Intractable Migraines

by Linda
(Saratoga)

I've had migraines since I was about 4 years old (I called them eye-aches)and would have severe nausea with them. I'm now 54 years old and am getting about 4 migraines a week. Some of them last for days.

I cannot take treximet or imitrex, I have tried almost every anti-depressant and anti-seizure drug (like tegretol) and with the exception of having total liver failure from IV depakote, they have not had any effect on me. I'm now taking a limited amount of dilaudid for the severe pain and my PET scan is now showing 4 'dark' spots in my frontal and temporal lobes.

My personality has changed and I've been on disability since 2000. I even had heart-attack symptoms (jaw pain, numbness left arm etc) that blossomed into the migraine from hell in the ER.

My heart is fine. I've had the botox shots around my head and neck (3 series) and after each one my headaches are worse. Can you think of anything else I could try to help my migraines? Do you think medical marijuana might help with pain relief?

Answer:

Hi Linda,

It does indeed sound like you have been through everything with these migraine headache symptoms.

I am sorry the Botox didn't work for you but the studies say 25% won't respond. That is what we are seeing in our clinic.

At this point, you are right, Treximet and other oral triptans will have little or no effect. It sounds as if you are in status migrainosus. You mentioned IV depakon, but have you had IV steroids or the Raskin protocol? This is IV steroid with DHE injectable twice a day for 2-3 days and compazine, then oral steroids for a few weeks to taper.

Your doctor could also consider oral methergine low dose for a few months. Sounds scary but really isn't and I have had some real success with this in refractory patients (those who nothing else works).

My best recommendation for you is to find a headache center that does inpatient treatment. Cases as severe as yours have a better chance when treated this way.

Two of the best are:
Michigan Head and Neurological Institute
Jefferson Headache Center

Both places have the ability to put you in the hospital for several days to treat the headaches. Insurance will have to be discussed with each place and your doctor may have to write some letters..I know I have for my patients and it has worked.

As for the marijuana, I know that some medical use has occurred for chronic pain symptoms but I have not heard of this (in readings or from patients) being used for chronic headache. In fact, those patients who are using it seem to get worse headaches! If you have some damage on a PET scan I would not recommend using this.

I wish you the best of luck and hope you get some relief soon!

Mary Kay Betz MS RPA-C