Migraine lasting over a month

by Janice H
(Brooklyn, NY)

Hi, my name is Janice and I am 21 years old with new onset headache.
It started Dec 25,2009 and continues to this day (Jan 28,2010)

I went to the emergency room 11 days after the onset of what i thought was a headache. They gave me Reglan over an IV Infusion for 5 hours. I had no relief, i explained i had this headache (worst pain ever) for 11 days and medications such as NSAIDS (MOTRIN, TYLENOL) were not working, they were so debilitating i couldnt go to work. I was discharged still in pain and was told to see my PCP. Blood was taken and not tested.

s/s
throbbing pain
tenderness** I couldn't wash my hair for periods of over a week
sensitivity to light/loud sounds
dizziness
confusion at times when pain is at its peak.


I finally saw my PCP two days later and was referred to a neurologist. The neurologist put me on Prednisone 60mg for 3 days 40 for 2 days and 20 for 2 days. Yesterday was my last pill and i woke up today in pain, still the same symptoms.
I have to wait two weeks for an MRI and a CTA.

If you would have any advice, an treatment modalities or just any information, I would greatly appreciate it.

Janice

Answer:

Hi Janice,

You do not mention whether or not you have had headaches before, if so something "tipped" you over the edge into status migrainosus.

The neurologist was correct in using steroids until testing can be performed. At the present time until the MRI and CTA can be performed triptans or ergots might not be such a great idea.

The good news is you responded to the steroid..the bad news is you need to be on it a bit longer. If your neurologist cannot offer IV steroids to break the migraine, then oral prednisone could work, but you need to be on it longer. Perhaps 60mg per day for 10 days, and then taper off by decreasing every 5 days. Decreasing every 3 days might have been a bit too fast.

Call the neurologist's office, get to a nurse and ask to have more treatment. You do not have to wait until you see the doctor again in the office..they might be able to manage this by phone.

The scalp sensitivity is called cutaneous allodynia. This occurs when the migraine has progressed to the status stage. Usually by this point, oral meds aren't too effective but in your case it might work if the treatment is a bit longer.

Good luck with the migraine headache symptoms!
Mary Kay Betz MS RPA-C