.
An additional option could be an occipital nerve block for the occipital neuralgia which has also shown great promise in preventing or reducing migraine profiles.
Interestingly enough, those patients of mine who have their sleep apnea corrected by use of a CPAP machine at night, have seen a reduction in their headaches. Lower levels of oxygen going to the brain definitely worsens a migraine profile. So this can be one of the causes of migraine headaches.
Good luck!
Mary Kay Betz MS RPA-C
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