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