Below you can read the results of the chat with Prof. Göbel from January 12, 2016. This link leads directly to the chat group: Live chat with Prof. Göbel on January 12, 2016
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Pain medication is no longer working!
Hello Professor Göbel,
I need your help. The problem is as follows:
I've had migraines and tension headaches since age 16 (now 41).
I don't have medication overuse headache (MOH). Triptans used to be effective (Relpax 40 mg + 500 mg Naproxen), but for about six months now, they haven't worked at all. I've tried several different triptans, and even Ibuprofen 1200 mg + 500 mg Naproxen hasn't helped with tension headaches.
What could be causing this? I take medication about 6-8 days a month, always hoping it might help this time.
It's awful not having emergency medication when you're fully employed and a chronic pain patient.
Do you have any advice?And thank you very much for the opportunity of this live chat.
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Dear Anastasia,
If triptans, after initially working well, no longer have any effect, even after rotating the active ingredients, a very thorough general and neurological examination is necessary. After years of stable headaches, another cause of the headache may have emerged, which must be diagnosed. Provided these examinations reveal normal findings, a new preventive treatment should be found that is sufficiently effective and allows for a renewed response to triptans. Your doctor can discuss the various options with you and, depending on their prior experience, initiate the appropriate treatment. As an alternative to triptans and NSAIDs for severe migraine attacks, metamizole (novaminsulfone) in combination with an antiemetic can also be tried.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I have been taking extended-release amitriptyline for prophylaxis for four months and am currently on 75mg.
Until recently, I tolerated the amitriptyline well, and my migraine days were decreasing.
Now I have the following problem: The extended-release tablets have been unavailable for some time. I am now taking the regular 75mg tablets. My neurologist advised me to experiment with taking them throughout the day or all 75mg in the evening. Taking them throughout the day is not possible due to the side effect of drowsiness. I have been taking them in the evening, around 6 pm.
Unfortunately, the effect is nowhere near as good as with the extended-release tablets. Furthermore, I have developed the following problem: My fingers become thick, swollen, and painful at night – something I didn't experience while taking the extended-release tablets.
What advice can you give me? Thank you in advance.-
Dear Bavarians,
You could try taking 50 mg of amitriptyline in the evening before going to bed. Throughout the day, you could then take an additional 3 x 10 mg of amitriptyline. This might give you a similar effect to that of extended-release amitriptyline.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
My migraine attacks typically last about 48 hours and occur roughly 5:1 more often on the left and right sides of my head. On the left side, I experience accompanying symptoms such as light sensitivity, nausea, and vomiting, while on the right side, I "only" have pain. However, the pain is most intense on the right side, affecting the entire eye area and radiating to the right side of my head, and I also experience a feeling of pressure in my eye. The pain worsens on both sides with physical exertion.
Unfortunately, the pain on the right side is almost unaffected by triptans or NSAIDs, whereas Allegro works quite reliably on the left (sometimes in combination with naproxen).
In recent years, I've repeatedly experienced persistent, several-week-long, and very painful episcleritis (rheumatoid factor normal, ophthalmological examination unremarkable). Could it be that this has caused the nerves in my right eye to become hypersensitive, triggering them to "fire"? Like a kind of pain memory that's activated and no longer responds to pain medication?What drug treatment options are available for this right side in this case?
Thank you so much for your participation here in the live chat and in Headbook in general!
Best regards,
Heika-
Dear Heika,
The pain system is structured differently on each side of the body. Similar to handedness (right-handedness, left-handedness), pain is processed and perceived differently on the different sides. Whether the painful episcleritis is related to this remains unclear. It is conceivable that increased sensitivity is partly responsible for the reaction. In the case of severe pain attacks on the right side, an intensification of acute therapy should be considered. A more effective triptan could be used, for example, zolmitriptan 5 mg or Relpax 80 mg. The additional administration of an NSAID such as naproxen 500 mg and an antiemetic is also conceivable.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
First of all, thank you very much for your time.
I suffer from diagnosed chronic migraine and experience severe migraine attacks lasting two to three days, one to two times a month, despite various preventative measures (currently 50mg amitriptyline/day and Botox every three months following PREEMPT). Imigran Inject is usually ineffective in stopping my attacks, even though I combine it with 500mg naproxen and 8mg ondansetron and take it at the first sign of a migraine. My problem, and what I find particularly distressing, is the constant vomiting, sometimes occurring just minutes apart, for a total of 25 to 30 hours (by which time my stomach is, of course, long empty). This vomiting is very draining, and I also become severely dehydrated because everything I drink comes right back up. I find the frequent vomiting episodes more burdensome than the actual migraine pain, which I would describe as a 5-6 on the scale. Neither MCP nor 16mg Ondansetron suppositories have any effect on me.
If I drag myself to my neurologist early in an attack to get an IV drip, the effect of all medications (including metoclopramide) only lasts for a few hours; after that, the attack returns in full force. Only towards the end of an attack, once the vomiting has stopped, does the IV medication help to completely end it.
Since my stomach "shuts down" shortly after the attack begins (a tingling sensation in my stomach is one of the first signs of a migraine for me), and I haven't found an effective anti-nausea medication, I endure most attacks without further medication. Even another Imigran injection only provides relief for a maximum of one hour. Do you have any suggestions for what else I could try?
Best regards,
MiRi-
Dear Miri,
You describe a particularly aggressive form of migraine. Your treatment is highly sophisticated and tailored to the severity of your attacks. Your acute medication is already adjusted to the severity of your attacks. The duration of action when medication is administered via infusion roughly corresponds to the idiological duration of action of the active ingredients; therefore, optimizing this therapy is only possible through repeated administration of the medication. With such a sophisticated attack therapy, it is therefore important to further optimize preventive treatment. This can then lead to a better response to acute medication, less aggressive migraine attacks, and thus easier to manage. It is necessary to consider which options can be used in addition to the botulinum toxin injections already administered. Furthermore, you will need a backup medication in case the acute medication is not initially effective. Typically, repeated administration of, for example, a triptan will then no longer be effective. Options for a backup medication include, for example, metamizole or diclofenac.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
I've been taking Topiramate 150 mg since October 2015. My pain medication needs have decreased from 10 to 5 days a month. However, since mid-December, in addition to the days I need pain medication, I've had mild headaches on one side almost every day, which are bearable without medication. In January, though, I already had 6 days needing pain medication. Within a month, I had to go to the hospital twice and receive IV treatment because the pain became unbearable and the triptan wasn't working.
