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Reader's Mail: Association Between Migraine and Weather

Q. I have suffered from migraines without aura for most of my life. I recently moved from Wisconsin to Arizona and had a substantial increase in migraines during the recent monsoon season. There is an excessive amount of lightning, which strikes the ground repeatedly during storms, and thunder as well. The barometric pressure elevates to as much as 30.28 inches. Has there been any research that would indicate that lightning, thunder and elevated barometric pressure can affect the brain and trigger these migraines?

I use Imitrex® to abort my headaches, but take so many in the course of a week, I am concerned it will affect my heart. Is there anything I can do to avoid so many headaches, short of moving?

A. You are absolutely correct that changes in the weather correlate with the occurrence of migraine headaches. Headache sufferers are not alone as other medical conditions, including arthritis, anxiety and even high blood pressure, have been shown to be affected by the weather. Why this happens is not clearly understood although there are a number of theories. One study out of Jefferson Medical Center in Philadelphia showed that migraines were more likely to occur when the atmospheric pressure rises. Since you are seeing very high barometric pressures during the monsoon season, it is not surprising that you are having more headaches. Another study suggested it was a combination of factors that triggers headaches, including low barometric pressure, passage of a warm front, humidity, rising temperatures and overcast skies. The actual role of thunder and lightning is less clear since it is hard to separate those specific weather phenomena from the overall weather changes. Poets have, however, described the migraine aura as being similar to lightning and migraine pain to thunder.If you know your migraines are triggered by fluctuations in the weather, you can use management strategies to handle this. First, you should prepare for your headaches when you know the weather is about to change. This will allow you to take your medication as early as possible, which usually leads to a better response. You can also begin or adjust a preventive medication if you know you are going into a season that will result in more headaches. Talk with your headache specialist to see what medications would be most effective in these situations.

Susan M. Rubin, M.D.
Women’s Neurology Center, North Shore University Health System
Glenview, IL

Plastic Surgery to Treat Migraine

Q. I have been keenly following the success of plastic surgery for the treatment of migraines. I have always believed that there was something in the head/sinus/neck area that affected my headaches and I believe that this treatment will cure me. I desperately need help, as my migraines have now increased in severity and frequency. I currently suffer from headaches about 40% of the time.  Can you recommend someone who does plastic surgery for migraines?

A. Many new patients I see believe they have tried everything for headache control, but that’s rarely the case. There are many different ways of treating headaches, but there are no cures. Anyone who states they can cure your headaches is not being completely upfront. The goal of headache treatment is improved quality of life. Have you been seen at a headache clinic?Plastic surgery for migraines is controversial. To my knowledge, there have not been any large, well-designed trials to prove effectiveness. There are, however, ongoing trials regarding the use of occipital stimulators, which may be effective in a select group of individuals.

Jennifer Bickel, M.D.
University of Kansas
Kansas City, KS

Thunderclap Headache with Sex

Q. I have thunderclap headaches with orgasm. I have tried various medications, none of which have worked. Hypertensive medications lowered my blood pressure so much that I cannot achieve an orgasm. Nonsteroidal anti-inflammatories (NSAIDS) didn’t work. An MRI was negative. I am ready to have a funeral for my sex life.

A. Before you call in the pallbearers, take heart. What you describe—explosive headache during sex—is termed coital or orgasmic cephalgia, and is more common in men than women. The fact that you appear to have repeated episodes makes an ominous cause of your sex headache unlikely. But it is important to know that thunderclap headache during sexual activity can be caused by a serious condition, such as rupture of a blood vessel in the brain. If this type of headache occurs for the first time, it should be considered a medical emergency.Although we don’t know the exact cause of coital cephalgia, it may be related to increased blood pressure and muscle contraction during sex. Sometimes simply changing position during sex can help. Although you state you tried NSAIDS, there is one in particular, indomethacin, that can be preventive when taken about an hour before sex. You might also ask your healthcare provider about taking a triptan medication prior to sex as well. The good news is that this type of headache often spontaneously resolves on its own.

Tarvez Tucker, M.D.
University of Kentucky College of Medicine
Lexington, KY

Where Is Bellergal-S®?

Q. I’ve been taking Bellergal-S, but my pharmacist can’t get it anymore. What is the name of the generic form of this medication?

A. Bellergal-S is a combination product that includes ergotamine, belladonna and phenobarbital. Other brand names of this combination are Bellaspas® and Bellamine-S®. This medication was in use prior to the establishment of the FDA review of medications. In 2007, the FDA requested it be taken off the market. Over the past couple of years, the FDA has asked for many medications to be withdrawn as their side effects and drug interactions were not well studied. This combination product is one of these medications.

Jennifer Bickel, M.D.
University of Kansas
Kansas City, KS

Sleeping Pills Triggering Migraine

Q. Sometimes I need to take Lunesta®, Ambien® or Ativan® to help with my sleep problems. I know headaches are a side effect of these medications. I’m guaranteed to get a migraine every time I use one. It’s often a choice between sleep and a headache the next day or no sleep. Why does this happen and is there any way to prevent the inevitable headache, especially if I have to take a sleep aid for more than a day or two?
I have also noticed that my migraines completely disappear when I’ve had bad pain from a more sudden problem like a broken wrist. Has anyone figured out why this happens?

A. While the sleep aids you have been using may allow you to fall asleep, they may not be helping the quality of your sleep. You didn’t specify what kind of sleep problem you are having. Trouble falling asleep can be helped with sleeping pills, but people who have trouble staying asleep may have a sleep disorder that could be worsened by sleeping pills, leading to more headaches. Even if your problem is falling asleep, there are non-medicinal ways to help that don’t have medication side effects. A consultation with a sleep specialist should be able to help you sort this out.In terms of your second question, your headaches probably get better when you have a different pain for two reasons. First, you are probably distracted by the other pain and are not focused on your headaches. Secondly, the medications you use to treat your acute pain probably help your head, too. Unfortunately, long-term use of any pain medication will lead to tolerance, so you can’t use the acute pain medication indefinitely for your headaches.

Susan M. Rubin, M.D.
Women’s Neurology Center, North Shore University Health System
Glenview, IL

Nerve Blocks for Occipital Neuralgia

Q. My insurance company has denied coverage of nerve blocks for diagnosed occipital neuralgia. They are calling it experimental and requiring that I produce scientific evidence with regard to the procedure. Do you know of any studies that I might be able to use?

A. Occipital neuralgia pain is usually located in the distribution of the greater and lesser occipital nerves in the upper neck or the base of the skull. The pain can be one or two-sided. The pain can sometimes be brought on by movement, especially increased extension of the neck. Treatment can include analgesics, muscle relaxants, physical therapy and occipital nerve blocks. Sometimes health insurance companies will provide coverage for the nerve blocks even though the procedure is considered experimental. Unfortunately, I cannot find any placebo-controlled studies that show the benefit of nerve blockade.

George Nissan, D.O.
Diamond Headache Clinic
Chicago, IL

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