Below you can read the results of the chat on January 12, 2016 with Prof. Göbel. This link leads directly to the chat group: Live chat with Prof. Göbel on January 12, 2016

    1. Profile picture of Julia
      Julia
      January 11, 2016 at 12:01 pm

      Hello Professor Göbel,
      in the last 2 years I have had my chronic migraines under control quite well; thanks to Botox I only had 2-3 attacks a month.
      In November I had a tooth extraction and after 14 days I had 2 dental implants inserted. Since then everything has been like it was at the beginning of my migraine story, pain without end. After the operation, hellish pain for 4 weeks (up to 6 IBU 800mg per day). I also had very severe migraine attacks every now and then, I was no longer able to work and had to cancel all appointments. I then got a large infusion of procaine and painkillers from my pain therapist because I couldn't get out of the migraine attack before Christmas. Now I still have tension headaches every day and migraines every few days. I will now see my pain therapist every week and get an infusion. I'm pretty desperate and I would love to have the dental implants removed. My question is what else can I do to become pain-free again? Can the implants trigger my migraines? I've been pretty mentally exhausted since then, it's really taken away my courage to live. Maybe you have an Ides. Thank you. Best regards

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:44 p.m

          Dear Julia,

          The pain after the dental implants and the regular daily intake of ibuprofen may have resulted in increased pain sensitization with the development of a medication overuse headache. The constant irritation of the nervous system due to the high level of excitability after dental implants can also explain the increased migraine situation. In this constellation, botulinum toxin cannot work. If the conditions for a medication overuse headache exist, a medication break would be necessary. If persistent pain persists, painkillers that are not normally used for migraines, such as a moderately potent opioid, should be used. Very often the situation calms down over time.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Anastasia
      Anastasia
      January 11, 2016 at 12:04 pm

      Pain medication no longer works!

      Hello Prof. Göbel,

      I need your help. The following problem:

      Migraines and tension headaches were 16 years old (now 41 years old).
      No MÜK, triptans used to be effective (Relpax 40 mg + 500 mg naproxen), but triptans have no longer had any effect for about 6 months, tried various different ones and also had no effect on tension headaches with IBU 1,200 mg + 500 mg naproxen.
      What could that be?
      around 6-8 days of medication per month, because you always hope that it might help this time. It's terrible not having emergency medication when you work full-time and are a chronic pain patient.
      Do you have a tip for me?

      And thank you for the opportunity to have this live chat.

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:46 p.m

          Dear Anastasia,

          If, after a previous positive effect, the triptans no longer have any effect at all, even with a rotation of the active ingredients, a very careful general and neurological examination must be carried out. After years of stable headache symptoms, another cause of headache may arise that must be clarified diagnostically. Provided that these investigations show a correct finding, a new preventive treatment should be found that is sufficiently effective and enables triptans to respond again. Your treating doctor can discuss the various options with you and then initiate them accordingly depending on your previous experience. As an alternative to triptans and NSAIDs for severe migraine attacks, Novaminsulfone can also be tried in combination with an anti-nausea medication.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Bavaria
      Bavaria
      January 11, 2016 at 12:04 p.m

      Dear Prof. Göbel,
      I have been taking Amitriptyline retard for prophylaxis for 4 months and have now reached 75 mg.
      I tolerated the Americans well until recently, and migraine days have decreased.
      I now have the following problem: The retard tablets have not been available for some time.
      I now have the “simple” Ami 75mg. Lt. I should tell my neurologist whether I should take it throughout the day or 75 mg in the evening. Spread throughout the day is not possible because of the side effect of tiredness. I took it in the evening, around 6 p.m. Unfortunately, the effect is nowhere near as good as the retard.
      And the following problems also occurred: I get thick, swollen, painful fingers at night - I didn't have them as long as I had the prolonged-release tablets. What do you suggest? Thanks in advance

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:47 p.m

          Dear Bavaria,

          You could try taking 50 mg of amitriptyline in the evening before bed. You could then take an additional 3x10 mg of amitriptyline throughout the day. Then you might have an effect similar to that of prolonged-release amitriptyline.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Heika
      Heika
      January 11, 2016 at 12:05 p.m

      Dear Prof. Göbel,

      My migraine attacks usually last about 48 hours and occur in an approximate ratio of 5:1 between the left and right sides of my head. On the left On the other hand, there are side effects such as sensitivity to light, nausea and vomiting. On the side I “just” have pain. However, on the right On the side the pain is strongest in the entire eye area, radiating from there to the right. Half of my head, and I also have a feeling of pressure in my eye. On both sides the pain increases with physical exertion.

      Unfortunately the pain is the right one.
      Page is virtually unaffected by triptans or NSAIDs, whereas the Allegro on the left works quite reliably (sometimes in combination with naproxen). In the last few years I have had to deal with stubborn episcleritis that lasts for several weeks and is very painful (rheumatoid values ​​are fine, everything is ok from an ophthalmologist). Could it be that this is damaging the nerves of the right? Eyes have become highly sensitive and then “fire”? Like a kind of pain memory that kicks in and no longer responds to pain medication?

      In this case, what options would there be for drug treatment for this re. Page?

      Thank you very much for your efforts here in the live chat and in Headbook in general!

      Kind regards,
      Heika

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:49 p.m

          Dear Heika,

          the pain system is designed on different sides. Similar to handedness (right-handedness, left-handedness), pain is processed and perceived differently on the different sides of the body. It remains to be seen whether the painful episcleritis is related to this. 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. You could use a more effective triptan, such as Zolmitriptan 5 mg or Relpax 80 mg. The additional administration of an NSAID such as naproxen 500 mg and an anti-nausea medication are also conceivable.

          Kind regards
          Hartmut Göbel

    1. Profile picture of MiRi
      MiRi
      January 11, 2016 at 12:05 p.m

      Dear Professor Göbel,

      First of all, thank you very much for your time with us.

      Having been diagnosed with chronic migraine, I suffer from severe migraine attacks lasting two to three days once or twice a month despite various prophylactic measures (currently 50 mg amitriptiline/day and Botox every 3 months after PREEMPT). For me, Imigran Inject usually cannot stop the attacks in the bud, even though I combine it with 500 mg naproxen and 8 mg ondansetron and take it at the first noticeable signs of migraines. My problem and what is particularly stressful for me is the constant vomiting, sometimes just a few minutes apart over a period of 25 to a good 30 hours (by then, of course, my stomach has long since been empty). This vomiting costs me a lot of energy, I also become severely dehydrated during this time because everything I would drink comes out straight away. I find the many vomiting attacks more stressful than the actual pain of the migraine, which I would describe as a level of 5 - 6. Even MCP in or 16mg Ondansetron suppositories don't work for me at all.