Until the beginning of December, I felt well on Topiramate, which is why I declined a visit to Kiel over Christmas, something I regret. Is it time to start a new preventative medication and stop taking Topiramate? Or am I giving up too easily? The almost daily migraines are really getting me down.Thank you very much and best regards
, Stefanie-
Dear Stefanie,
Topiramate generally reduces the intensity of attacks rather than their frequency. Therefore, the need for acute medication is often not reduced by topiramate alone. For example, study data on the use of topiramate in chronic migraine show that the frequency of acute medication is not altered by preventive treatment with topiramate. However, since you are at risk of developing medication-overuse headache, other preventive treatments should be considered. Furthermore, you should not rely solely on preventive medication but also make sufficient use of the various behavioral medicine therapies available.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
Thank you so much for the opportunity to ask you another question.
I have been suffering from a complex pain syndrome for several years (chronic migraine, neuropathic pain in the area of the second branch of the trigeminal nerve, tension-type headaches). After migraine attacks that last for several days and barely respond to triptans or other pain medications (microscopic cephalalgia has been ruled out), my head is extremely sensitive to pain, and the intensity of the other types of headaches that occur immediately after the migraine is significantly increased. This rather severe pain then often becomes a trigger for the next migraine attack.
I take amitriptyline as migraine prophylaxis; I have tried other prophylactic medications (e.g., beta-blockers, topiramate, Botox, and related recommendations) over the years, so further optimization of my migraine prophylaxis is not possible. I consistently adhere to recommended behavioral measures (e.g., relaxation techniques).
My pain specialist suggests trying to alleviate the non-migraine pain by taking a sustained-release opioid daily, so that it no longer triggers migraines. Lyrica, gabapentin, and carbamazepine have not reduced this pain.
My question is whether sustained-release opioids could be helpful in this case, especially during the pain-sensitive phase immediately following a migraine, to improve my overall situation.Thank you for your efforts and best regards to the entire team.
Marlene-
Dear Marlene,
The use of extended-release opioids for migraine prophylaxis is not supported by scientific studies. No effect is to be expected. In my view, this would essentially only result in side effects of the opioid, without any therapeutic benefit. In individual cases, there are very aggressive forms of migraine that respond very poorly or not at all to standard preventive measures. In such situations, inpatient pain therapy should be considered. Various existing treatment methods can be further optimized and combined for this purpose.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
1. I have a question about the 10/20 rule. Is it possible to deviate from the rule that a treated day begins at midnight and count the days from the start of medication plus 24 hours as one day? Is this only about the 24-hour interval, or is there another reason for the count?
2. Can a migraine attack that has been successfully treated recur as a headache after, for example, 48 hours, or is it always considered a new attack if more than 24 hours have passed?Thank you so much! You are the only doctor I know who is so knowledgeable and offers this great Q&A session!
Jenny-
Dear Jenny,
The 10-20 rule essentially means that you should not take triptans on at least 20 days per month. This prevents sensitization of the nervous system and the development of medication-overuse headache. How you then draw the line on the other 10 days is relatively flexible. Whether a headache that recurs after an initial good effect can be considered a relapse headache within 48 hours depends on the definition. If one assumes that a migraine attack lasts up to 72 hours, then even a headache that recurs after 48 hours is still considered the initial attack with relapse. This may be defined differently in studies.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
First of all, thank you so much for the book "Successfully Combating Headaches and Migraines." It greatly helped me find my way through the many options and diverse therapeutic advice. Besides autogenic training and mental relaxation, I've been focusing primarily on Progressive Muscle Relaxation (PMR) according to Jacobson as a relaxation technique. PMR, in particular, allows me to unwind noticeably quickly and effectively after a workday.
I have now sought medical help again, as my symptoms – migraines and tension headaches – which sometimes occur individually and sometimes together, have worsened. I have problems with neck tension and a constant feeling of pressure and pain at the back of my head (hairline above the neck), which always eventually leads to headaches/migraines.
The new doctor I found through the list of headache specialists (Kiel Pain Clinic) near me says roughly the following:
– Progressive muscle relaxation (PMR) is no longer recommended these days; it's absolutely the wrong thing to do for muscle tension because you can't control tension effectively and it would worsen existing tension and problems with your cervical spine. Instead, they now offer and recommend Qigong.
– Strength training is completely wrong for the same reasons. I've been doing health-oriented strength training on machines for years and have had good and lasting results with it for my back and lower back problems. However, I haven't been able to get my neck problems under control with it so far.
– I should only use techniques with flowing movements, like Qigong, and go jogging and swimming, for example.What is your professional opinion on this, and should I follow the doctor's advice and stop doing PME and strength training?
Thank you for your commitment and best regards
, Waldi-
Dear Waldi,
Progressive muscle relaxation is still recommended. Studies have shown it to be the most effective relaxation method. However, some patients respond better to one method than another. Doctors also have different preferences depending on their experience. Relaxation techniques involving flowing movements, such as Qi Gong, jogging, and swimming, are also highly recommended. Here, too, one should follow their personal inclination and choose what is most enjoyable. From our perspective, it must also be confirmed that strength training is not suitable for migraine prophylaxis. On the contrary, it can often even worsen migraines.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
Due to progressive hemifascial microsomia (increasing difficulty swallowing and breathing, formation of a wide cleft in the skull), I am scheduled for distraction osteogenesis of the upper and lower jaw. However, since I suffer from chronic, therapy-resistant cluster headaches (currently without prophylaxis), I am very worried that such facial surgery might worsen the cluster headaches. Unfortunately, no one has been able to tell me anything about this so far.
Do you think such a worsening is to be expected?Thank you in advance,
Emma
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Dear Emma,
In our experience, such surgery cannot worsen cluster headaches. Therefore, any concerns you may have are unfounded.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
I took topiramate for over four months, gradually increasing the dose from 0.25mg to 100mg.
Due to severe side effects, especially tingling in my head and face, I had to stop. However, my attacks did decrease.I take sumatriptan 50mg, but for years now, half a tablet (25mg) has been enough for me. I always stay below 10 doses per month.
Because of this low usage, I thought that perhaps a smaller amount of topiramate, maybe 50 mg, would help me.
Do you think it makes sense to try this?
Many many thanks
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Dear Giotto,
Some patients respond adequately to 50 mg of topiramate. 25 mg can also be effective. This needs to be determined on an individual basis.
