Headache-Adviser.com

Status Migrainosus

by Brittany

Long lasting headache

Long lasting headache

Hi.

I have had a headache for 10 days now, and its constant pain. It seems to be concentrated mainly on the right side, but the pain is also in my forehead. I have had a cough since september.

The pain gets worse if I bend over, and it is excruciating in the morning, enough to wake me up out of my sleep. I take 3 advil to get rid of the pain, but it takes an hour to kick in, and then the pain is dull, but constant. My mom gets migraines, and I have only gotten a visual migraine once, a long time ago.

I usually don't get headaches. it hurts so bad. occasionally, especially before the medicine kicks in, i feel sick (though I haven't gotten sick) and it hurts to move. I haven't been able to rest though because I can't miss class.
what kind of headache do you think this is?



Answer

Hi Brittany,

With the history you have just given me, you are describing the classic migraine headache symptoms. This means a somewhat disabling headache associated with nausea, and movement makes the pain worse.

You also have a family and personal history of migraine so it is possible that the stress of school is the cause of headache.

Migraines are usually worse or can attack between 4-7AM. When the headache has gone beyond 3 days it is called status migrainosus. Oral medication like Advil will have little effect at this point.

I would recommend that you go to an urgent care center or the ER. They will be able to treat the headache in a more aggressive way. You should then consider seeing either your own physician or the school doctor as a follow up and talk about the best headache medication for you.

Many of the triptans for migraine are very effective and fast acting.

Good luck!
Mary Kay Betz MS RPA-C

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22 days and counting...

by Sparrow Morgan
(LA)

I am 30, female, history of mild migraines in adolescence.

I have had a severe unilateral headache for the last 22 days. Intermittent dizziness and sometimes severe nausea have occurred. Sensitivity to light and sound has also occurred but not been consistent. Exceptionally stiff neck has been mitigated by muscle relaxants but has not ceased.

Over last three days, tingling and numbness has occurred in left elbow and hand but may not be related due to preexisting back problems. Due to an immune disorder I usually run a low grade fever and have muscle aches, I take Tramadol and Vicodin.

Treatments:
Trigger point lidocaine
9 days of Maxalt (mostly effective)
1 day of new ergot med (not effective)
Visited ER on day 12, had CT (negative) and full blood panel (also negative)
Received intravenous Dialudid (very effective)
Have been taking Fioricet for last week to some benefit, but it has now stopped working.

I have an appointment with a neurologist next week, but am at a loss for what to speak to him about. I'm completely out of ideas. I would appreciate any ideas you have as to what to talk with my neurologist about, any possible causes or treatment options I should suggest we follow.

Sparrow

Answer:

Hi Sparrow,

Thanks for the complete history. It sounds as if you are in status migrainosus which is a migraine that has gone beyond 72 hours. I do see many patients like this in our practice.

Migraines can return at any time in your life and the severity can vary depending on the stressors in your life. Buffalo, NY is the #2 hot spot in the US (Seattle being #1) for autoimmune disorders. Many of my patients have concomminant lupus, rheumatoid arthritis, thyroiditis or MS. These conditions create "stress" on the body from a physiological point of view and can trigger migraines.

One other thing that can trigger migraines is over use of Tramadol and/or the Vicodin. Studies in headache medicine have shown that 10 doses a month may be protective against headache, but more than that and you move into analgesic rebound headache.

Maxalt is great for migraine but unfortunately wears off in 10-12 hours. Frova is a longer acting triptan for migraine and I have patients take it twice a day for up to five days to break a bad headache. I also combine it with low dose steroid such as a medrol dose pak. Other options would be IV steroid with reglan for nausea, followed by steroid for a week as a taper.

I think you have received what we call "step wise" treatment..if A doesn't work let's try B, then C. Headache treatment should be "stratified". In other words, take A,B and C and throw it at the headache all at the same time as mentioned above.

I am glad you are seeing a neurologist. He/she may recommend and MRI which would get a better look at the brain than a CT.

Once the headache is stopped, the neurologist may recommend other medication to treat or prevent the migraines.

Best of luck..

Mary Kay Betz MS RPA-C


COMMENTS:

Thanks for the quick response. I'll definitely bring up the things you suggested with my neurologist.

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Headache for 2 weeks straight

I've been having a headache for 2 weeks straight. I've taken aleve, advil, excedrine migraine, tylenol, and asprin, but no use. It may ease it somewhat, but not eliminate it. cold packs or straight hot water help occasionally ease the pain so I can sleep. I have had several minor concussions and 3 major concussions.