      When I go to my neurologist early in the course of an attack to get the drip, the effects of all the medications (including MCP) only last for a few hours, after which the attack comes back in full force. Only towards the end of an attack, when the vomiting has already stopped, does the medicine from the drip help to stop the attack completely.

      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) and I haven't found an effective remedy for the vomiting, I suffer through most attacks without any further medical support. Even another Imigran Inject can only give me a maximum of one hour of rest anyway. Do you have any suggestions as to what else I could try?

      Kind regards
      MiRi

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:51 p.m

          Dear Miri,

          You describe a particularly aggressive form of migraine. Their treatment is very sophisticated and corresponds to the severity of the attacks. Your acute medication is already tailored to the severity of the attacks. The duration of the effect when medication is administered via an infusion corresponds approximately to the idiological duration of action of the active ingredients, so optimization of this therapy is only possible through repeated administration of the medication. With appropriately sophisticated attack therapy, it is therefore important to further optimize preventative treatment. This can then mean that the acute medical treatment responds better, the migraine attacks are not as aggressive and can therefore be stopped more easily. It must be considered what options can be used in addition to the botulinum toxin that has already been carried out. You also need so-called replacement medication in case the acute medication does not initially work. Typically, repeated administration of a triptan, for example, no longer works. Possibilities for replacement medication include Novaminsulfone or Diclofenac.

          Kind regards
          Hartmut Göbel

    1. Profile picture of lacoccinelle
      lacoccinelle
      January 11, 2016 at 12:06 pm

      Dear Prof. Göbel,

      I have been taking topiramate 150 mg since October 2015.
      My pain medication days have reduced from 10 to 5 days a month. Since mid-December, however, in addition to the painkiller days, I have had a slight headache on one side almost every day, which I can bear without medication. In January, however, I already had 6 days of painkillers. Within a month I had to go to the hospital twice and receive IV treatment because the pain was unbearable and the triptan wasn't working. I was doing well with topiramate until the beginning of December, which is why I turned down a visit to Kiel over Christmas, which I regret. Is it time to take a new prophylaxis and stop taking topiramate? Or am I giving up too quickly? The almost daily migraines bother me a lot.

      Thank you very much and best regards
      Stefanie

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 5:59 p.m

          Dear Stefanie,

          Topiramate usually reduces the frequency of attacks rather than the intensity. Therefore, the need for acute medication often cannot be reduced with topiramate. For example, study data on the use of topiramate for chronic migraines show that the frequency of acute medication does not change even as a result of preventative treatment with topiramate. However, since you are at risk of developing a medication overuse headache, other preventative treatment should be considered. In addition, you should not only rely on preventive medication, but also make sufficient use of the various behavioral health therapy measures.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Marlene
      Marlene
      January 11, 2016 at 12:19 p.m

      Dear Prof. Göbel,

      Thank you very much for the opportunity to ask you a question again.
      I have been suffering from complex pain syndrome (chronic migraines, neuropathic pain in the area of ​​the 2nd trigeminal branch, tension-type headaches) for several years.
      After migraine attacks that last for several days and hardly respond to triptans or other pain medications (muk is ruled out), there is increased sensitivity to pain in the head and the intensity of the pain of other types of headaches that recur immediately after the migraine is significantly increased. This quite severe pain then often becomes a new trigger for the next migraine attack. I take amitriptyline as migraine prophylaxis;
      I have tried other prophylaxis (e.g. beta blockers, topiramate, Botox and corresponding recommendations) over the years, so further optimization of migraine prophylaxis is impossible. I consistently adhere to recommended behavioral measures (e.g. relaxation procedures). My pain therapist suggests trying to alleviate the migraine headaches by taking a daily sustained-release opioid so that they can no longer become a migraine trigger.
      Taking Lyrica, gabapentin and carbamazepine did not reduce the pain. My question to you would now be whether sustained-release opioids could be helpful in this case, especially in the pain-sensitive phase immediately after the migraine, in order to improve my overall situation.

      Thank you for your effort and best wishes to the entire team.
      Marlene

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:00 p.m

          Dear Marlene,

          The use of sustained-release opioids for migraine prophylaxis cannot be proven by scientific studies. No effect is expected. In my opinion, this would essentially only result in side effects from the opioid, but there would be no effect. In individual cases, there are very aggressive forms of migraine that respond only with great difficulty or not at all to standard preventive measures. Inpatient pain therapy should be considered in this situation. A wide variety of therapeutic methods, even if they are already known, can be optimized and used in combination.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Jenny
      Jenny
      January 11, 2016 at 12:23 pm

      Dear Prof. Göbel,

      1. I have a question about the 10/20 rule.
      Can one deviate from the rule that a treated day begins at midnight and count the days from the start of the intake + 24 hours as one day? Is it just about the 24-hour interval or is there another reason for the count? 2. Can a migraine attack that has been successfully treated return as a recurring headache after, for example, 48 hours or is it always a new attack if it lasts more than 24 hours?

      Thank you!
      You are the only doctor I know who is so knowledgeable and offers this great range of questions! Jenny

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:02 p.m

          Dear Jenny,

          The 10-20 rule essentially means that you don't take a triptan at least 20 days a month. This prevents the sensitization of the nervous system and the development of medication overuse headaches. How you then draw the line on the other 10 days is relatively free. The question of whether, after a headache returns after an initial good effect within 48 hours, this can be considered a recurring headache depends on the definition. If one assumes that a migraine attack lasts up to 72 hours, a headache that returns after 48 hours is still the initial attack with recurrence of the headache. This may be defined differently in studies.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Waldi
      Waldi
      January 11, 2016 at 12:30 p.m

      Dear Prof. Göbel,

      First of all, thank you very much for the book “Successful against headaches and migraines”, it helped me a lot to find my way through the many options and various therapeutic advice. In addition to autogenic training and mental relaxation, I had now concentrated primarily on progressive muscle relaxation according to Jacobsen as a relaxation method. Especially with PME, I come down noticeably quickly and well after a day at work.

      Now I have sought medical support again because my symptoms - migraines and tension-type headaches - which sometimes occur individually or sometimes together, have worsened. I have problems with neck tension and a constant feeling of pressure and pain at the back of the head (hairline above the neck), which always leads to headaches/migraines at some point.