Kind regards
, Hartmut Göbel
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Hello Prof. Göbel,
I'm considering participating in a study where I would receive an electronic device for several weeks, which I would use to briefly stimulate my vagus nerve daily. Apparently, this method has only been used for cluster headaches so far, and they now want to test it on migraines, which I suffer from. Have you heard of this, and what is your opinion on the benefits and effectiveness of this method?
Thank you very much and best regards
Ute
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Dear Ute,
The effectiveness of transcutaneous vagus nerve stimulation has not yet been sufficiently proven by study data. The procedure is very well tolerated, and when used within the framework of a scientific study, individuals can gain their own experience.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
thank you very much for taking the time to answer my questions.
I was at the Kiel Pain Clinic in the fall, diagnosed with tension headaches and chronic migraines. I was prescribed 50 mg of topiramate (which was reduced at my request after nine years due to side effects), 100 mg of opipramol, and 600 mg of magnesium. I also received desogestrel continuously due to a seven-day period of status migraine during menstruation. I had Botox treatment in Kiel at the beginning of November 2015.
Since the end of October, I have been on a pain medication break (using prednisone suppositories as an emergency medication), but I am not experiencing any relief from the pain.
In November, I had 12 migraine days, in December 15, and already 6 in January. I have not noticed any improvement, let alone three consecutive days without tension headaches.
Constantly enduring the pain is very draining. In your opinion, how long should I continue the pain medication break? When can I expect to see improvement? Perhaps with the second Botox treatment in February?
Kind regards,
SR-
Dear Peppi,
The treatment of chronic migraine aims to reduce the number of migraine days. This isn't always quickly achievable, especially with chronic migraine. Therefore, a consistent approach is necessary. The various options used in your case demonstrate that a single measure is insufficient to achieve a sufficient effect. Therefore, consistent and persistent adherence to the treatment schedule is crucial. It's positive that you don't have constant headaches. If the pain medication break was consistently followed, the prognosis is generally favorable, meaning the likelihood of long-term effectiveness can be increased. Repeating the treatment with botulinum toxin also increases the chance of long-term improvement.
Kind regards
, Hartmut Göbel
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Dear Prof. Göbel,
I was diagnosed with migraine about a year ago. Currently, I've been taking 75 mg of topiramate daily as a preventative measure for a month.
On average, I have headaches 23 days a month. I only need acute medication on a maximum of 7 days (no medication overuse headache). Amitriptyline and duloxetine as preventative measures were unsuccessful.I feel like the migraine is constantly there, just mild. As soon as I become physically active, it gets progressively worse. Walking, swimming, spending time with the kids, fitness... everything triggers it 100%. The headaches start even during the activity itself. My quality of life is nonexistent. I'm afraid I
'll soon be unable to work.All blood values are okay, blood pressure – okay. Only my pulse is slightly elevated (approx. 90) and my blood sugar is at its minimum (approx. 76 even after I eat breakfast).
What could be done about it? What approaches could be taken?
Thank you so much for your reply!
Larysa-
Dear Lora,
The description of your migraine symptoms suggests a diagnosis of chronic migraine. If not already used, treatment with botulinum toxin should be considered. If tolerated, high-dose topiramate can also be used. You should also discuss with your doctor whether inpatient treatment at a headache center for multimodal pain therapy is advisable.
Kind regards
, Hartmut Göbel
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Hello Dr. Göbel,
After treatment in Kiel in March 2015, I have my migraines pretty well under control. My medication is very effective, and I only have about 5-7 pain days a month.
Recently, however, I've been experiencing severe pain in my right eye (when reading for extended periods). My eye becomes very red (like with conjunctivitis) and waters. This lasts for about half an hour, sometimes accompanied by blurred vision. Afterward, I have a sharp, dull, and stabbing pain above my right eye! I don't think it's an aura; I'm used to experiencing it differently. It doesn't feel like the familiar migraine pain. To manage the pain, I've usually just taken an ibuprofen, which has helped relatively well. I didn't want to take triptans because I don't consider it a migraine. What could this be? Is it perhaps a type of cluster headache? I would be very grateful for your reply.
Sincerely, Sibylle Kolm-
Dear Sikol,
First, have your eyes examined by an ophthalmologist. Your description does indeed sound like the possible development of cluster headaches. Therefore, carefully observe your symptoms and document them in a headache diary. A current neurological examination is also necessary.
Kind regards
, Hartmut Göbel-
Thank you for your feedback. I've already had an eye exam; the intraocular pressure is normal, and the optic nerves are also fine.
And I have a neurological appointment in the next two weeks.
Wishing you and your team all the best, I'll keep you updated in our next chat
Warm regards,
Sibylle Kolm
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Dear Professor Göbel,
thank you very much for taking the time again today to answer our questions!For many years I have suffered from migraines with aura. During an attack, and for some time afterward, I've noticed that the side of my face affected by the migraine—usually the left side—is noticeably swollen and very sensitive to pain and touch. A dark spot often appears under my eye. Could there be a connection between this and the migraines?
Since I also suffer from rheumatoid arthritis (RA), my jaw joint is frequently inflamed, but the swelling looks different, and the pain is different as well. While with migraines the entire side of my face from my temple below the eye to my chin is swollen, with the jaw joint, the swelling is more localized and also reddened and hot. Cooling helps in both cases, as does a course of high-dose cortisone.
Is it possible that the migraines cause this kind of swelling?
Thank you very much in advance for your reply!
Sincerely,
Augenstern-
Dearest of my eyes,
The symptoms you described can also occur during a migraine attack. Eyelid swelling, excessive pain sensitivity, and sensitivity to touch are also common with migraines. Migraines can also cause corresponding swelling.
Kind regards
, Hartmut Göbel
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Dear Prof. Dr. Göbel,
My new neurologist prescribed Levetiracetam as migraine prophylaxis, noting that it can increase the growth of cysts/fibroids, but on the other hand, it would not cause weight gain, which is also crucial for me.
I had clearly pointed out my adenomyosis to him after his mention of the medication.
1. Can I take this medication without any concerns given my pre-existing gynecological condition?
2. Is levetiracetam ever used as migraine prophylaxis?
3. Does it really not cause weight gain? I keep reading the opposite.
Thank you so much for your information.
Greetings from Flensburg!
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Dear Ivitho,
Medications should never be taken without careful consideration. If all other guideline-recommended preventive medications are ineffective, levetiracetam can be used experimentally. However, its effectiveness is unpredictable. It is not expected that the medication will interfere with adenomyosis. Both weight gain and weight loss have been reported as side effects.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I am almost 72 years old and have been battling migraines for 25 years.
