Health Topics

Treating Migraine

Andrew Schorr:

Welcome back to Andrew Schorr's Patient Power. Thanks for joining us. This is where we're on live every Sunday morning taking your questions and giving you our thoughts about how to be a smarter patient, whatever your health concern may be. Today we're primarily talking about headache and migraine, and certainly there are millions of sufferers out there. And we're starting to get your calls. But flood us with calls, it's fine. These hours go really fast. The number again is 206-421-5757. 206-421-5757. Or 888-312-5757. Now, how did we end up with a call from Dayton, Ohio? Ron, you are live on the air on KVI in Seattle. Are you really in Dayton, Ohio.

Caller:

I am definitely in Dayton Ohio.

Andrew Schorr:

Are you listening on the internet? Oh, good, okay. I'm an internet guy so I love it. How can we and Dr. Sylvia Lucas, all the way over here from the University of Washington but a true national headache expert, how can we help?

Caller:

Well, my wife and I both listen as often as we can. She's a CLL sufferer and that's how we found out about you.

Andrew Schorr:

And me too. Folks, that means chronic lymphocytic leukemia. And I've got my friends who have that more rare condition, certainly than migraine, but we're kind of in a little club. Well, Ron, thanks for listening. Your question about headache today.

Caller:

Okay. Well, my cross to bear is migraine. I've had them since I was a teenager, I'm 48 now. And I've got through periods throughout my life where they've been better and worse. But I've been through a lot of treatment, to a lot of neurologists, I've been to the Diamond Headache Clinic in Chicago as recently as two years ago. But I feel like I've been through a drug roulette, like they're just picking drugs to try to prevent, and nothing really seems to address the issue. And I'm just trying to see if there's anything I'm missing, a new approach.

Andrew Schorr:

Okay. And tell us what drugs you've been on, just so we know.

Caller:

Oh, gosh. I've been through most of the beta blockers, calcium channel blockers, most of the anticonvulsants. Some of the antipsychotics. I've got a list of all of them.

Andrew Schorr:

The triptans, the headache medicines that you can take?

Caller:

Oh, the triptans for prevention, yes. And those work very well, but I end up in a situation where I'm not supposed to take triptans more than twice a week.

Andrew Schorr:

Okay. What I'm going to do, Ron, because it's complicated and we can't really do your healthcare on the radio or the internet, but what we're going to do is we're going to talk to Dr. Lucas now and get some guide for you and some other folks how you go through this process. So listen on the internet and we're going to talk about this for a minute. I appreciate you calling in and my best to your wife. Okay? And I'm going to be back in Cincinnati next week. We'll be broadcasting from there. So if you take a road trip we'd love to see you.

Caller:

Okay. Thanks.

Andrew Schorr:

So, Dr. Lucas, headache a complicated. Migraine is complicated. Here's Ron who is on a journey for maybe years. How do you and other headache specialists try to sort that out? And there isn't always an easy answer, is there?

Dr. Lucas:

There isn't, and obviously Ron has been to some expert headache experts, including the Diamonds. Ron has chronic daily headache, and about four to five percent of people with headaches, severe headaches have daily headaches, and those are much tougher to treat. I'm going to back up, though, Ron, and address some other things before we get to your problem.

Most people come to the doctor with three kinds of headaches. A lot of people will call them regular headaches, and that's a tension type headaches. Those are mild to moderate, and most people can go to Bartell's or Rite Aid and get some Aleve or some Tylenol Extra Strength or Excedrin and do well. These are not disabling headaches. They don't keep you from going to the theater or doing what you want.

Then there are cluster headaches that men get more than women. These are very short 15-minute to three-hour headaches. They're very severe, sometimes called the suicide headache, and they're very treatable but we don't see those as often as we do the third and most common kind, which is migraine.

Migraine has often been misdiagnosed because if you have the pain in your face you might think it's a sinus headache. If you have the pain in your neck you might think it's a tension headache. But migraine are true moderate to severe headaches. They can last anywhere from four hours to three days. A lot of people will have one-sided headache. They can't turn their head around without getting a lot more pain. And they can have some nausea and light and sound sensitivity. And these headaches can last as long as three days, so they can be very debilitating for some people.

Many of my patients feel that just because they don't have twinkly lights in their vision or they're not vomiting that they don't have migraine, but that's not necessarily true. And there are many medications to treat these. Sometimes, however, depending on genetics, depending on your trigger factors, you can end up like Ron and get more and more and more headaches, sometimes leading to chronic daily headaches. And then you not only have to have something like the triptans --these are drugs that most people might know as Imitrex, Maxalt, Relpax, Axert, Zomig--you might not only need that but you might need a medication to take every day to prevent the headache from coming on.

And typically it's not something you're doing. It's not your fault. It's not the life you pick. Sometimes I feel like it might be the city we're living in because the barometric pressure here is really awful, but migraines tend to be genetic, and most people I talk to have at least one first degree relative that has migraine, mother, grandmother, brothers, sisters, father.

Andrew Schorr:

So, Sylvia, there's Ron, and he's going from specialist to specialist. Any suggestions?

Dr. Lucas:

Well, I know he's received some excellent care, and again it's hard to treat someone over the internet.

Andrew Schorr:

Or the radio.

Dr. Lucas:

As the case may be. But I think that Ron actually said something that was very important. He said that the triptans work for him, and there's a small paper out now and some physicians are saying that perhaps it might be reasonable to use the triptans on a daily basis to do prevention. And there's going to be a paper coming out using Amerge, 2.5 milligrams twice a day as preventive. So this will be published. There's also medications like the triptans, they're called the ergonovines. They're derivatives of a very old drug called an ergot alkaloid, Methergine, methylergonovine, ergonovine, that while not highly available are available, or you can get your pharmacy to compound them, and that may be very, very helpful.

Andrew Schorr:

Okay. I think there's a point here too, and I know it was the case for me in leukemia, Ron, and your wife, I went to more than one specialist. Because there's an art, and I think it sounds to me with complex headache problems there's not a one-size-fits-all at all. And so while you may go to top specialist A, seeing top specialist B may be in your case, maybe in Ron's case, worthwhile as well to get some consensus or to see if there's another perspective on it. Am I all wet on that, Sylvia or what do you think?

Dr. Lucas:

No, I think that's true. Many people have different philosophies of patient care. And the other thing about Ron is that we again have these hints of things that are going to help him. But I must say, one thing you said, Ron, that was just so amazing and that was you felt like you were a drug roulette, and I think that's a great way to describe how some people feel when we treat them. Because we don't know what your genetic process is going on to allow you to have headaches, but the genetic work that we have done shows that different people may inherit different genes that are driving the ability for your brain to carry a headache. And that's why we have to try different medications, because we just can't open up your head, pull out the brain and say, oh, that's the problem and then fix it. So we're trying to target as best we can, but a lot of times it's a trial and error process.

Andrew Schorr:

So neurologists don't do that, can't just take it out like fixing an engine.

Dr. Lucas:

Oh, I wish.