      The new doctor, who I found through the list of headache experts (Pain Clinic Kiel) in my area, now says roughly the following:
      - PME would no longer be recommended today; if you have tension it would be absolutely the wrong thing, as you cannot specifically control tension and would therefore worsen the existing tension and problems with the cervical spine.
      QiGong would now be offered and recommended. – Strength training is totally wrong for the same reasons.
      I have been doing health-oriented strength training on machines here for years and have achieved good and lasting success with back and lumbar spine problems. However, I haven't been able to get my neck problems under control here yet. – I should only use techniques with flowing movements, such as QiGong, and go jogging and swimming, for example.

      What is your professional opinion on this and should I follow the doctor's advice and skip PME and strength training?

      Thank you for your commitment and best regards
      Waldi

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:05 p.m

          Dear Waldi,

          progressive muscle relaxation is still recommended. Studies have shown it to be the most effective relaxation method. However, there are patients who do better with one method than the other. Doctors also have different preferences depending on their level of experience. Relaxation techniques with flowing movements such as Qi Gong, jogging and swimming are also highly recommended. Here, too, you should follow your personal inclinations and prefer what is most fun. From our point of view, it should also be confirmed that strength training is not suitable for migraine prevention. On the contrary, it can often worsen migraines.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Emma
      Emma
      January 11, 2016 at 12:35 pm

      Dear Professor Göbel,

      Due to progressive hemifascial microsomia (increasing difficulty swallowing and breathing, formation of a wide gap in the skull), I am scheduled to undergo distraction osteogenesis of the upper and lower jaw.
      However, since I suffer from chronic, treatment-refractory cluster headaches (currently without prophylaxis), I am very worried about whether such a facial operation would lead to a further aggravation of the cluster. Unfortunately, no one has been able to tell me anything about it yet. Do you think such a deterioration could be expected?

      Thanks in advance,

      Emma

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:06 p.m

          Dear Emma,

          In our experience, surgery does not make cluster headaches worse. In my opinion, such concerns are unfounded.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Giotto
      Giotto
      January 11, 2016 at 12:36 pm

      Dear Prof. Göbel,

      I took topiramate for 4 months, building up to 0.25 to 100 mg.
      I had to stop taking it because of severe side effects, especially tingling in the head and face. However, my attacks have decreased.

      I take Sumatriptan 50mg, and ½ a tablet, i.e. 25mg, has helped me over the years. I always stay below 10 income per month.

      Because of this low use, I thought I might be given a smaller amount of topiramate, perhaps 50 mg. would help.

      Do you think it makes sense to try this?

      Many many thanks

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:13 p.m

          Dear Giotto,

          There are patients who respond adequately to 50 mg topiramate. Even 25 mg can be effective. You have to try this individually.

          Kind regards
          Hartmut Göbel

    1. Profile picture of ute d.
      ute d.
      January 11, 2016 at 12:38 p.m

      Hello Prof. Göbel,

      I am considering taking part in a study in which I will receive an electrical device for weeks with which I can briefly stimulate the vagus nerve every day. So far they have probably only had experience with cluster headaches and now want to test it for migraines, which I have. Have you heard of it and what is your opinion on the benefits and effects of this method?

      Thank you very much and best regards

      Ute

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:11 p.m

          Dear Ute,

          The effect of transcutaneous vagus nerve stimulation has not yet been adequately proven by study data. The procedure is very well tolerated and if it is used as part of a scientific study, you can gain your own experience.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Peppi
      Peppi
      January 11, 2016 at 12:39 p.m

      Dear Prof. Göbel,
      thank you very much for the time you took to answer the questions.
      I went to the Kiel pain clinic in the fall and was diagnosed with tension headaches and chronic migraines.
      Set with 50 mg topiramate (was reduced at my request after 9 years due to side effects), 100 mg opipramol, 600 mg magnesium. Hormone Desogestrel continuously due to 7-day Status Migranosus during menstruation. Botox treatment at the beginning of November 2015 in Kiel. Since the end of October I have been on a break from painkillers (prednisone suppositories as an emergency medication), but I have not been relieved of pain.
      In November I had 12 migraine days, December 15, January 6. There is no sign of improvement or even 3 tension headache-free days in a row.
      Constantly enduring the pain costs me a lot of strength.
      How long do you think the painkiller pause should continue? When can improvement be expected? Maybe with the 2nd Botox treatment in February? Kind regards,
      SR

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:14 p.m

          Dear Peppi,

          The treatment of chronic migraines aims to reduce the number of migraine days. This is not always possible quickly, especially with chronic migraines. Therefore, you have to proceed consistently. The various options that you use show that a single measure cannot achieve sufficient effect. Therefore, you have to be consistent and persistent when planning the timing of the treatment. The good thing is that there is no constant headache. If the break from painkillers has been carried out consistently, this is usually prognostically favorable, ie the probability of a long-term effect can be increased. Repeating treatment with botulinum toxin also increases the chance of long-term improvement.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Lora
      Lora
      January 11, 2016 at 12:41 pm

      Dear Prof. Göbel,

      I have been diagnosed with migraines for about a year.
      I am currently taking 75 mg topiramate a day as prophylaxis (for 1 month). I have headaches on average 23 days per month. Acute medication for a maximum of 7 days (no MÜK). Amitriptyline and duloxetine as prophylaxis were unsuccessful.

      I feel like the migraine is always there, just mild.
      As soon as I become physically active it gets progressively worse. Going for a walk, swimming, doing something with children, fitness... everything is 100% triggering. The headache comes during the activity. My quality of life is 0. I fear that I will soon be unable to work.

      All blood values ​​are ok, blood pressure – ok. Only my pulse is slightly elevated (approx. 90) and blood sugar is at the minimum (approx. 76 even when I eat breakfast).

      What could you do there? Which approaches?

      Thank you very much for the reply!
      Larysa

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:20 p.m

          Dear Lora,

          The description of the migraine progression suggests the existence of chronic migraine. If not already used, treatment with botulinum toxin should be considered. If tolerated, high doses of topiramate can also be used. You should also discuss with your doctor whether inpatient treatment in a headache center should be carried out to implement multimodal pain therapy.