My pain specialist at the Institute for Microecology recently discovered significantly elevated histamine levels in my blood and extensive deficiencies in essential nutrients.
Since following his advice, I haven't had those severe migraine headaches again (for the past two months; previously I had them two to three times a month). However, I still experience weekly attacks of other migraine symptoms (nausea, leg cramps, etc.). Is
it possible to take triptans even without a headache? My neurologist never recommended prophylaxis; I'm only just starting to take topiramate and Bisohexal.
Thank you in advance for your understanding.
Margit
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Dear Margit,
Histamine levels and a significant deficiency of essential nutrients are considered by some institutions to trigger migraines. However, scientific studies do not sufficiently support this. Many factors can be responsible for changes in migraine symptoms following a change in treatment. Age, particularly after the age of 70, also leads to changes in migraine symptoms. It is absolutely correct that, when migraine is present, established and guideline-based therapies should be used first before trying experimental options, which are often very expensive for the individual. You should therefore consider having one of the proven therapies explained to you and using it systematically.
Kind regards
, Hartmut Göbel
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Dear Professor,
since I also have a mobility impairment, I don't have many options for changing doctors.
I did manage reasonably well with Maxalt.
My question, however, was whether triptans should be taken even without headaches, or if there's something else you'd recommend.
Sincerely,
Margit.
Botox was rejected because of my eyes.-
Dear Margit, please do not take a triptan if you do not have a headache. Furthermore, it is not certain that these symptoms are even related to a migraine. Best of luck with your preventative measures!
Kind regards,
Bettina
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Good day, Professor Göbels,
first of all, I would like to thank you for giving us the opportunity to describe our problems and for helping us via chat! I am almost 20 years old. I work in an office and sit almost all day. For the past two years, I have been suffering from very frequent and severe headaches. These headaches start in my neck, rise up to my forehead, and go down to my eye. They usually affect the right side of my forehead, and sometimes the left. My orthopedist has adjusted my spine twice and diagnosed cervical spine syndrome and a slight curvature of the spine. After that, I did physical therapy, and I often do exercises at home as well. This usually helps a lot. I have also had an MRI and a neurological examination, but nothing was found. I know that I suffer from neck tension, but I am sometimes really desperate because the pain is so intense. These attacks occur very intensely 2-3 days a week, but I feel mild pain almost every day. In the worst cases, I always take a Thomapryin. These usually help. When I feel the need to move around, I do exercises at home. A warm neck pillow also relaxes my neck. Unfortunately, I live in Stuttgart and therefore can't come to Kiel, but I will go to a headache clinic in Munich. I really hope a solution can be found soon… It's depressing to have such problems at only 20 years old… I would be very grateful for a reply from you.Thank you very much and best regards
, Francesca-
Dear Francesca,
Migraine is a distinct condition, and it's advisable to seek treatment at a specialized facility to develop a specific plan. Changes in the cervical spine and neck tension are not considered the cause of migraines; rather, they are consequences. Crucially, migraine must be viewed as a primary condition requiring specialized treatment methods.
Kind regards
, Hartmut Göbel
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Hello Professor Dr. Göbel,
Thank you again for the chat. For about two or three years now, my migraine attacks have been increasing in frequency and intensity. Lately, I've been having up to ten attacks a month, some lasting several days. Before that, I was doing relatively well for extended periods on a medication of 100 mg of topiramate per day (maximum two attacks per month).
Increasing the dose to 150 mg of topiramate per day had no effect. Increasing the dose from 40 mg of Dociton to 100 mg of topiramate also proved unsuccessful (Docton caused severe fatigue and depressive moods as side effects for me). Therefore, this medication was also discontinued.
Since mid-December, I've been weaning myself off Topiramate and will be finished by the end of January. So far, there have been no changes regarding my seizures. My neurologist suggested in December that I taper off Topiramate and then try going four weeks without it.
My fear is that there will be no improvement even after discontinuing or restarting the topiramate. Calcium channel blockers were tried previously and caused depression as a side effect.
Are there any other options here? Thank you very much and best regards
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Dear Xandrian,
From your description, I understand that the treatment with topiramate has brought about improvement, at least temporarily. However, you are reaching the limits of your tolerance. One option would be to maintain a moderate dose of topiramate (e.g., 75-100 mg). Simultaneously, a tricyclic antidepressant such as amitriptyline or doxepin could be used. This could, on the one hand, improve the effectiveness of the topiramate and, on the other hand, prevent the development of depressive moods.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
what is your opinion of the Cephlas procedure for migraine?(Regardless of the price and whether or not there are scientific studies to support it)
Would it be worth a try?
What's your opinion?
(My migraines are indeed mainly concentrated in my eyes.)http://www.augenklinikhoeh.de/cephlas-verfahren/
https://www.youtube.com/watch?v=XKYCR5wRbn0-
Dear Belting,
The method you mentioned has not been scientifically proven to be effective and is therefore not generally recommended.
Kind regards
, Hartmut Göbel
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Hello to Kiel,
I was treated by you two years ago. Since the end of December, I've been experiencing the following symptoms:
Since I worked until December 23rd and only then took my vacation, I had a migraine attack on Christmas Day. I can certainly imagine it was a kind of weekend migraine. The day before New Year's Eve, the following occurred: I experienced a stabbing pain on the left side of my heart, shortness of breath, and immediately my severe migraine began in my neck. The day before yesterday, I also felt the stabbing pain in my chest and shortness of breath before going to sleep. I had a migraine during the night.
An ECG and a stress ECG indicate that everything is fine. What could this be, and what should I do?
A little about me: I have a lot of work, both professionally and politically.-
Dear Gerd,
It was very important that you had a thorough cardiological examination. One possibility for your symptoms is so-called cardiac migraine. This involves similar symptoms to those you describe. Although this form is not included in the International Classification of Headache Disorders, it is well-documented in the literature. Many patients also experience chest tightness and pain during a migraine, which is often attributed to triptan use. This could also be the corresponding subtype.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I take one Naproxen 500 tablet and one Almogran tablet when a migraine starts. If this doesn't help, I often have severe migraine headaches with vomiting for 2.5 days.
My question is: Can I use Ascotop nasal spray after at least 12 hours, since it's a different triptan, and which triptan can I take in addition if the headache returns?
