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I am a strong believer in carefully evaluating migraineurs in the context of their other medical conditions . The approach to chronic headaches must include careful evaluation of behavioral problems such as anxiety and depression , sleep disorders such as sleep apnea ( see page 12 ), and other conditions , including systemic illness such as autoimmune diseases and connective tissue disorders . Everything is important .
Patients commonly tell me that , when it comes to medication , they ’ ve been on “ everything .” It is important to know whether those treatments matched the headache diagnosis . We also need to know whether the optimal dose of an appropriate medication was used for an adequate length of time , whether appropriate medications were used in synergistic combinations , or whether certain combinations of medications actually neutralized each other or produced side effects that led to their discontinuation . Often , medications are switched too quickly , before the medication has had a chance to work . It sometimes takes many weeks to know whether the medication will be beneficial . Keep at it , and don ’ t give up !
— Edmund Messina , MD , Michigan Headache Clinic , East Lansing , Mich .
A CHILLING EFFECT
I take Premarin ® ( conjugated estrogen tablets ) for post-menopausal reasons . I ’ ve had pre-menstrual migraines throughout my adulthood while menstruating . Recently I took Premarin before bedtime and woke up the next morning with a severe migraine and cold sweats , followed by uncontrollable nausea . Could the Premarin have triggered a migraine ? Why am I having cold sweats ? — Linda J . Migraines are often made worse by fluctuations in estrogen levels . Estrogen levels drop before menstruation , triggering migraines in some women . This is not the case in all women , but two out of three women stop having migraines after menopause when estrogen levels drop and remain stable . Taking Premarin causes estrogen levels to fluctuate again , resulting in recurrence of migraines . According to the manufacturer , 26 percent of women taking 0.625 mg of Premarin have headaches as a side effect . Cold sweats and nausea are also known side effects of Premarin .
— Alexander Mauskop , MD , New York Headache Center , New York , N . Y .
GOING OVERBOARD ?
My 79-year-old mother has been experiencing severe headaches for 11 years . My theory is that she is addicted to paracetamol ( an acetaminophen ). She takes six to eight each day and has done so as long as I can remember . She gets the shakes when she is due for the tablets and , if she misses a dose , the headache completely consumes her . Her physician is happy to have her continue with the paracetamol as he says it is harmless , but I ’ m not so sure that she should be taking it this regularly and for an incredible length of time . Could she be suffering from medication overuse headache ? If so , what can we do to help her ? — Julia W . When someone has medication overuse headache , the longer it exists , the harder it is to treat . With paracetamol , we also worry about its effects on the liver .
There are various strategies for substituting a preventive headache medication for overuse of an acute headache medication . It often requires hospitalization , and it ’ s always a long , deliberate process that needs to be done under the care of a headache specialist .
— Mark Green , MD , Mount Sinai School of Medicine , New York City
Do you have a question or comment for NHF ? Send it to info @ headaches . org .
8 HEAD WISE | Volume 2 , Issue 4 • 2012