Case Histories - July 1996 (1/5)

Hello, all you migraineurs out there!

My actual case history appears elsewhere in Ronda's lists of case histories. I wanted to respond to several migraineurs openly in case the information is useful to others.

To Roger of the UK: I loved your description of your aura as being "as though the film of reality was catching fire in its projector." Really, a perfect description of what it looks like. My lights are sometimes white and sometimes an intense blue. Recently I was hospitalized for injections of dihydroergotomine and sudden withdrawal from narcotics. One night I looked up and saw a red light flash and thought, "oh no! now I'm getting them in red, too!" Actually, it was a red light attached to the smoke detector which flashed occasionally to let us all know its batteries were still good. (It's good to laugh at ourselves occasionally; but, only if we feel up to it.)

To J Sparks: When I was taking Nardil I had more problems with aura than with actual pain. It was damned annoying. I've also had auditory auras, like the time (twice) that my computer sounded like a car engine to me, but not to anyone else. With my case history is a poem I wrote which features an auditory aura. My neurologist had never heard of an auditory aura, but I asked every migraineur I met if they'd ever had one and most of them had, even those who had never had a visual aura. I also have a problem with "persistence of vision," the effect you get when you look at a light source and when you look away the former image is superimposed onto what you're really seeing. I get this far more than I did when I was relatively migraine-free.

To Mario from Italy: Excessive warmth is also a trigger for me and I'm in California where our weather is much like Italy's. However, we are both relatively lucky. I visited the state of Nebraska last year and experienced heat with humidity for the first time; as I walked out of the airport in Omaha, my knees buckled and I found it very hard to cope. Physical stress is also a trigger for me. For instance, last fall I came down with pneumonia and the day I was sickest I woke up with a massive migraine and as the pneumonia came under control from antibiodics, the migraine also lessened. Just walking more than about a half block makes my head ache. Of course, I'm also on propranolol which prevents my heart from speeding up and therefore, prevents even mild exercise. Also I would like to caution you about both acetaminophen and codeine. Both cause "bounce back headaches" which can make your headache keep getting worse and worse and put you in a cycle of dependency where you get a headache, so you take acetaminophen and/or codeine, which (when it wears off) gives you a bad headache, so you take more of it. If your stomach can stand it, switch to aspirin, ibuprofin or naproxen (non-steroidal anti-inflammatories). These drugs do not cause bounce-back headaches.

To Kerrie: Oooooh. Do be careful with Stadol. The bounce back effect I just described to Mario applies doubly with Stadol. It works great but as the levels of it decrease in your body, it actually creates a bad headache, making another dosage necessary and on and on forever until you are much too stoned to work at all.

To Harry in Canada: You wondered about allergies and migraine. Many of us migraineurs also get really dreadful belly aches (not stomach aches) from eating the wrong foods. For me, the foods are chicken, turkey and mushrooms. My neurologist, who is a fellow-migraineur, gets terrific belly aches from eating eggs. I believe science will show that these belly aches are migrainous in nature and are also caused by a dysfunction in how our brains process serotonin. (There's a really nice article describing the role of serotonin in the brain written by a pharmacology professor at a university in Mississippi; if you type in "migraine headache" in Yahoo, the article will be listed in Yahoo's references.) So, the article says that serotonin is sent and received at several different kind of brain sensors (that's not their actual name, but I easily forget medical terms). One or more of these receptors are implicated in migraine. Another receptor controls gut action. I think that whatever dysfunction my brain has that causes the veins in my brain to swell painfully also doesn't function properly at the receptor sites controlling gut action. Therefore, the belly aches are another type of migraine, because they are also caused by a dysfunction in how my brain handles serotonin. Everyone who's had Imitrix fail to help them knows of their own knowledge that simply increasing the amount of serotonin in their brains may or may not be helpful. (Did you know that they developed Imitrix by figuring out how to give a migraine headache to pigs and then attempting to cure it? Apparently the pigs were grateful for the Imitrix, although I doubt anyone asked them their opinion of this procedure!) Anyway, apparently I have an allergy to chicken, turkey and mushrooms, which results in a migraine-like reaction in my gut -- extremely painful. Well, that's all for now, except to thank everyone else who wrote. I often print these stories (and others I find on the net) for my neurologist, who is learning as much about migraine from these stories as he is from the neurology seminars he attends.

