Causes Of Migraine Headaches

by Devin T.
(Mandeville, LA)

Exercise Migraine

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?



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?



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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Severe Headaches

by Kayla C
(Caneyville, Ky)

I am 23 years old. I have been having severe headaches at least three times a week for about a year. However this week I have had the same headache for three days now, I am actually suffering as I type because looking at the computer screen is not helping.

The headaches start in my eyes and work their way through my forehead. I have sensitivity to the light so bad that I bury my head in a pillow. I also have sensitivity to sound but I rarely can escape it because I have a four year old who plays video games.

I am an online college student so I spend a lot of time looking at this screen.I have been told they could be sinus headaches but I have no other sinus symptoms.Something else that seems weird is that the headaches are worse when my glasses are on rather than off.

Please help, I do not have health insurance and cannot afford to go to the doctor. I have been taking ibuprophen but I worry because I know it is bad for your liver and I am taking way to much and it still doesn't help very well. Oh I also have the IUD Marina, I don't know if that is important or not but I figured Id tell you. Thank you so much and God Bless....

Kayla C.


Hi Kayla,

You sound as if you have all the symptoms of migraines which are very often mistaken for 'sinus headache'.

One thing (besides stress!) that is fueling the headaches is over use of ibuprophen or any other over the counter medicine taken for migraine. If taken more than 3 times a week it is making the migraines worse.

Try to get to a doctor, perhaps a clinic? Imitrex is now generic and there are other alternatives if you have no insurance. Remember the money you spend on ibuprofen could go towards better options.

One last thing..if your headaches got worse after the Mirena, consider another form of birth control. Although it usually doesn't affect migraine, sometimes I have heard patients tell me that it made them worse.

Good luck..
Mary Kay Betz MS RPA-C

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Migraines and other symptoms worst than the headache

by Jenni
(Flint, Michigan)

My husband is 35 yr old male- has migraines associated with the occiptal nerve on the right side of his neck and head. migraines seem to stay mostly on that side. They did an MRI of his head neck and spine and all was fine except for a cycst they said is nothing, not pressing on anything.-

He has had a headache almost everyday for 3 years. He wakes up with one usually and sometimes it keeps him in bed all day, sometimes it gets better as he goes through the day. When the headache is not happening he has the aura and light sensitivity.

he also gets muscle spasms in his head and neck and face on the right side that pulls his mouth and ear back towards his neck. and he gets burning in his forehead and sometimes the right arm, which also comes with sensitivity of the nerves in his forehead.

Often these other symptoms are worse than the migraines. These symptoms appear if the headache goes away, they also appear before a headache comes. His primary doc thinks it is all in his mind/ but humored him by sending him to a neurologist.-

The neurologist gave him a occipital nerve block in Nov. it worked but wore off after a couple months. He got another nerve block but that one did not work at all. They put him at first on doxepine which made him violent so they took him off it they put him on paxil which was taking away the burning.- the neurologist put him on propranalol which stopped the pounding in the back of the head but he was stll having headaches in the front and needing to take a ton of excedrin.

A month ago the neuologist took him off the propranalol since he was still having a headache at all, and put him on topamax and elavil which meant cutting the paxil down.- The evavil made him very violent and the burning came back from cutting down the paxil ( they did this to avoid seretonin syndrome). He got off elavil because of the violent reaction and now is just on topamaz, paxil and klonopin.

He is still having headaches, the burning is not going away even though the normal paxil dose is back and now the pounding in the back of the head is back since being off the propranalol.- He wants to die everyday- and often feels like he is going too.He is still taking alot of excedrin and his stomach is very upset alot ( and the topamax is making him very dehydrated even though he is drinking 70 - 100 oz a day of water)-

His primary does not really help- and his neurologist seems like the the treatment should be working and i think wants us to wait it out. We are unsure how long it should take for topamax to work before we know if it ever will.- What should we do?? most of the headache specialists on the list don't take our insurance, and the one that does needs a referral and I don't think the primary will agree to give it. Thanks for your time



Hi Jenni,

I am sorry he is in so much pain. Clearly he has a mixed headache syndrome which sounds like migraine in addition to neck pain which may be fueling the headaches.

