Chronic cluster sufferer
Pushing pain headache
Migraine for 20years
Migraines
Chronic Stiff Neck
Q: Chronic cluster sufferer
I am a long term chronic cluster sufferer and have been one since I was around 26. I'm 51 now. Over the past 1 1/2 years, my attacks subsided while I was using Topomax but just recently, they came back and regretably, have come back rather violently.
I'm currently experiencing around 3 to 4 attacks a day, some are mild and can be treated with oxygen and Imigrin pills but the more violent attacks require Imigrin injections which unfortunatley, Glaxo have discontinued distribution here in Singapore.
I would most grateful for suggestions of headache specialists here in Singapore who are familiar with cluster / migraines headaches and the medications available for the prevention of this very rare form of headache who I could meet with to discuss my case.
Any assistance that you could provide would be very gratefully appreciated.
A:
The most effective preventive medications for cluster headaches are Verapamil, Valproate and Lithium.
S/C Imigran is still available in Singapore - the company brings the drug in on an indentured basis, and I order it from Glaxo Smith-Kline regularly. Am unsure it NUH or SGH pharmacies have the medication, though. Could call 67725183/4 for NUH pharmacy to check. SGH general number is 62223322.
Q: Pushing pain headache
My daughter of 7 years has been complaining of headache for the past 2 weeks. The pain (like pushing pain as described by her) is saturated at the middle back of head.
Been visiting 3 docs & finally diagnose as due to astimatigsm; have gone to optician & proven true. But up till now still headache (with painkiller given pain comes when medicine time wears off).
Would this problem possibly be remedied after use of spectacles as of tomorrow??? For now have not allowed long tv hours for her; but when wakes up in the morning will complain of headache again.
Pls advise what to do, as 2nd doc did suggest CT scan but I don't want to put my child through this ordeal.
A:
Although there is a link between visual strain and headaches, this is not as important as is generally believed. In other words, visual problems certainly do not have to be the cause of the headaches in your daughter.
They may contribute to the headache, but may not be the primary reason for the headaches appearing
There is generally no necessity to perform scans of the head unless aspects of the clinical history or examination are of concern.
I'd see a neurologist who is interested in headaches to get these worked out.
Q: Migraine for 20years
I having an migraine for almost 20 over years. After 40 years old geting worst, it can be happen every week and persistant for few day. It so painful from day till night.
I went for brain scaning sometime two years ago confirmed migraine. I took the medicine mainly for migrain it does not help, even worst.
Kindly advise.
A:
There are many strategies available for treating migraine. For example, medication can be used not only to treat each attack of migraine as and when it comes, but to prevent migraine attacks.
Other techniques such as dental splints, acupuncture, behavioural therapy and myofascial therapy also benefit migraine sufferers. I feel that the chances for relief are actually quite good.
Q: Migraines
I had an RTA 2 years ago (where I was hit by a lorry and spun across the motorway at 70mph eventually hitting the crash barrier hitting the back of my head on the side window).
As a result I also have two verterae slightly protruding (C4/5 & C5/6 I think), this ranges from extremely painful to raw. I have soft tissue damage and 'hot spots' of pain around my spine.
Since the accident I have been having Migraines on the left hand side of the head (opposite side to the side that crashed into the barrier). I have had 75 episodes in 2 years which lasted for between 1.5 and 2 days until diagnosis. Zomig was prescribed and this reduced the recovery time to 0.5 to 1 day albeit that I feel tired the following day and look 10 years older!
I have now been presribed Propranolol which I take daily (leaving me dizzy, forgetful and disorientated) and still need to take the Zomig as there does not seem to be a signficant decrease in Migraines. I have cranial osteopathy which helps for the day after.
I have had 2 MRIs, seen a neuro surgeon, ortopaedic surgeon and my GP. I have physio every 2 weeks and osteopathy every 2 weeks.
I did not have migraines or a significant number of headaches before the accident and am keen to understand if you have any suggestions (not acupuncture though as I've tried it and it made me faint). Any suggestions or help you can give would be much appreciated. Could you also advise if, in your experience, this is likely to heal?
A:
It is not uncommon for migraines to appear post trauma. There should first be a clear diagnosis (i.e. that the headaches are indeed migraines). Many prophylactic medications are available for migraine, and if propanolol gives problems you could always switch to another medication. On the other hand, the attack frequency of approximately once every 1 1/2 weeks may not merit daily medication if symptomatic treatment (e.g. with Zomig) is fast and effective enough.
I would consider adding in a non-steroidal antiinflammatory to the Zomig for more complete relief. A prokinetic agent like Domperidone can also improve the speed of the pain relief.
Q: Chronic Stiff Neck
I have chronic stiff neck that causes frequent headaches. I usually take 2 panadol extra pills to remove the pain. Most of the time, it works, but sometimes, I have to take up to 3 times or 4 times dosage i.e. 6 to 8 pills to clear the headache for the day.
I tried chinese acupuncture, traditional massage, foot massage, muscle relaxant pills etc. but they do not seem to provide any good long-term solution as the headaches keep recurring.
A:
It is common for tension-type headaches to originate in the neck. Muscle tension with tender points in the neck and shoulder muscles as well as oversensitization of the brain to muscle pain signals are responsible.
There is no quick and complete solution. This kind of pain generally waxes and wanes throughout one's life.
Combinations of physiotherapy/occupational therapy under an interested therapist, as well as medication (e.g.Amitriptyline) to reduce the oversensitivity of the pain can give a lot of prolonged relief. Massages and painkillers can offer short-lived but useful relief as well.
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