You ask. Our headache experts answer. reader mail
Tired of searching the internet for answers?
It’ s time to learn from those in the know. In every issue of HeadWise ®, our experts respond to reader-submitted questions about migraine and headache disorders.
TOLOSA HUNT SYNDROME
I have recently been diagnosed with Tolosa Hunt Syndrome. I am hoping that you may have up to date information on this rare condition. I have just finished taking steroids and am suffering from the many side effects. Can you advise me how to manage this? – Jan J, Perth, Australia
This is a rare syndrome of pain and paralysis of eye movements, associated with an inflammatory mass behind the eye. A rapid response to steroids, associated with improvement in the scan, is expected. If this is not the case, the evaluation should continue, which may include a biopsy to rule out other masses which could be causing the same symptoms.
There is little experience with agents other than steroids, but some have responded to azathioprine or methotrexate. If the dose of corticosteroids needed to continue to make you comfortable is otherwise unacceptable due to side effects, you should speak to your doctor about the possible use of these other agents. Even when these medications help, the response is not immediate and steroids may need to be continued. You might start this discussion early.
Mark Green, MD Mt. Sinai Medical Center
New York, NY
VITAMINS AND HEADACHE
Can you please tell me the best type of vitamins and minerals to take for headaches? I have been taking a supplement of A-Z multivitamins and minerals for at least 90 days. What effects should this have on the body and the type of condition it should be in after 90 days use? My diet is very good. I try to incorporate all the five food groups in my meals as well as a 10 minute daily exercise routine. I’ m 5.7 in height and wear a size 8 dress in British size. I’ m not sure whether my size plays a factor into the headaches I receive. Can you please offer some suggestions as to how to remedy this issue? – Claudine J, United Kingdom
There are many supplements that are being used for the prevention and treatment of headaches. The ones with the most scientific evidence supporting their efficacy include magnesium, CoQ10, and riboflavin. All three have been specifically tested for the prevention of migraine headaches. Multivitamins usually do not have enough of any of these supplements to help with headaches.
Up to half of patients with an acute migraine and 40 % of those with cluster headaches have been found to be deficient in magnesium. The recommended dose of magnesium is 400 mg a day and the types of magnesium that tend to be better absorbed are two of the so called chelated forms- magnesium glycinate and magnesium aspartate. Some patients have poor absorption of magnesium and may need to take 400 mg twice or even three times a day. Magnesium should be taken with food, which reduces the chance of it causing diarrhea. Some patients who do not absorb magnesium taken by mouth require intravenous infusions, which are usually administered monthly.
According to a very large study( 1,550 patients; mostly adolescents), 35 % of migraine sufferers are deficient in CoQ10. The dose of CoQ10 used in one of the studies is 100 mg, taken three times a day. Since CoQ10 often makes people feel more energetic, some cannot fall asleep if they take it at night. I recommend taking 300 mg once a day, in the morning.
Riboflavin, 400 mg daily was shown to help prevent migraines, although a clear effect occurred after 3 months of taking it. Riboflavin causes urine to turn a bright yellow color, so do not get alarmed.
Alexander Mauskop, MD New York Headache Center
New York, NY
www. headaches. org | National Headache Foundation 11