In 1991, I developed a ridge down the center of the top of my head, which is so sensitive that if light pressure is applied, it causes migraines. With this came a headache that lasted almost 6 MONTHS. I have been to a few doctors...one neurologist(obviously a comedian) said it was "all in my head" and was a 'borderline migraine' and another doctor (family care) said that the ridge was just the way my skull formed as a baby, but refused to listen to me when I said it was never there before.

I also occasionally feel "soda bubbles" going up my spine, and feel like they break at the base of my skull, followed within 10 minutes by a debilitating migraine headache, with light and sound sensitivity,nausea and sparkles (floaty swirly lights in my eyes). Should I keep asking people to help figure this out, or just give up, and realize I'm totally screwed up?

Answer

No..you are not screwed up...you sound like many of my patients who are confused about their symptoms and frustrated when they feel no one is listening.

With a history of several concussions I am not surprised that you are having migraines. At this point, the current migraine has gone beyond 3 days so you are in status migrainosus and oral medications do not help too much.

I do not see any mention of an MRI of the brain. It would be worthwhile to get one considering your history and a good headache specialist will be able to order that for you. There is special imaging that can be done to look for post-traumatic changes in the brain.

Excessive sensitivity of the scalp is common in headache profiles and is called cutaneous allodynia. I have had many patient tell me that they cannot even comb their hair as at times the scalp hurts so much..so no you are not "nuts". This can become chronic and occur outside of a headache phase. For instance, when people have migraines 2-3 times a week, the scalp is sensitive everyday.

Spasming in the spine and pain there can definitely trigger migraines. This has been proven in many published headache studies.

I would recommend that you go to an urgent care center to get the current headache treated. Then start looking for a headache specialist who can properly sort things out for you.

Good luck!
Mary Kay Betz MS RPA-C

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Chronic Migraines

by Mark
(West Central Minnesota)


I have had undiagnosed migraines since childhood, over 50 years now, but they became chronic and progressively more debilitating since age 34. I am a 55-year old male, only recently diagnosed with migraines because past doctors treated them as sinus headaches for many, many years.

I have persistent aura with most of these migraines along with muscle weakness. A neurologist I saw recently believes they are classic migraines, but I wonder if they aren't basilar or hemiplegic.

I had three "concussions" when I was really young. The one I was old enough to remember, I remember like it was yesterday, leading me to believe that the symptoms resembled a concussion, but it may have actually been a hemiplegic migraine. The cardiologist I've seen doesn't believe that PFO causes migraines.

I have tried topomax, depakote, beta blockers, verapimil, and other medications. I have not tried triptans because I'm concerned about the risk if these are hemiplegic migraines. I am a current smoker, about half a pack a day, but I'm working on quitting.

My weirdest symptom (maybe even not related to migraines) is that I can shift or turn or twist or bend my body and I will have immediate mood changes. Like going from depression in one position to anxiety in another position to feeling fine in another. I can do the same and my hands will turn cold or white.

I have had an MRI of head and neck, 72 hour Holter monitor, numerous blood tests, and basic allergy testing. Also, I've tried various diets (eliminating possible triggers), homeopathic remedies, herbs, and dietary supplements. So far, the tests are all in the normal range, and none of the remedies has helped my symptoms.

Can you provide any insight as to whether or not these bizarre symptoms are migraine-related or what might be causing them? I'd certainly appreciate any help you can offer.
I'm scheduled to see a different neurologist next month for another opinion and am hopeful for some kind of successful treatment.

Mark

Answer:

Hi Mark,

You sound like so many of my patients who present for a new consultation for migraines. I understand that you are a bit worried about hemiplegic migraine but this is a very rare type of migraine and unless you have a family member with this, chances are this may not be an issue.

Please understand that most migraineurs have some degree of anxiety and/or depression which fuels migraine. Unfortunately, all three of these diagnoses involve serotonin receptors in the brain, and when one is having a migraine, anxiety symptoms may flare up. This includes, weakness, tingling, and numbness. I think you realize by now that smoking makes alot of this worse. It fuels anxiety AND makes headaches worse. Excess nicotine in the brain makes the brain "hyper-irritable" (like caffeine) and makes headaches worse.

If you have not been truly diagnosed with hemiplegic migraine, then you can take triptans and you will be surprised at how well they work. Your headache should be aborted within an hour with these headache medications.

Have you spoken to any headache specialists? These are board certified sub-specialists and with a complex long history like yours I would highly recommend this. Here is a list of headache specialists in the United States. Consider seeing one need you.

One last thought...what about botox for migraines? We have been doing this in our clinic for 7 years now and have seen alot of success.

Good luck,
Mary Kay Betz MS RPA-C

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