          Kind regards
          Hartmut Göbel

    1. Profile picture of sikol
      sikol
      January 11, 2016 at 12:43 pm

      Hello Dr. Göbel,

      After the treatment in March 2015 in Kiel, my migraines are quite well under control.
      I'm very well adjusted to medication and only have about 5-7 pain days a month. Recently, however, I have had a severe pain in my right eye (when I read for a long time), the eye becomes completely red (like conjunctivitis) and watery, this lasts for about half an hour, sometimes with blurred vision and then I have over the a severe pain in the right eye, dull and stabbing!
      I don't think it's an aura, I know otherwise, it doesn't seem like the familiar migraine pain to me. To deal with the pain I usually just took an ibu plug and it helped relatively well. I didn't want to take a triptant because I can't classify it as a migraine. What could this be, is this perhaps some kind of cluster headache? I would be very grateful for an answer. Kind regards Sibylle Kolm

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:21 p.m

          Dear Sikol,

          First, have yourself examined by an ophthalmologist. In fact, your description is reminiscent of the possible development of a cluster headache. Therefore, monitor the symptoms closely and document them in a pain calendar. A current neurological examination is also required.

          Kind regards
          Hartmut Göbel

            • Profile picture of sikol
              sikol
              January 11, 2016 at 7:50 p.m

              Thank you for your feedback, I have already seen an ophthalmologist, pressure inside the eyes is normal, optic nerves are also fine.

              And I have a neurological appointment in the next two weeks.

              Wish you and your team all the best, I'll keep you posted in the next chat :)

              Kind regards
              Sibylle Kolm

    1. Profile picture of augenstern
      augenstern
      January 11, 2016 at 12:43 p.m

      Dear Prof. Göbel,
      thank you very much for taking the time again today to answer our questions!

      I have been suffering from migraines with aura for many years.
      During an attack and for some time afterwards, I observed that the side of the face affected by the migraine, in my case usually the left side, was noticeably swollen and was also very sensitive to pain and touch. A dark spot often forms under the eye. Is it possible that there is a connection with migraines? Since I also suffer from rheumatism (RA), my jaw joint is often inflamed, but this swelling looks different and the pain is also different.
      While with migraines the entire area of ​​the face from the temple below the eye to the chin is swollen, with the jaw joint it is more localized and also red and hot. Cooling helps in both cases, as does cortisone shock therapy. Is it possible that migraines cause such swelling?
      I would like to thank you very much in advance for your answer!
      Kind regards,
      Augenstern

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:22 p.m

          Dear star of eyes,

          The symptoms you describe can also occur as part of a migraine attack. Eyelid swelling, excessive pain and sensitivity to touch are also common with a migraine. The migraine can also lead to corresponding swelling.

          Kind regards
          Hartmut Göbel

    1. Profile picture of ivitho
      ivitho
      January 11, 2016 at 12:54 pm

      Dear Prof. Dr. Göbel,

      my new! The neurologist prescribed me Levetiracetam as a migraine prophylactic, pointing out that it can lead to increased growth of cysts/fibroids, but on the other hand it would not lead to weight gain, which is also crucial for me.

      I had clearly pointed out to him my adenomyosis disease after his comment about the medication.

      1. Can I take the medication from my gynecologist? Take it without hesitation if you have a pre-existing condition?

      2. Is Levetiracetam even used as a migraine prophylactic?

      3. Does it actually not cause weight gain? I keep reading the opposite.

      Thank you very much for your information.

      Greetings from Flensburg!

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:23 p.m

          Dear Ivitho,

          You can never take medication without hesitation. If all other guideline-based preventative medications are ineffective, levetiracetam can be used experimentally. However, the effect cannot be predicted. The drug is not expected to interfere with adenomyosis. Both weight gain and weight loss have been described as side effects.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Margit44
      Margit44
      January 11, 2016 at 12:56 p.m

      Dear Prof. Göbel,
      I am almost 72 years old and have been battling migraines for 25 years.
      Now my pain doctor at the Institute of Microecology has found that histamine levels in the blood are significantly too high and there are extensive deficiencies in important substances.
      Since I've been living this way, I've never had these bad migraine headaches again (for 2 months, previously 2-3 times a month), although I still had the other migraine symptoms (nausea, cramps in the legs, etc.) every week.
      Can you take triptans without a headache?
      My neurologist never recommended prophylaxis to me, I am now starting with topiramate and bisohexal. I thank you in advance for your understanding.
      Margaret
      .

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:25 p.m

          Dear Margit,

          The histamine level and an extensive lack of important substances are considered by some institutions to trigger migraines. Scientific studies do not provide sufficient evidence of this. Many influencing factors can be responsible if the migraine condition changes after a corresponding change in treatment. Age also leads to a change in migraines, especially after the age of 70. It is absolutely true that if you have a migraine, you should first use the proven and guideline-based therapies before trying out experimental options, which are often very expensive for the individual. You should therefore consider having one of the proven forms of therapy shown to you and using it systematically.

          Kind regards
          Hartmut Göbel

        • Profile picture of Margit44
          Margit44
          January 11, 2016 at 7:02 p.m

          Dear Prof.,
          since I am also disabled, I don't have many options to change doctors.
          I got along fairly well with Maxalt.
          But my question was whether you should take the triptans without a headache or whether something else is recommended.
          Kind regards,
          Margit
          Botox was rejected because of the eyes.

            • Profile picture of Bettina Frank - presenter
              Bettina Frank – presenter
              January 11, 2016 at 9:51 p.m

              Dear Margit, don't take a triptan if you don't have a headache.
              In addition, it is not said that these symptoms can be attributed to migraines at all. Good luck with the prophylaxis! Kind regards,
              Bettina

    1. Profile picture of Francesca
      Francesca
      January 11, 2016 at 1:05 pm

      Hello Professor Göbels,
      first of all I would like to thank you for giving us the opportunity to describe our problems and for helping us using the chat! I am almost 20 years old. I work in the office and sit almost all day. I have been suffering from very frequent and severe headaches for 2 years. This pain starts from the neck, goes up to the forehead and goes down to the eye. It usually affects the right and sometimes the left side of the forehead. My orthopedist has already adjusted me twice and diagnosed cervical vertebra syndrome and a slight curvature of the spine. Afterwards I did physiotherapy and I often do exercises at home too. This is usually very good. I've already had a magnetic resonance imaging, a neurological examination, but nothing was detected. I know that I suffer from neck tension, but sometimes I really despair because the pain is so severe. These appear very strongly 2-3 days a week, but I feel the slight pain almost every day. In the worst case scenario, I always take a Thomapryin. These usually help. When I feel like I need exercise, I do exercises at home. A warm neck pillow also relaxes my neck. Unfortunately I live in Stuttgart and therefore don't have the opportunity to come to you in Kiel, but I will go to a headache clinic in Munich. I really hope that a solution can be found soon... It's depressing to have such problems at the age of 20... I would be very happy to receive an answer from you.