Thank you very much and best regards
Christiane-
Dear Christiane,
As a general rule, triptans should not be mixed during a single attack. The interactions between the individual substances have not been studied, and therefore this combined use is not recommended. If the triptan is initially effective and the headache recurs, repeated administration of the same triptan will also be helpful. Therefore, there is usually no reason to switch triptans. However, if the initial dose of the triptan is ineffective, then a so-called alternative medication should be taken. This should be from a different class of drugs, such as metamizole or diclofenac.
Kind regards
, Hartmut Göbel
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Good day, Dr. Göbel,
I would also like to thank you for this online resource for patient questions.
I am 35 and have had chronic headaches for 20 years (mostly tension headaches including eye pain, but sometimes also migraine-like, one-sided, throbbing headaches). For the past 7 years, my medication has consisted of amitriptyline (10-25 mg once a day) and, if needed, 600 mg ibuprofen once a day (up to 10 times a month, but no more often). I most recently received the prescriptions from my family doctor.
My questions:
– Can amitriptyline be taken indefinitely if indicated, or should it be discontinued or switched medications after a few months or years?
– My last ultrasound showed significant fatty liver (but blood tests were normal), and my pancreas has also shown more homogeneous levels on some days. How do you assess my medication in this regard? Are the amounts of amitriptyline and ibuprofen (at this dosage) concerning for these organs, or am I within a reasonable range?
– What's the deal with naproxen? Even after consulting 4-5 specialized pain therapists and having a stay in a day clinic, I've never been informed about it; I only ever read about it in forums or here in the chat. Would this be a "harmless" alternative to ibuprofen?One of my biggest problems isn't just the pain, but the guilt I always feel when I take medication. Because of this, I often take it too late. So my questions are along the lines of whether I shouldn't just consider it a gift that I can manage quite well with a relatively manageable amount of medication :).
Thanks in advance!
PeterPS: I should also mention: I eat a moderately healthy diet, weigh average weight, and hardly ever do any exercise – but I've been doing it more and more often in the last few days :).
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Dear Peter,
There is no time limit for taking amitriptyline. In fact, many patients take this medication for several years, as they often have legitimate concerns about a recurrence of their migraines. Switching to a different medication is not necessary. However, liver function should be checked regularly.
If liver function tests are normal, the dosage of amitriptyline or ibuprofen generally does not need to be changed. Many people have fatty liver disease, but if their metabolic function is adequate, the effective medication does not need to be altered. Naproxen has the unique property of being effective for up to 12 hours. Ibuprofen, on the other hand, only lasts about 3 hours. Since a migraine attack lasts 2-3 days, theoretically, one would have to take ibuprofen every 3-4 hours to achieve sufficient relief. This is completely impractical. Furthermore, naproxen is not very effective initially. Therefore, it is combined with a triptan. The triptan then initiates the action against the migraine attack, while naproxen provides sustained relief during the acute phase. In some countries (e.g., the USA), naproxen is therefore always combined with the triptan in a single capsule.
It's always surprising how afraid migraine sufferers are of medication that helps them. They also feel guilty about taking something that helps. This is related to old prejudices against migraines. On the one hand, people assume that a medication that can eliminate such severe pain and accompanying illness must be incredibly effective. However, the opposite is true; it precisely targets the migraine mechanism and can therefore achieve a high degree of effectiveness with minimal effect. On the other hand, earlier migraine medications that were effective had very serious side effects. This still lingers with today's migraine medications, coupled with prejudices against the condition itself. The migraine, however, is the enemy, not the treatment.
Kind regards
, Hartmut Göbel-
Dear Dr. Göbel,
Thank you so much for your reply, which, like so many others today, has helped me both online and in real life. Everything I need to know about amitriptyline, the liver, and naproxen is now clear. And you're absolutely right about the anxiety surrounding the therapy. There's always a kind of "co-dependency" within the whole family, which makes it painfully clear with every attack and every dose how bad it all is and that you shouldn't take it so often…
A quick question: Since you mainly talk about migraines and migraine medication: I assume your answer (regarding the acceptable frequency <10x and the positive view of the therapy) also includes tension headaches and their medication (ibuprofen)?
I wish you a relaxing evening later and send kind regards from the Kurpfalz region,
Peter-
Yes, that also includes the treatment of tension headaches. All within the 10/20 rule, of course.
Best regards,
Bettina
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Hello Professor Dr. Göbel,
I have suffered from chronic tension headaches for 12 years and have extreme neck and shoulder tension, primarily from working at the computer. Neither medication such as Saroten (150mg), nor physiotherapy, osteopathy, massages, or Botox injections have been able to relieve my constant headaches or even eliminate the pain for a few hours. My neurologist at the time, Dr. Wöber, told me a few years ago that the pain was chronic and that the trigger might no longer be present, and that I would have to learn to live with it. I rule out medication overuse headache (MOH) because I have always adhered to the maximum of 10 tablets per month.
In November 2014, I received acupuncture and massage treatment (12 sessions) from a Chinese medical team and was then almost pain-free for nearly four months – after about 10 years of constant headaches! Unfortunately, the headaches then returned with increasing frequency and within a month had become chronic again. In November 2015, I received another 12 treatments from the team in China, and the pain is now about 70-80% better. I've just gone 2.5 weeks without a headache, which is still a miracle to me.
Since this success, I have great hope that the pain is indeed curable and that I can still hope for an almost pain-free life. What is your opinion? Is chronic tension headache still curable after such a long time, or can it really only be caused by muscle tension?Thank you for your assessment!
Kind regards
Michaela
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Hello Michaela,
Unfortunately, I have the exact same problem! I didn't have Chinese therapy, but rather a few osteopathic treatments. However, that only helps for a while, and then the vicious cycle starts all over again….
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Dear Michaela,
Even chronic pain conditions and difficult, aggressive forms can improve significantly after many years and sometimes even resolve completely. Giving in to the pain is never an option. It won't make it better; on the contrary, this attitude prevents you from participating fully in life and leads to many complications. There are many treatments that can help. Sometimes you have to find your own individual path, which may not work for others. I wish you the best of luck.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
Our son is 14 years old and has suffered from migraines since 2012. At the beginning of 2014, you diagnosed him with chronic migraine; at that time, he had constant headaches. Currently, with flunarizine as a preventative measure, he has approximately 11 migraine days per month. Between the relatively clear attacks, our son usually only has mild headaches in the morning, which then intensify throughout the day, so that from about 4 or 5 pm onwards, he usually just wants to withdraw and rest. These headaches are less pronounced in all symptoms than clear migraine attacks, but are otherwise indistinguishable. Physical activity also worsens these headaches. Days when our son is truly fit and able to handle physical demands are very rare.
