02 Nov Reader’s Mail: Migraine Postdrome
Tender Head after Migraine
Q. I was diagnosed with migraine disease three years ago and started taking propranolol to stop the attacks. Since I have been on the medicine, I haven’t had a migraine—until a week ago. I was on my way to pick my children up from school when my eyes started to go funny—seeing zigzag lines—and I knew a migraine was about to start. By the time I got home, my right arm and the right side of my face were numb, and then the pounding headache started. I went straight to bed, and the migraine headache lasted until the next day. This is typical of my headaches except for one thing—my head is still tender and sore to touch, and it feels like my hair hurts. I just want some reassurance that this is normal. Should I be feeling like this a week after having a migraine?
A. That’s great that propranolol worked so well to reduce the frequency of your migraine attacks. Since migraine is a potentially lifelong medical condition, it’s not unusual to still have breakthrough attacks even when taking preventive medication. It is reassuring that this recent attack started the same way as your other attacks. You didn’t mention taking any medication to treat the attack, so it likely ran the entire course of neuron excitation in the brain; vascular changes and inflammation. Symptoms such as your hair hurting and tender or sore scalp/muscles on your head are common complaints of cutaneous allodynia (meaning that normal touch is unpleasant or painful). These sensations are due to abnormal brainstem processing of pain signals during the migraine attack. Some migraine sufferers experience postdrome—vague symptoms that can last days after the migraine attack. If you are still not feeling back to normal, see your healthcare professional.
Lisa Mannix, M.D.
West Chester, OH
Triggered by Changes in Weather
Q. I have had migraine without aura for over 40 years. However, nothing works for headaches caused by high barometric pressure. I have been on Imitrex® for years, and it generally works, but I have to take it again when the headache comes back after it rains or when there are unstable weather patterns. I know to be careful not to take too many analgesics or Imitrex, so rebound is not a problem. I am also careful of what I eat and, after so many years, I know my triggers. My grandmother, mother and brother had these headaches and I passed them on to my two daughters. What can I do about these high-pressure headaches?
A. Headaches triggered by barometric pressure are a challenge for many headache sufferers. Studies have shown that some headaches are triggered by relative humidity, barometric pressure, temperature and precipitation. It’s possible that the change in weather pattern, not the specific weather itself, is the triggering factor. You mention a strong family predisposition to migraine. That inherited sensitive nervous system is likely responding to changes in weather.
Unfortunately, there is no single simple solution for this trigger. The best thing you can do is raise your protective level by eating a healthy diet, avoiding caffeine, having good sleep habits, exercising regularly, and managing stress. Preventive medications may also be necessary to reduce your risk of headaches, including those triggered by weather changes. Your healthcare professional can work with you to find the best medication or combination of medications to reduce your headache frequency. When you do get a migraine, whether or not it’s from the weather, treat it early to get pain-free.
Lisa Mannix, M.D.
West Chester, OH
More Frequent Migraines Bring Other Symptoms
Q. My wife has had a constant migraine for the last four years and counting. She has done a few MRI and CT scans with no further answers. She has tried a few migraine medications including some triptans, but they only relax the headache for an hour or two. She is starting to have problems sleeping, which is not good when you have three kids to watch. We are out of ideas.
A. The MRI and CT scans are important to confirm that no serious underlying condition, such as a brain tumor, is causing your wife’s headaches. Most of the time, people with migraine have normal scans and other tests. We know that migraine is a neurobiological condition. Between attacks, the nervous system returns to a normal baseline. As headaches become more frequent, the nervous system may not have a chance to return to a normal healthy baseline. Associated symptoms such as changes in mood and sleep can occur. These symptoms are more common in people with migraine than the general population and create additional challenges to managing migraine.
Your wife may need to address lifestyle issues such as diet, caffeine, sleep, exercise and stress to help protect her sensitive nervous system. Her healthcare professional or headache specialist may recommend a preventive medication to reduce the frequency of the headaches and possibly help with sleep.
Lisa Mannix, M.D.
West Chester, OH
Nerve Stimulators for Headaches
Q: My son suffers from terrible cluster headaches. I read about a rechargeable battery-powered electrode device that is the size of a matchstick and is being called the latest headache cure. When implanted in the back of the neck, it sends signals that reduce the pain by as much as 95% for patients with chronic headaches. Can this device be used to treat people who suffer from cluster headaches?
A: Occipital nerve stimulators have been studied for the treatment of occipital neuralgia and chronic daily headache (chronic migraine, chronic cluster headache and hemicrania continua). They are primarily implanted in patients who have headaches in the back of the head (in the occipital region) and who have failed multiple preventive drug therapies, or in those who experience significant side effects from common migraine preventive medications. Deep brain stimulation has been analyzed in a few smaller studies in patients with chronic cluster headaches, and 50% to 70% of the patients showed significant clinical response. Continued research in larger patient populations will be needed to further determine whether nerve stimulation (occipital nerve or deep brain stimulation) will show clinical promise in patients with chronic cluster headache or chronic migraine.
George R. Nissan, D.O.
Co-Director, Diamond Headache Clinic
Research on Chiropractic Techniques to Treat Headaches
Q. What research is being done on using chiropractic techniques to treat headaches?
A. There are not a lot of studies looking specifically at chiropractic techniques for treating headaches. One metanalysis of non-invasive treatments for headaches, written by Dr. David Biondi (Expert Review of Neurotherapeutics, May 2005), showed that chiropractic treatment resulted in a trend toward improvement in tension-type headaches but not migraines. Physical therapy was shown to be beneficial for both, but most of the studies did not have rigorous scientific design or specific data showing a quantitative improvement in headache frequency or intensity. Stanton and Jull (Headache, Oct. 2003) studied cervicogenic headaches and compared the benefit of manipulative therapy vs. therapeutic exercise. They found that patients did better if they received both, compared to just receiving manipulative therapy alone because the passive nature of manipulation does not positively affect patients’ sense of control over their health.
I agree that a well-designed study is needed to assess the benefits of chiropractic treatments in different headache syndromes. We may find that chiropractic treatment is particularly beneficial for a specific patient type.
Susan M. Rubin, M.D.
NorthShore University HealthSystem