---Nancy Leake Flack nanflack@metro.net

Here is another, rather minor, case history for all those who spend the occasional night curled up on the bathroom floor felling more mortal than they deserve to.

I am thirty one now and only realised that I was having migraines a couple of years ago. I used to refer to them as 'out of proportion hang overs'. A typical case would be after college exams or a tight work deadline. I would have a beer or two (honestly just one or two) and then start feeling odd. I'd go to bed and wake up an hour later with and incredible headache and nausea. I never thought it was migraine because my mother used to have migraine and I thought that they always involved seeing lights. Then one day it looked as though the film of reality was catching fire in its projector. Spots of light would appear, grow and disappear. This made me do some reading and I realised that what I usually had was all the symptoms of migraine without aura and had had a one off aura migraine. My triggers are stress and alcohol combined. I can drink when I am not stressed and I can usually handle stress if I don't drink. The danger zone is coming to the end of an emotionally/mentally charged period. It is like stepping off the end of a conveyor belt. If I am not careful I trip. I do occasionally get them when I haven't had a drink and I haven't felt stressed but these are rare. After the attack and around 8 hours sleep I feel like I have been raised from the dead, with a very clear mind.

I am lucky compared with other cases mentioned on your page. I take no medication and if I am careful I keep my migraines down to 5-6 a year.

Great web pages though. Keep up the good work.

---Roger R.Hyam@rbge.org.uk

Yes, here's another one. It's great to see your page and know that there are other folks out there with the same problems -- however it isn't so great to see that so many people are in pain as well. Here's my story. I had my first migraine at age 16 (on my birthday, no less). I had no idea what was happening to me -- as I sat in class, I gradually noticed to my horror that my peripheral vision was disappearing, my left arm becoming numb and tingly, dots of light danced before my eyes. My head started to throb and I became quite nauseous -- I had a great deal of difficulty speaking -- just forming the words to tell my teacher that I needed to go to the nurse's office - NOW! After a visit to the emergency room and a shot of what must have been Demerol or some other painkiller, I started the search for what was wrong with my head. A visit to the neurologist determined it was indeed migraines -- my mother had the same debilitating headaches in her teens through college days. I was prescribed Midrin, but I only had one or two bad migraines a year for the following years, and didn't have to worry about it on a daily basis. If I did get one, it was so severe I had to go to the ER or doctor, was out for a day or two. I figured there was no pattern to them, it was just an unfortunate hereditary problem that would go away as I got older, as my mother's migraines did.

But this year they came back. I'm in my mid twenties now, and I am experiencing a monthly series of what I call "headache days" which begin with extreme nausea, tingling/numb feeling on the left side, seeing dancing lights & "holes" in my vision, slightly confused thoughts and speech...but they may or may not develop into a headache. It's almost worse in its own way than having a full-fledged migraine, as the "aura" can go on for hours, even days, interfering with my job -- if I get one at work I end up having to have someone drive me home, and then missing days of work. Needless to say, it's not doing much for my career, as most people don't understand that a migraine isn't "just a headache". Aspirin or other over-the-counter pain relief doesn't help, nor did daily propranolol , procardia xl, that type of preventative medication. I haven't been able to isolate a particular food or environmental element that causes them -- seems to be a hormonal thing. It's difficult for my doctor to understand because I don't really need the strong painkiller-type "headache stopper" medication, as I don't even develop a full migraine most of the time. My doctor suggested trying an anti-depressant taken daily, such as nortriptylene, which I'm going to try. We'll see what happens. Does anyone else hasmore of a day-to-day problem with the "aura" symptoms than the actual migraine headache?

---J. Sparks sparks@ssnet.com

My name is Mario. I'm 45 years old and live in Italy.

My migraine started during my adolescence: 1 or 3 times in a month. Only one pill of aspirin (500 mg.) and caffiene could work enough. The circumstances that could trigger headaches were only excessive warm, excessive study and physical stress.

Then, slowly my migraine increased and I have periodical medical checkups by various specilaized clinics. I have tried all the kinds of analgesic and, especially, preventive drugs, but without relief.

Only the beta-blockers have had positive effects: at first they decrease migraine's frequency and after only her intensity.