Do you have any explanation for why he is so limited in his physical capacity even on days without attacks?And how should we as parents best deal with this?
I'm unsure whether resting on these days is the right thing to do. In addition to the attack days, when everything is canceled for him because his acute medication doesn't work, he'll also only have school and homework on these days. Furthermore, I'm worried that lying down or sitting for so long will eventually make the attacks even more frequent.Thank you very much for your effort.
Warmest regards,
Lilli 13-
Dear Lilli,
Your description suggests that the migraines are still quite severe and draining your son's energy. Hopefully, he will experience further improvement over time. A change in therapy could also be considered. Activity and relaxation are generally beneficial. However, if your son is significantly affected by the migraines, he should be able to withdraw and rest.
Kind regards
, Hartmut Göbel-
Dear Professor Göbel,
Thank you so much for your advice. Do I understand you correctly that you also classify the headaches between the clear attacks as migraines? I'm always worried that we're misinterpreting it and that's why we haven't been able to manage it better so far.
Warmest regards,
Lilli 13-
Yes, that's how it should be understood, dear Lilli. These are probably migraine attacks, which is why he should rest when he's exhausted. Nevertheless, a good balance needs to be found so that he doesn't miss out on life and become depressed.
Best regards,
Bettina
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Hello Professor Göbel,
I've had migraines and tension headaches since I was 16, very severe and occurring 2-3 times a week without prophylaxis. The migraines can last up to 3 days if the acute medication isn't effective. I've been taking Stangyl and valproic acid for 3 years. Thanks to the valproic acid, the migraines are very infrequent and relatively mild. For acute relief, I take Superpep travel gum and naproxen 750mg. Now I often have pain behind both eyes or one (more often on one side) and in the front of my forehead, which is difficult to treat.
Do you suspect this is more likely a tension headache or a migraine, and do you have any suggestions for what I could take for acute relief? Accompanying symptoms include nausea and sometimes dizziness.With kind regards, Linda S.
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Dear Linda,
You have a very well-balanced preventative regimen, which seems to be stabilizing your migraines effectively. However, your acute medication may not be sufficiently effective. Discuss with your doctor whether the use of a triptan could be considered. Based on your description and the location of the pain, it appears you are experiencing migraine attacks. However, this can only be confirmed through a thorough examination and interview.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel, I'm sorry I forgot to ask a question in my previous post. Is it a problem if you exceed the 10-day limit in just one month? I managed it well last year. Only in December did it go to 12 days. Is that a one-off problem? I only took naproxen and no triptans. Unfortunately, sinusitis made everything worse :-(
Thank you very much, Linda S.-
Dear Linda,
It's not a problem if you exceed the 10-day limit for just one month. If you then reduce the number of pills accordingly the following month, this will even out. However, a trend that shows a continuous increase in the number of pill days taken over the past few months is problematic, for example, 7, 8, 12, 14, 16, etc. In this case, it must be assumed that there is an increase in relapses and that medication overuse headache (MOH) has developed.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I have suffered from chronic migraines for 30 years and take approximately 8-10 triptans per month. I have tried many preventative medications. For the past few months, I have been trying candesartan 8mg. Initially, I seemed to have great success (8 weeks pain-free in a row). Unfortunately, my migraine levels have returned to normal (approximately 10 triptans). Is there an explanation for this? Could a recently removed amalgam filling be the cause?
Thank you very much and best regards,
Su-
Dear Su,
Migraines can fluctuate significantly in frequency over time. Removing amalgam fillings is unlikely to be the cause. Very often, a change in preventative treatment leads to an initial, marked improvement. Unfortunately, after this so-called "therapeutic honeymoon" ends, everyday life resumes, and the migraines return with their usual frequency. This illustrates that it's not necessarily the medication itself that is effective, but rather that other variables, such as expectations and hopes, are far more significant. This doesn't mean that the effect is "imagined." Instead, it demonstrates the complexity of pain and how psychological and social mechanisms and evaluations can directly modulate the experience of pain.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
Five years ago, I was a patient at your clinic. My diagnosis at the time was chronic tension-type headache and migraine without aura. Back then, I wasn't taking triptans, but I started after my stay, which significantly improved my quality of life, as I can finally effectively stop attacks.
Several preventative medications followed, and I'm currently taking Metoprolol 50mg, with moderate success. After longer pain-free intervals, I often experience several weeks of almost daily migraines.
However, I'm now planning a pregnancy. My neurologist recommends continuing to take Metoprolol. I also take Citalopram for a (mild) anxiety disorder, and I'm supposed to replace it with St. John's wort after tapering off the medication before becoming pregnant.
What is your opinion on taking Metoprolol during pregnancy?
Furthermore, I'd like to have a plan in case I experience attacks during pregnancy. My neurologist leaves the decision regarding attack treatment entirely to my gynecologist, meaning I haven't been able to discuss treatment options for an emergency with him. I'm afraid my gynecologist will routinely forbid me from taking migraine medication, or suggest paracetamol, which I shouldn't be taking anymore and which doesn't help me in the event of an attack with severe vomiting. Do you have any suggestions for acute medication I could recommend? Would a letter from my neurologist about the severity of my migraines be helpful?Thank you so much for your time and advice!
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Dear Kitty,
You're raising a very complex issue that I can't fully address in a live chat. Generally speaking, if you're planning a pregnancy or already pregnant, you should avoid all non-essential medications as much as possible. This also applies to metoprolol. The same goes for citalopram. Pregnancy is a temporary condition. Many things change in the body. Migraines can improve significantly. If the course of the illness allows and you have a relatively mild form of aggressive migraine, we generally recommend discontinuing preventative treatment completely. Concomitant treatment with magnesium, physical rest, and intensifying your preventative behavioral therapy should always be considered. We don't recommend paracetamol due to the high risks to the unborn child during pregnancy. It's also very weak and may not be effective enough for severe migraine attacks. Mild migraine attacks can be managed without paracetamol. Ibuprofen would be an option. For very severe migraine attacks, sumatriptan can also be considered.
All the best and kind regards
, Hartmut Göbel
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I'm 22 and have had migraines for 10 years. I suffer three times a week. I've tried all the migraine preventatives, I exercise, do autogenic training, and I maintain a structured routine. Nothing works. Currently, I'm taking 150mg of venlafaxine and 8mg of candesartan. For several weeks now, my hands have been trembling, and I have this twitching sensation in my body (legs and arms). Could this be a side effect? Do you have any advice for me?