      Thank you and best regards
      Francesca

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:26 p.m

          Dear Franzesca,

          Migraine is a disease in itself and it is a good idea to go to a specialized facility to have specific treatment developed. Changes in the cervical spine and neck tension are not considered to be the cause of migraines. Rather, they are consequences. What is crucial is that migraine must be viewed as a primary disease that also requires special treatment methods.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Xandrian
      Xandrian
      January 11, 2016 at 1:06 pm

      Hello Prof. Dr. Göbel,

      Thank you again for the chat. My migraine attacks have been increasing in frequency and severity for about two or three years. Recently I had up to ten attacks a month, some of which lasted several days. Previously, I was feeling relatively well for a long time on medication of 100 mg topiramate/day (max. two attacks per month).

      Increasing the dosage to 150 mg topiramate/day did not bring about any change. Increasing 40 mg of Dociton to 100 mg of topiramate was also unsuccessful (Docition causes severe fatigue and depressive moods as side effects for me). For this reason it was canceled again.

      I've been in the process of stopping the topiramate since mid-December and will be finished here at the end of January. So far there have been no changes regarding the seizures. In December my neurologist said I should taper off topiramate and then try it for four weeks without it.

      My fear now is that there will be no improvement once the topiramate is stopped or is then used again. Calcium antagonists have been tried before and had depression as a side effect.

      Are there any other options here? Many thanks and best regards

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:28 p.m

          Dear Xandrian,

          From your descriptions I understand that treatment with topiramate brought about an improvement, at least temporarily. However, you reach your tolerance limit. One option would be to leave topiramate at a medium dosage (e.g. 75-100 mg). At the same time, a tricyclic antidepressant such as amitriptyline or doxepin could be used. On the one hand, this could improve the effect, but on the other hand it could also prevent the development of depressive moods.

          Kind regards
          Hartmut Göbel

    1. Profile picture of belting
      belting
      January 11, 2016 at 1:08 pm

      Dear Prof. Göbel,
      what do you think of the Cephlas procedure for migraines?

      (regardless of the price and whether there are scientific studies for it or not)
      Would that be worth a try?
      What is your opinion on this?
      (In fact, my migraines are essentially concentrated in my eyes)

      http://www.augenklinikhoeh.de/cephlas-verfahren/
      https://www.youtube.com/watch?v=XKYCR5wRbn0

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 6:29 p.m

          Dear Belting,

          The procedure you mentioned has not been scientifically proven to be effective and is therefore not generally recommended.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Gerd
      Gerd
      January 11, 2016 at 1:14 p.m

      Hello to Kiel,

      I was treated by you 2 years ago. I have had the following complaints since the end of December:

      Since I worked until December 23rd and only then took my vacation, I got a migraine attack on Christmas Day.
      I can definitely imagine that it was some kind of weekend migraine. The day before New Year's Eve the following happened: I got a stabbing on the left side of my heart, shortness of breath and immediately my severe migraines started in my neck. The day before yesterday I also felt the stinging in the heart area and the short breathing before going to bed. I had a migraine at night. An EKG and stress EKG said everything was OK.
      What could this be and what should I do? About me: A lot of work professionally and politically.

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:24 p.m

          Dear Gerd,

          It was very important that you had a thorough cardiological examination. One possibility for your description is the so-called cardiac migraine. This causes similar symptoms to those you describe. This form is not included in the international headache classification. however, it is well known in the literature. Many patients also know that they develop chest tightness and chest pain during a migraine, which is often attributed to triptan use. This can also be this corresponding sub-form.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Chrismo
      Chrismo
      January 11, 2016 at 1:16 pm

      Dear Professor Göbel,
      I take 1 Naproxen 500 and one Almogran tablet when the migraine starts.
      When this doesn't help, I often have severe migraine headaches with vomiting for 2.5 days. My question: Can I take Ascotop nasally after 12 hours at the earliest, since this is a different triptan and which triptan can I then take additionally if the headache occurs again?
      Thank you very much and kind regards
      Christiane

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:26 p.m

          Dear Christiane,

          The general rule is that you should not mix triptans within the same seizure. The interactions between the individual substances have not been investigated and therefore this combined intake is not recommended. If the triptan helps initially and the headache comes back, taking the same triptan repeatedly will also help. Therefore there is actually no reason to change the triptan. However, if the initial administration of the triptan does not help, a so-called replacement medication should be taken. However, this should come from a different class of substances, e.g. Novaminsulfone or Diclofenac.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Peter
      Peter
      January 11, 2016 at 1:24 pm

      Good afternoon, Dr. Göbel,

      I would also like to thank you for this online offer for patient questions.

      I am 35 and have had chronic headaches for 20 years (mostly tension headaches including the eyes, but sometimes also one-sided, pulsating, typical of migraines). For 7 years now my medication has consisted of amitriptyline (1x, 10mg to 25mg) and, if necessary, 1x 600mg ibuprofen (up to 10x a month, but not more often). Finally, I received the prescriptions from my family doctor.

      My questions:
      – can you take amitriptyline indefinitely if indicated, or should you stop or change the medication after a few months or years?
      – my last ultrasound showed a clear fatty liver (but blood values ​​were OK), the pancreas also had more homogeneous days.
      How do you assess my medication in this regard - are the amounts of amitriptyline and ibuprofen (see above) questionable for these organs, or am I in a good range here? - what's the deal with naproxen... Even after visiting 4-5 special pain therapists and staying in a day hospital, I've never been informed about this, but only read about it in forums or here in the chat. Would this be a “harmless” alternative to ibuprofen?

      One of my biggest problems is not just the pain, but the guilty conscience I always have when I take something. That's why I often take it too late. My questions therefore go along the lines of whether I shouldn't just take it as a gift that I'm doing quite well with relatively manageable medication :).

      Thank you in advance!
      Peter

      PS: I should also mention: I eat a moderately healthy diet, weigh medium weight and hardly do any exercise - but in the last few days I have been doing more and more often :).

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:31 p.m

          Dear Peter,

          There is no time limit for taking amitriptyline. In fact, many patients take this medication for several years because they are often justifiably worried that their migraines will recur. A change is not necessary. However, you should check your liver values ​​regularly.

