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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.
CAROTIDYNIA VERSUS MIGRAINE My migraines are often accompanied by severe pain in my throat / neck, which my neurologist has termed carotidynia. Is this a form of migraine? The throat pain can strike before the headache, or occur alone. Triptans help, and I take a steroid when the throat pain hits – but is there another pain reliever that would be more effective? – Deborah S.
Carotidynia is not a form of migraine. It is an inflammatory condition of the carotid artery which is associated with tenderness over the artery. Also, pain is relatively constant, not episodes like migraine. Migraine can cause pain into the throat so it still could just be a variation of migraine. It could not be diagnosed without a lot more information including an examination, but talk to the doctor whether this could be migraine. If frequent, they might want to try some migraine preventive agent. Triptans and steroids help many causes of pain, so a good response does not help in the diagnosis.
Mark Green, MD Mount Sinai Medical Center New York, NY
TREATMENT WITH TRICYCLIC ANTIDEPRESSANTS I have had luck with nortriptyline and imipramine in the past, but for short periods – 3 months for nortriptyline and 5 months for imipramine. My primary physician suggested doing a rotation of antidepressants since they do not seem to work for long periods for me, even after increasing the dosages. Do you know of any success stories with this type of regimen and are there any downsides to trying it?
– Mindy D.
We frequently rotate the tricyclic antidepressants in certain patients. These drugs would include protriptyline, nortripyline, doxepin, and amitriptyline. I would continue that method if it works. There are no down sides to this form of treatment. I started prescribing tricyclic antidepressants for headaches in the early 1960s. Side effects from these agents, such as dry mouth and constipation, can be remedied.
Seymour Diamond, MD National Headache Foundation Chicago, IL
LONG-TERM BOTOX THERAPY I have been using Botox for migraine for about 17 years. After my last dose, I had all the symptoms of an allergic reaction. Can you become hypersensitive after so many years? – Dasha I.
What is meant by an allergic reaction? If this means a rash or hives, yes it is theoretically possible but we have not seen it in our own clinic experience. If you have been using Botox injections for 17 years, I must assume that is has been used outside of the usual 31 site injection paradigm, since it has only been approved for chronic migraine less than 4 years ago. If there is a question about an allergic reaction, hold off on future injections until you see an allergist who could do a skin test before proceeding. Since Botox is a very expensive drug, it would be a shame to waste a 100 unit vial, so perhaps your physician could give or sell you a small quantity in a syringe to bring to the allergist for testing.
Edmund Messina, M. D. Michigan Headache Clinic East Lansing, MI
10 HeadWise ® | Volume 6, Issue 1 • 2016