Now, althouth I continue to take beta-blockers (propanolol), I have migraine 6-7 times a week, sometimes at night, sometimes by day. However,fortnately, my life is normal because I hold my pain under control: as prophylactic I take propanolol (100 mg); to get out migraine I take alternately these drugs:

medium migraine: aspirin(250 mg) + acetaminophen 600 mg) +codein (15 mg) + benzodiazepin (10 mg) or toradol (ketoralac) or indometacin (25 mg) + caffeine (75 mg) or contramal (tramadol)

bad migraine (or in case of analgesic failure) imitrex--sumatriptan (50 mg);

then every month I must take:

10-12 LONARID+ASPIRIN or Tramadol
10-12 DIFMETRE(INDOMETACIN)
2-4 IMITREX(SUMATRIPTAN)

I am worried about the large quantity of analgesic drugs I must take, althoutgh--currently--my urine and blood test are normal.

My question is: It is better take analgesic drugs or better to take only sumatriptan? The sumatriptan is a miraculous drug, but I fear that his abuse can cause the and of his efficacy.

Has anyone else had this or similar experience? Any thoughts, experiences, advise?

Thanks for your attention.

Greetings

----Mario mariocatania@netsys.it

Approximately 12 weeks ago I suffered a massive panic attack that required hospitalisation. On admittance I complained of a residual bad head that left me living in some sort of dreamworld. I was off work for 8 weeks and my Consultant Neurologist game me both a Brain Scan and a Lumber Puncture to see if anything "serious" was wrong. Fortunately they found no tumour etc. and gave me a course of tablets known as Ibuprofen. This of course had no effects on my now crippling headaches (a bit like trying to down a Rhino with a pea). My tablets were changed, had no effect and I have now been diagnosed as having Chronic Cluster Headache. My Doctor has since prescribed me with Sanomigram but after 3 days they are having the only effect of making me extremely debilitated and drowsy. I have come to the realisation that a similar attack I had 3 years ago has left me with a permanent bad head, that to be honest I have just got used to. Can anyone tell me how long I should give Sanomigram to work. I go to see the Neurologist towards the end of July. I am now back at work (couldnt stop off indefinately) but to be honest with you I am really struggling. I notice that one or two of your contributors have made a complete recovery and walk around with the luxury of a clear head. We have a saying in England that if you havent got your health you havent got anything....how true. ---Paul PAUL.DAYS@Sunderland.AC.UK

Wow! Ronda, I'm sure you have heard before how comforting it is to know that we are not alone. My name is Kerrie, I am twenty-one and have been experiencing migraines for only a couple of years. My mother and sister also suffer the pain of migraines. It seems that lately, I am having severe attacks roughly two or three times per week. I do not experience any kind of numbness but I do experience the nausea and vomitting. My boyfriend of three years is growing ever frustrated with me. I am very irritable when I have pain and it is difficult to maintain constant silence in a small apartment. I am taking Imitrex and Stadol NS, but they don't provide the answers that I am looking for. I feel so doped up while taking them but I suppose it is better than the migraine. I have found some useful info on food triggers, so perhaps I can find a way to get through this. Does anyone know if oral contaceptives contribute to a migraine? My doctor suggested something to that effect. You can reach me care of my step-dad's address. Good luck to all beating you're demons! ---Kerrie rhoggan@mail.inforamp.net

Hi Ronda, yes I am one of those migraine suffers as well. Well, I usually start with flashing/blinking lights prior to felling any pain. I then progress to a pain behind my right eye, which begins to move to the back of my head and begin throbbing, which is usually when I begin vomiting; although, I do begin feeling the urge to vomit earlier than this. If I develop a "full blown" migraine I cannot tolerate light, sounds, etc. and develop left-sided numbness and sometimes paralysis.

I usually suffer most of my migraines during the allergy season from April-October. I have very few migraines during the rest of the year because I am very careful to avoid triggers. Also, one trigger I cannot avoid is the weather. I feel like a walking barometer since I usually experience migrains just before a low pressure system. I use Imitrex (injectable) to treat migraines as well as Fiorinal. I also take Tanacet twice per day with good success. Tanacet has reduced the frequency of migraines from about 3-4 per week to about 1-2 per month!

Currently, I am having lots of problems with migraines and am having lots of problems with allergies. I live in Southern Ontario, Canada and am interested in the connection between allergies and migraines. My allergist insists there is a connection but cannot give me any information? Any ideas? Is this common? Any information would be most helpful! Thanks and good luck!

---Harry harry.ennis@sympatico.ca