          If the liver values ​​are normal, there is generally no need to change the intake of amitriptyline or ibuprofen. Many people have a fatty liver, but if the metabolic situation is sufficient, the effective medication does not need to be changed. Naproxen has the special property that it is effective for up to 12 hours. Ibuprofen, on the other hand, only works for about 3 hours. Since a migraine attack lasts 2-3 days, you would theoretically have to take ibuprofen every 3-4 hours to have sufficient effect. This is completely impractical. On the other hand, naproxen doesn't help that much initially. Therefore it is combined with a triptan. This then practically initiates the effect against the migraine attack, and naproxen then takes over the sustainability of the acute therapy. In some countries (USA), naproxen is therefore firmly combined with the triptan in a capsule.

          It's always surprising that migraine sufferers are afraid of a medication that helps them. Likewise, they feel guilty about taking something that helps them. This has to do with the old prejudices against migraines. On the one hand, you think that a drug that can eliminate such a severe pain problem that causes severe discomfort must somehow be “very strong.” However, the opposite is the case, it intervenes precisely in the mechanism of migraines and can therefore achieve a high degree of effectiveness with little effect. On the other hand, previous migraine medications that were effective had very serious side effects. This still depends on today's migraine medications, combined with the prejudices against the disease itself. However, migraine is the enemy, not the therapy.

          Kind regards
          Hartmut Göbel

            • Profile picture of Peter
              Peter
              January 11, 2016 at 7:55 pm

              Dear Dr. Göbel,

              I would like to thank you very much for your answer, which, like many others today, helps me online and in a very real way. Regarding amitriptyline, liver and naproxen, everything has now been answered for me. And you are absolutely right about the fearful image of therapy. There is always a “co-dependence” of the entire family, which makes it clear to you with every attack and every intake how bad it is and that you shouldn't take something so often...

              A small question: Since you are primarily talking about migraines and migraine medications: I assume your answer (as far as the acceptable frequency <10x and the positive image of the therapy is concerned) also includes tension headaches and their medication (ibuprofen)?

              I wish you a relaxing evening later and send kind regards from the Electoral Palatinate
              Peter

                • Profile picture of Bettina Frank - presenter
                  Bettina Frank – presenter
                  January 11, 2016 at 9:55 p.m

                  Yes, this also includes the treatment of tension headaches.
                  All within the 10/20 rule, of course. Kind regards,
                  Bettina

    1. Profile picture of michaela
      michaela
      January 11, 2016 at 1:29 pm

      Hello Prof. Dr. Göbel,

      I have been suffering from chronic tension headaches for 12 years and have extreme neck and shoulder tension, especially from working on the computer.
      Neither therapy with tablets such as Saroten (150mg), nor physiotherapy, osteopathy, massages or Botox injections could relieve me of my constant headache or at least 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 no longer had to be present and that I had to learn to live with it. I rule out MÜK because I always followed the max. 10 tablets/month rule. In November 2014 I received an acupuncture treatment with massage (12x) from a Chinese medical team and was virtually pain-free for almost 4 months - after about 10 years of constant headaches!
      Then the pain unfortunately came back more and more frequently and became chronic again within a month. In November 2015 I received 12 treatments again from the team from China and the pain is about 70-80% better again. I've just had 2.5 weeks without a headache, which is still a miracle for me. Since these successes, I have great hope that the pain can be cured and that I can still hope for an almost pain-free life. How do you see that? Can chronic tension headaches still be cured after such a long time or can they really just be caused by tension?

      Thank you for your assessment!

      Kind regards

      Michaela

        • Profile picture of Francesca
          Francesca
          January 11, 2016 at 2:56 pm

          Hello Michaela,

          unfortunately I have exactly the same problem! Only I didn't do any Chinese therapy but rather a few osteopathic treatments. But all this only helps for a while and then the vicious circle starts again...

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:32 p.m

          Dear Michaela,

          Even chronic pain disorders and difficult aggressive courses can improve significantly after many years and sometimes resolve themselves happily. Surrendering to the pain is never an option. This doesn't make him any better; on the contrary, with this attitude you can no longer participate in life and many complications arise. There are many procedures that can help. Sometimes you have to find your own individual path that isn't effective for others. I wish you much success.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Lilli 13
      Lilli 13
      January 11, 2016 at 1:36 p.m

      Dear Professor Göbel,

      Our son is 14 years old and has been suffering from migraines since 2012. At the beginning of 2014 you diagnosed chronic migraines, at that time he had constant headaches.
      He now has about 11 migraine days per month with flunarizine as prophylaxis. Between the relatively clear attacks, our son usually only has a slight headache in the morning, which then gets worse over the course of the day, so that after 4 or 5 p.m. he usually just wants to withdraw and rest. These headaches are milder in all symptoms than clear migraine attacks, but otherwise do not differ clearly from them. Exercise also increases these headaches. Days when our son is really fit and resilient are very rare. Do you have an explanation for why he only has such limited resilience 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. So in addition to the attack days, when everything is canceled for him because no acute medication is effective, he only has school and homework on these days. I'm also worried that lying or sitting a lot will make the attacks more frequent in the long run.

      Thank you very much for your effort.

      Kind regards,
      Lilli 13

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:34 p.m

          Dear Lilli,

          Your descriptions could indicate that the migraines are still quite aggressive and are taking up a lot of your son's energy. It is hoped that further improvement will occur over time. A change in therapy can also be considered. Activity and balance are generally welcomed. However, if your son is affected by the migraine, he should be able to retreat and rest.

          Kind regards
          Hartmut Göbel

            • Profile picture of Lilli 13
              Lilli 13
              January 11, 2016 at 8:09 p.m

              Dear Professor Göbel,

              Thanks for your advice. Do I understand you correctly that you also classify the headaches between distinct attacks as migraines? I'm always worried that we're misjudging it and that's why we haven't gotten a better handle on it yet.

              Kind regards,
              Lilli 13

                • Profile picture of Bettina Frank - presenter
                  Bettina Frank – presenter
                  January 11, 2016 at 9:59 p.m

                  Yes, that's how it should be understood, dear Lilli.
                  These are probably also migraine attacks, which is why he should rest if he is exhausted. Despite everything, a good middle ground must be found here so that he doesn't miss out on life and become depressed. Kind regards,
                  Bettina

    1. Profile picture of Linda
      Linda
      January 11, 2016 at 1:43 pm

      Hello Professor Göbel,
      I have had migraines and tension headaches since I was 16, very severe and without prophylaxis 2-3 times a week.:-( The migraine can last up to 3 days if the acute medication does not work. I have been taking stangyl and valproic acid for 3 years. Because of the valporate, migraines are very rare and rather mild in comparison. I take acute superpep travel chewing gum and naproxen 750mg. Now I often have pain behind both or one (more one-sided) eye and the front of the forehead and this is difficult to treat. Do you think it's more like a tension headache or migraine and do you have any tips on what I could take acutely? Accompanying symptoms include nausea and sometimes dizziness.