The occipital nerve blocks can be done once a month and if he responds to those, he may qualify for an occipital stimulator. I have a couple of pain management and neurosurgeons in my area who are doing this for my patients and the results are really quite good.

I would strongly recommend talking to the PMD to get the referral to the headache specialist. You are in Michigan so how about the Michigan Head and Pain Institute in Ann Arbor? They are excellent and see a couple of our patients per year who need inpatient treatment. They are only one of two headache centers in the north east who offer this.

Don't worry about the seratonin syndrome thing..in 20 years of practice, my doctor has never seen a case of this and we have patients who are numerous medications...many more than your husband is taking. I would also recommend a course of steroid for a week or two to break the cycle of pain. When he has a severe migraine, an injectable such as Sumavel or Imitrex injection would be the best option.

Finally, while on steroid this will give him a chance to stop the Excedrin. He must absolutely stop this as it is fueling the headaches and making them worse. This is called analgesic rebound headache now also called headache due to medication overuse.

Get to the headache specialist!

Good luck!
Mary Kay Betz MS RPA-C

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New type of Migraine

by Jessica
(Virginia Beach, VA)

I am getting these throbbing headaches on the top, above and on my temple, on the front of my head above my eyebrow, and sometimes behind my eye and/ or eyebrow as well, and also at the back base of my head above my neck; all on the left side of my head. They have been starting with a slight throbbing and then start pounding.

I can't seem to find anything 2 relieve them. I have tried my Maxalt, Fiorcet, now nasal dose version of Imitrex (NSAIDS don't even attempt to touch it). The problem is none of these are working and I can't even tame it enough to try and sleep it off. I have suffered from migraines for years, but normally proceeded with both an out of it feeling then an aura, causing an ocular visual prism-like thing across one and a half of my eyes (normally the side the headache will be present).

I have also had numbing and tingling in my tongue and my fingers before the headache hits. These both mean I've had warning signs letting me know my migraine is coming, and they normally only last a day (with me feeling drained the follow
ing day, of course). These recent headaches never seem to fully go away and have lasted for three days plus (really only dulling for awhile before throbbing a little stronger at some later points), in which I may have a day of relief before I seem to get one again. This is different from my previous migraine history, and I am at a loss of what to do. These new headaches started less then a month ago, where I had to eventually go to the ER bc nothing worked. Then again less then 20 days later, with a worse outcome the second time around going to the ER bc the relied I got there lasted shortly then wore off and the headache was still present for the 3 day period I have spoke of. Then the most recent one coming on only a few days after the last (at least to a dulling point) day of the second one; to which I took the newly prescribed nasal spray Imitrex after I tried Fioricet. Nothing!

I will admit the last several months I have been under more than normal stressful conditions. Ordinarily my migraines come 2-6 times a year, maybe more, with having to be hospitalized (despite taking my migraine prescription meds) 1-2 out of that number of occurrences. I have had an MRI years ago, and I also have been through many different migraine meds, normally have to switch every 6 months to a year or so because they quit working. I have an extremely high pain tolerance; however, my migraines (and whatever these new headaches are, I'm assuming migraines as well) are a different story because the a truly extremely painful and debilitating! Any help, suggestions, or advice would be amazing!



Hi Jessica,

It sounds as if your migraines are increasing in severity and frequency. Stress is the most common cause for this so it is up to you to take a look at the stressors in your life and develop coping skills. If it is the job..leave work at work. If a relationship then look at that.

Since your headache profile is changing and it has been many years since you had an MRI, I would recommend that you speak to your doctor about getting one done.

I do not see that you have been on any preventative medication? By this I mean topamax or depakote low dose to get the headaches under control. The fact that these migraines are now disabling and causing visits to the ER also warrants daily preventative for awhile. Once you get back to your baseline of a headache every other month or so then you can stop it. I would also consider magnesium, 800mg a day as a preventative for migraine.

For treatment, if the headaches are truly severe you may need an injectable. Sumavel is the new needle free injectable sumatriptan with an onset of 10-12 minutes to treat the headache.

Talk to your doctor. It may be time to see a neurologist or headache specialist if you haven't already done so.

Good luck,
Mary Kay Betz MS RPA-C

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