are so bad that his left eye becomes blood-red ( not bloodshot , I mean real blood covering the white part ) and then the skin under his eye turns black , yellow and green . Why is this happening and what can he do for his migraines ? He has tried all kinds of medications and they haven ’ t helped . — Jennifer D .
It is important to know that the definitive brain imaging technique is magnetic resonance imaging ( MRI ), rather than the CT scan . There is a huge difference in the accuracy of these techniques , and important decisions should not be made because of a single CT scan .
Because a CT scan was performed in response to the headaches , there is no way of knowing whether the cyst appeared at the same time as the headaches ( unless there was prior testing ). Many people are born with cystic changes in the brain , and the term “ cyst ” could mean many things . For example , an area of the brain that was damaged at birth is known as a porencephalic cyst , where there is an absence of brain matter and the space is filled with cerebrospinal fluid . Cystic structures in the brain are not uncommon and usually do not cause headache . One type of cyst that might cause headache is known as an arachnoid cyst , but only if it is expanding and exerting pressure on the brain itself . Small arachnoid cysts are a common incidental finding and do not require treatment unless they change in size . They need to be monitored over time . Again , without knowing the details of the cyst , additional testing such as MRI and magnetic resonance angiogram ( MRA ) might be helpful .
It is not entirely clear by your description , but one type of headache that produces extreme redness in the eye is known as Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing ( SUNCT syndrome ). These are very brief attacks and are accompanied by tearing and redness , but that would not explain changes in the skin below the orbit . At this point , a careful neurological evaluation with appropriate testing would be in order . Unusual headache patterns are best treated by headache specialists who are certified in headache medicine .
— Edmund Messina , MD , Michigan Headache Clinic , East Lansing , Mich .
DAILY DISTRESS
Is there any hope at all for someone with a diagnosis of hemicrania continua ? The pain never stops and I discovered I ’ m allergic to indomethacin , the typical treatment . What can I do ? — Anthony T .
Hemicrania continua is an ongoing , one-sided headache that is sometimes accompanied by watery eyes , a runny nose , etc . It is certainly difficult to treat someone with hemicrania continua when the use of indomethacin is not an option . However , we have treated some people successfully using celecoxib ( e . g ., Celebrex ® ), topiramate ( see page 30 ), or verapamil ( e . g ., Covera ® ). Some have responded to onabotulinumtoxin A ( Botox ® ) and some improved with C2-C4 medial branch and facet nerve blocks . You should discuss these options with a headache specialist .
— Mark Green , MD , Mount Sinai School of Medicine , New York City
“ WHAT IS THERE LEFT TO DO ?”
I am 29 years old and have suffered with migraines since 1995 . I also started experiencing fibromyalgia two years ago . Around 2001 during my senior year of high school , the migraines became daily , and I am still experiencing daily migraine . They are throbbing and aching , located in the forehead and temples , and sometimes make me nauseous . I have seen three headache specialists and four neurologists . I ’ ve taken dozens of different preventive and abortive medications with no relief ; most recently I was on Zonegran ® ( zonisamide ), Lyrica ® ( pregabalin ), and nadolol for migraine prevention . I have also tried Botox ® ( onabotulinumtoxin A ) and nerve blocks without success . What is there left to do ? I feel absolutely debilitated . — Jackie S .
It is common for migraine and fibromyalgia to coexist in many patients . Although the majority of chronic migraineurs can gain at least some relief from onabotulinumtoxin A injections , a good number of people do not respond .
www . headaches . org | National Headache Foundation 7