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Dear Julia,
You describe a very severe form of migraine. It's not accurate to say that nothing is working. You wouldn't know what would happen if you didn't undergo treatment. The side effects you described could be related to venlafaxine, but this cannot be said with certainty. Read up on preventative treatment here on Headbook. You can also find further information at https://schmerzklinik.de . You will find many suggestions there about what you could do. However, always keep in mind that there is hardly any method that will allow you to live with it exactly as you wish. Migraine is a lifelong condition of the nervous system that is genetically determined. You have to adapt to it; unfortunately, you can't simply shake it off.
Kind regards
, Hartmut Göbel
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Dear Professor Dr. Göbel,
I was a patient at your clinic about four years ago, and you prescribed Concor and Doxepin. It helped until two months ago. I was only having about four to six attacks a month, not the 15 I used to have.
But now I've been experiencing migraines almost daily for the past two months. I've also been having severe hot flashes for the past two months due to menopause, and I'm sure it's related.
What would you recommend specifically for the hot flashes and hormone deficiency? I'm not allowed to take hormones anymore. I'm currently taking sage for the hot flashes. But what medication would you recommend for the migraines, which are probably triggered by the hormonal fluctuations?
I would be very grateful for any advice; I'm willing to try anything.
Thank you in advance for your help.
Sincerely,
Bettina-
Dear Bettina,
Many factors could be relevant to explaining the current escalation of your migraine. The question is: Do you also take acute medication daily, meaning you might be experiencing medication-overuse headache? Regardless, you should consider how your preventative treatment can be adjusted. Hormone therapies are not effective for prevention. Therefore, you should schedule another appointment with a specialized pain clinic and consider a new treatment plan.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I have suffered from chronic migraines since my youth, which have worsened considerably with age (I am now 74). After being treated at your pain clinic almost exactly four years ago and subsequently taking an eight-week break from medication, I only needed to take painkillers once a month for the first year, as the attacks had become less frequent and significantly less severe. I am quite certain that my previous use of triptans, up to eight times a month, led to overuse headache. In the following years, my need for medication increased again, although I have been avoiding triptans as much as possible (about once a month). Now I am back at the limit. In November and December, I had headaches on average every other day, roughly half migraines and half tension headaches. On average, I have had 5.6 days of taking medication this year, with a maximum of seven days per month. This has meant enduring several days of severe headaches and vomiting. Could another eight-week break from medication help me?
Thank you in advance and best regards,
your still very grateful patient
Wilhelm Westermann-
Dear Mr. Westermann,
The frequency of migraine days is significantly influenced by medication dosage over the past three months. An annual average cannot adequately explain an increase in frequency. Therefore, if you have found yourself increasingly taking more triptans or acute medications over the last three months, approaching the ten-day mark, it is likely beneficial to take another medication break. In fact, this should be done whenever possible.
Kind regards
, Hartmut Göbel
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Hello Professor Göbel,
for 23 years I've had menstrual migraines for 3 days during ovulation and 5-7 days before and after my period. Since triptans are no longer effective, or rather, the attacks are getting longer, despite modern triptans like Relpax or Formigran, I'd like to consider prophylaxis.
Which prophylaxis would you recommend given my very low blood pressure, insulin resistance, and Hashimoto's thyroiditis? I don't want to gain any more weight, and I've already tried various continuous birth control pills for years without any improvement!
May I take two 2.5 mg Naramig tablets at once? The over-the-counter ones don't seem to work otherwise.
Thank you, and have a good evening!-
Dear Lily,
You describe menstrual migraine. If you don't experience any other migraine attacks, you could try short-term prophylaxis within the 10 "permitted" days of use per month. For example, you would take Naramig 2.5 mg one day before your expected period. This can also be taken in combination with Naproxen 500 mg. Studies have shown that 5 mg of Naramig is significantly more effective than 2.5 mg. Unfortunately, only Naramig 2.5 mg is available in Germany. However, you can overcome this by simply taking two tablets. If short-term prophylaxis is ineffective, continuous, individualized preventive treatment can be considered. This can be initiated according to the guidelines, primarily with a beta-blocker, such as metoprolol or bisoprolol.
Kind regards
, Hartmut Göbel
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Dear Professor Göbl,
thank you so much for your time!
As someone who has suffered from migraines for many years, I have now been diagnosed with a severe deficiency in vitamin B9 (folic acid) and a slight deficiency in vitamin B12. I have been taking supplements for three weeks, and my migraines have significantly decreased. My depressive moods and lack of motivation have also improved.
Is there a possible connection? Or is it just a coincidence?
Thank you for your reply.
Best regards, Biggie-
Dear Biggie,
It is entirely possible that your migraine pattern is related to a severe deficiency in B vitamins. These vitamins are responsible for many bodily functions, particularly energy metabolism in nerve cells. However, it is important to determine how this severe deficiency occurred. For this, you should undergo a thorough internal medicine examination. This answer should not be interpreted as meaning that migraines are always caused by a corresponding vitamin deficiency.
Kind regards
, Hartmut Göbel
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Dear Mr. Göbel,
Thank you in advance for the opportunity to ask your questions here.
I've had chronic tension-type headaches for three years and visited the Kassel Pain Center two years ago. Since then, I've been actively trying to manage them through activities like running and muscle relaxation. Six months ago, on my doctor's advice, I stopped taking amitriptyline, which I was previously taking daily.
How successful can the therapy be without amitriptyline?
How long will it take until I'm headache-free? Is that even possible? My doctor said one to two years, but my progress has stalled for a year.Doctors from almost every specialty have confirmed that I am perfectly healthy, except for the headaches I described. What are the likely causes? And is it unusual for someone my age (18) to have headaches of this kind? Are there many people who suffer from chronic tension-type headaches?
Best regards,
Robert
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Dear Robert,
Amitriptyline reduces the aggressiveness of chronic tension-type headaches. Studies show that pain intensity and severity are reduced by an average of approximately 30%. Complete pain relief is not a realistic expectation. Tension-type headaches likely arise from a dysfunction in the body's pain defense system. This dysfunction cannot be detected using standard clinical examination methods. Approximately 3% of the population suffers from chronic tension-type headaches.