      Kind regards, Linda S.

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:35 p.m

          Dear Linda,

          You have used prevention in a very differentiated manner; it seems to stabilize your migraines well. Acute medication, on the other hand, may not be effective enough. Discuss with your doctor whether the use of a triptan can be considered for you. Based on your descriptions and the location of the pain, it appears to be migraine attacks. However, this can only be clarified through a thorough investigation and questioning.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Linda
      Linda
      January 11, 2016 at 1:54 pm

      Dear Professor Göbel, unfortunately I forgot a question in my post.
      Is it bad if you get past 10 days in just one month? I accepted it well last year. Only in December there were 12 days. Is that just bad? I only took naproxen and no triptan. Unfortunately sinusitis made everything worse :-( Thank you Linda S.

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:36 p.m

          Dear Linda,

          It's not bad if you only exceed the 10-day limit in one month. If you then go back to a correspondingly smaller number the next month, this will even out. What is problematic, however, is the development that shows a continuous increase in the number of days taken over the past few months, e.g. 7, 8, 12, 14, 16, etc. It must then be assumed that an increase in recurrences is occurring and that an MOC has developed .

          Kind regards
          Hartmut Göbel

    1. Profile picture of su
      see
      January 11, 2016 at 1:57 p.m

      Dear Prof. Göbel,
      I have had chronic migraines for 30 years and take around 8-10 triptans a month.
      I have tried many prophylactics. I've been trying Candesartan 8mg for a few months. At first I seemed to have great success (pain-free for 8 weeks in a row). Unfortunately the normal state (about 10 triptans) has returned. Is there an explanation for this? Could a removed amalgam filling be the reason? Thank you very much and kind regards
      Su

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:54 p.m

          Dear Su,

          Migraines can vary greatly from time to time in terms of frequency of occurrence. Removing the amalgam fillings is probably not the reason. Very often, after switching to preventive treatment, there is initially a significant improvement. Unfortunately, after the so-called “therapeutic honeymoon” is over, everyday life is back and the migraines return with their usual frequency. Here, too, you can see that it is not necessarily the drug that acts as an active ingredient, but other variables such as expectations, hopes, etc. are much more important. This does not mean that an effect is “imaginary”. Rather, it shows how complex the process of pain is and that psychological as well as social mechanisms and evaluations can directly modulate the process of pain.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Kitty85
      Kitty85
      January 11, 2016 at 1:59 pm

      Dear Professor Göbel,

      I was a patient at your clinic 5 years ago.
      The diagnosis at that time was chronic tension-type headache and migraine without aura. I wasn't taking triptans at the time and started taking them after my stay, which has significantly improved my quality of life as I can now finally stop attacks effectively. Several prophylactic treatments followed, currently metoprolol 50mg, moderately successful.
      Longer pain-free intervals are often followed by several weeks in a row with almost daily migraines. Anyway, I'm now planning a pregnancy.
      My neurologist recommends continuing to take metoprolol. Because of a (mild) anxiety disorder, I take citalopram and am supposed to replace it with St. John's wort after tapering off until I become pregnant. How do you feel about taking metoprolol during pregnancy?
      I would also like to be prepared with a plan in case attacks occur during pregnancy. My neurologist leaves the decision about attack treatment entirely to the gynecologist, which means I couldn't clarify any treatment options for an emergency with him. But I'm afraid that my gynecologist will forbid taking migraine medication by default or will switch to paracetamol, which shouldn't be taken anymore and won't help in the event of an attack with severe vomiting. Do you have any tips on what acute medication I can suggest? Would a letter from my neurologist about the severity of my migraines make sense?

      Thank you for your time and advice!

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:55 p.m

          Dear Kitty,

          You address a very complex topic that I cannot answer fully in the live chat. The basic rule is that if you have a planned and existing pregnancy, you should avoid any medication that is not absolutely necessary. This also applies to metoprolol. The same applies to citalopram. A pregnancy is “limited” in time. A lot changes in the body. A migraine can improve significantly. If the course allows it and the aggressive form of migraine is not too severe, we usually recommend stopping the preventative treatment completely. Accompanying treatment with magnesium as well as physical protection and intensification of the behavioral medicine preventive program should always be taken into account. We do not recommend paracetamol due to the high risks during pregnancy for the unborn child. It is also very weakly effective and may not intervene adequately in severe migraine attacks. You can get through mild migraine attacks without paracetamol. Giving ibuprofen would be an option. For very severe migraine attacks, sumatriptan may also be considered.

          All the best and kind regards
          Hartmut Göbel

    1. Profile picture of Julia
      Julia
      January 11, 2016 at 2:17 pm

      I'm 22 and have had migraines for 10 years. Suffer 3 times a week. I've now completed all migraine prophylaxis, do sports, autogenic training and maintain my structure. Nothing works. At the moment I am taking 150mg venlafaxine and 8mg candesartan. My hands have been shaking for several weeks and my body (legs and arms) is twitching. Could this be a side effect? Do you have any other advice for me?

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:56 p.m

          Dear Julia,

          You describe a very severe form of migraine. It's not easy to say that everything doesn't work. You wouldn't know what would happen if you didn't do treatment. The side effects you describe can be attributed to venlafaxine, but this cannot be said with certainty. Read about the preventive treatment here on Headbook. Further information can also be found at https://schreinklinik.de . You will find a lot of advice there about what you could do. However, always remember that there is hardly any method that allows you to live as you want. Migraine is a lifelong peculiarity of the nervous system that is genetically determined. You have to adapt to it, unfortunately it's not possible to shake it off.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Bettina
      bettina
      January 11, 2016 at 2:55 p.m

      Dear Prof. Dr.
      Göbel, I was in your clinic about 4 years ago and you gave me Concor and Doxepin back then.
      It helped until 2 months ago. I only had about 4-6 attacks a month instead of the 15 attacks I used to have. But now I've had migraines again almost every day for 2 months.
      However, I've also been having severe hot flashes from menopause for the past 2 months and I'm sure it's related to that. What would you recommend for me now, especially for the hot flashes and hormone deficiency.
      But I can no longer take hormones. Take time sage for hot flashes. But what remedies would you recommend for the migraines that are probably caused by the hormonal fluctuations? I would be very grateful for a tip, I'll try everything.
      Thank you in advance for your advice.
      Many greetings,
      Bettina