Kind regards
, Hartmut Göbel
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Dear Professor Göbel,
I've had migraines with aura since my teens. It's gotten worse over the years. I used to have 13-15 pain days a month.
I've been taking 75mg of topiramate for prophylaxis for three years. My acute medications are: 10mg rizatriptan + 500mg naproxen + 20 drops of metoclopramide. Since starting topiramate, I now only have about five flare-ups a month, much milder than before, no longer at night, and the acute medication is effective, unlike before. I've already tried reducing the dose to 50mg, but the number of flare-ups immediately increases.
I'm 42 years old, childless, and the flare-ups I still have always coincide with my period and ovulation. However, I do get a few occasionally outside of this pattern. According to my gynecologist, I'm still far from menopause. My anti-Müllerian hormone level is 2.1.
Question 1: I use condoms for contraception; all other methods were out of the question due to my migraines. I'm now afraid of getting pregnant anyway. For example, the condom might break. I can't assess the risks that topiramate poses to the embryo. As soon as my period is late, I would stop taking the topiramate immediately. But by then, several weeks could have passed. Is there any information available about the effects of topiramate on the embryo if it was accidentally taken during the first 4-8 months of pregnancy? I would simply like to be informed. But neither my gynecologist nor my neurologist can give me a definitive answer.
Question 2: Despite being 42 and still having good fertility, the topic of children isn't off the table. If I decide to try for a baby, I would stop taking Topiramate. How should I do that? My neurologist suggested tapering off over 8 days. I thought that was quite fast.
Now I'm lacking a plan. My neurologist can't give me one, and unfortunately, neither can my gynecologist. Which beta-blockers would be an alternative? Are there any that don't cause weight gain? I've already tried antidepressants. Unsuccessfully, but surely there are other options. Is it even possible to get pregnant while taking beta-blockers or antidepressants? What are the risks? Wouldn't you have to stop taking everything once you're pregnant? Which would be perfectly fine with me, since I've read on your website that 70% of all pregnant women are usually migraine-free.Thank you for your reply.
Sincerely,
SHilmer-
Dear SHilmer,
You can take a pregnancy test immediately after your expected period is due. These tests are very sensitive nowadays and can detect a pregnancy at this early stage. Generally, it's better not to use topiramate if you are trying to conceive. There is always a risk of birth defects. There are no fixed guidelines for discontinuing topiramate. In my opinion, there's nothing wrong with stopping topiramate completely and abruptly. In the worst-case scenario, a migraine attack could occur. Slow tapering is particularly important for epileptic seizure disorders. There is a risk of triggering a seizure if you stop abruptly, which you naturally want to avoid. For a complex adjustment of your therapy, you would need to have a personal examination and consultation. This cannot be done via chat.
Kind regards
, Hartmut Göbel
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Hello and thank you for the opportunity to chat live.
I'm having my first Botox treatment on Wednesday, and at the same time, I was diagnosed with insulin resistance by my diabetologist and prescribed Metformin. He couldn't tell me if there are any interactions with Botox or triptans, only mentioning that ibuprofen wouldn't be good because it increases insulin requirements. Are there any known interactions between Botox treatment, triptans, and Metformin?Best regards
, Jade1986-
Dear Jade,
No interaction between Botox treatment, triptans and metformin is known.
Kind regards
, Hartmut Göbel
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Hello Professor Göbel,
I'm 47 now, have suffered from severe migraines for decades, and also have type 2 diabetes, Hashimoto's thyroiditis, fibromyalgia, and a few other conditions. The vast majority of my severe migraine attacks occur on the left side of my body; attacks on the right side are very rare.
For the past few weeks, I've been having increasing problems with my teeth on the right side, some of which have crumbled and had to be extracted. This means that I now have no teeth left in my lower jaw on the
right side, for example. Even shortly after the extractions (the last one was on December 29, 2015), I have the feeling that my migraines are improving (I've only had one minor attack this year).
Until now, I've always assumed that with migraines, the "problem" lies on the side where the migraine occurs. Could it be that my situation is different, or that the "problem" on my right side is causing the severe migraine on my left side? I should also mention that I usually have paradoxical reactions to many medications.
Best regards,
Royan-
Dear Royan,
Migraines arise from an innate peculiarity in the processing of stimuli within the nervous system. It is not related to any particular side of the body. Migraine sufferers often exhibit increased activation of the chewing muscles. This is also referred to as parafunctional habits. These include jaw clenching, grinding, tongue thrusting, etc. These functions are an expression of heightened activation of the motor nervous system. The underlying cause lies in the processing and control of stimuli. While it is always conceivable that various manipulations could alter the migraine symptoms, this has no connection to the actual cause of the migraine.
Kind regards
, Hartmut Göbel
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Unfortunately, the chat has to be closed early today due to an unusually high number of questions. Answering them all takes several hours, and at some point, we have to draw the line. We ask for your understanding and please DO NOT post any further questions. Thank you!
The comment function has been closed.
January 11, 2016 at 12:01 PM
Hello Professor Göbel,
for the past two years I had my chronic migraines quite well under control; thanks to Botox, I only had two or three attacks a month. In November, I had a tooth extracted, and two dental implants were placed 14 days later. Since then, everything has been like it was at the beginning of my migraine ordeal—endless pain. After the surgery, I had excruciating pain for four weeks (up to six 800mg ibuprofen tablets per day). In addition, I've been experiencing frequent, very severe migraine attacks. I was unable to work and had to cancel all my appointments. I then received a large infusion of procaine and painkillers from my pain specialist because I couldn't recover from the migraine attack before Christmas. Now I still have tension headaches every day and migraines every few days. I will now be going to my pain specialist every week for an infusion. I'm quite desperate and would love to have the dental implants surgically removed. My question is, what else can I do to become pain-free again? Could the implants be triggering my migraines? I've been pretty much at my wit's end since then; it's really taken away my will to live. Perhaps you have some ideas. Thank you very much.
Kind regards
, January 11, 2016 at 5:44 PM
Dear Julia,
It's possible that the pain following dental implant surgery, combined with the regular daily use of ibuprofen, has led to increased pain sensitivity and the development of medication-overuse headache. The constant irritation of the nervous system due to the heightened excitability after implant surgery could also explain the increased migraine frequency. In this situation, botulinum toxin will not be effective. If the conditions for medication-overuse headache are present, a medication break would be necessary. If persistent pain continues, painkillers not typically used for migraines, such as a moderately potent opioid, should be considered. Very often, the situation improves over time.
Kind regards
, Hartmut Göbel