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 7:58 p.m

          Dear Bettina,

          many possibilities may be relevant to explain the escalation of your migraine now acutely. The question that arises: Do you also take acute medication every day, so has a medication overuse headache possibly arisen? Regardless, consideration should be given to how preventative treatment can be adjusted. Hormone treatments are not effective in prevention. You should therefore come back to the specialized pain consultation and consider a new appointment.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Wilhelm Westermann
      Wilhelm Westermann
      January 11, 2016 at 3:20 p.m

      Dear Professor Göbel,

      I have suffered from chronic migraines since my youth, which have become increasingly severe as I get older, now 74.
      After I went to your pain clinic almost exactly 4 years ago and then took an 8-week break from medication, I only had to take painkillers once a month for the first year because the attacks had become less frequent and much more harmless. I'm pretty sure previous use of triptans up to 8 times a month resulted in overuse KS. In the following years the need has increased again, although I have so far avoided triptans as much as possible (about once a month). Now I'm back at the border. In November and December I had headaches on average every other day, half migraines and half tension headaches. On average this year I had 5.6 tablet days with a maximum of 7 tablet days per month. I had to endure a few days of severe headaches and vomiting. Is it possible that an eight-week break from tablets would help me again? Thank you in advance and kind regards,
      your still very grateful patient
      Wilhelm Westermann

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:00 p.m

          Dear Mr. Westermann,

          The frequency of migraine days depends on the frequency of use in the last 3 months. An annual average cannot well explain the increase in frequency. If it is the case that you have had to take increasingly more triptans or acute medications in the last 3 months and have reached the 10 limit, it is probably a good idea to take another medication break. If in doubt, this should happen anyway.

          Kind regards
          Hartmut Göbel

    1. Profile picture of lily
      lily
      January 11, 2016 at 3:21 pm

      Hello Professor Göbel,
      for 23 years I have had menstrual migraines 3 days during ovulation and 5-7 days before and after my period.
      Since the triptans no longer work properly, or the attacks become longer, despite modern triptans such as Relpax or Formigran, I would now consider prophylaxis. What prophylaxis can you recommend for very low blood pressure, insulin resistance and Hashimoto's?
      I don't want to gain any more weight and I've been testing various weight loss pills for years with no improvement! Can I take 2 pieces of Naramig 2.5 mg each at once, otherwise the over-the-counter ones don't work at all.
      Thank you and have a nice evening !

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:02 p.m

          Dear lily,

          You describe a menstrual-related migraine. If no other migraine attacks occur, you could try short-term prophylaxis within the 10 “allowed” days of use per month. You then take Naramig 2.5 mg, for example, one day before the expected menstruation. You can also take this in combination with Naproxen 500 mg. Studies have shown that 5 mg of Naramig works significantly better than 2.5 mg. Unfortunately, there is only Naramig 2.5 mg available in Germany. However, you can fix this by just taking 2 tablets. If short-term prophylaxis does not work, individual preventive treatment can be continuously considered. This can be initiated according to the guidelines, primarily with a beta blocker, e.g. metoprolol or bisoprolol.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Biggie
      Biggie
      January 11, 2016 at 3:28 pm

      Dear Mr.Prof.Göbl,
      first of all, thank you very much for your time!!
      As a migraine sufferer for many years, I was now diagnosed with a massive deficiency in vitamin B 9 folic acid and a slight deficiency in B12.
      I've been substituting for 3 weeks and my migraines have significantly reduced. My depressive moods and listlessness are the same. Is a connection possible?
      Or coincidence? Thanks for your answer.
      Greetings Biggie

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:03 p.m

          Dear Biggie,

          It is entirely possible that your migraines are linked to the massive deficiency of B vitamins. These vitamins are responsible for many functions in the body, especially the energy turnover in the nerve cells. However, it is important to find out how the massive deficit came about. To do this, you should have a thorough internal examination. However, it should not be concluded from this answer that migraines are fundamentally associated with a corresponding vitamin deficiency.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Robert
      Robert
      January 11, 2016 at 4:01 pm

      Dear Mr Göbel,

      Thank you in advance for the opportunity to ask you questions here.

      I have had chronic tension-type headaches for 3 years and went to the Kassel pain center two years ago and have been trying to actively combat the headaches by running and muscle relaxation ever since.
      Six months ago, on the advice of my doctor, I stopped taking the medication Amitritptyline, which I used to take every day. To what extent can the therapy be successful without amitriptyline?
      How long will it take until I can be “headache free”? Is this even possible? My doctor said one to two years, but the improvements have stagnated for a year.

      Doctors from almost every specialty have confirmed that I am perfectly healthy, except for the headaches I described. What are likely causes? And is it unusual for my age, 18, to have this type of headache? Are there many people who have chronic tension-type headaches?

      Best regards,

      Robert

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:05 p.m

          Dear Robert,

          Amitriptyline reduces the aggressiveness of chronic tension-type headache. According to studies, the intensity of pain and the severity of the disease are reduced by around 30% on average. Freedom from pain would not be a realistic expectation. Tension-type headaches are likely caused by a disruption in the body's pain defense system. This cannot be revealed using standard clinical examination procedures. Approximately 3% of the population suffers from chronic tension-type headache.

          Kind regards
          Hartmut Göbel

    1. Profile picture of SHilmer
      SHilmer
      January 11, 2016 at 4:09 pm

      Dear Prof Göbel,

      I've had migraines with aura since I was a teenager. This has increased over the years. I had up to 13-15 pain days a month.

      I have been taking 75mg topiramate as prophylaxis for 3 years. Acute medication: 10mg Rizatriptan + 500mg Naproxen + 20 MCP drops. Since the topiramate I now have around 5 attacks a month, much lighter than before, no longer at night and the acute medication works, unlike before. I've already tried reducing to 50mg, but the number of attacks increases immediately.

      I'm 42 years old, childless, the flare-ups I still have now always come with my period and ovulation. But a few now and then out of order. According to the gynecologist, I'm still a long way from menopause. Anti Müller hormone is 2.1.

      Question 1: I use a condom for contraception, all other methods were out of the question due to the migraines. I'm now afraid of getting pregnant anyway. The condom breaks, for example. B. I cannot assess the risks that topiramate poses to the embryo. As soon as the period stops, I would stop taking the topiramate immediately. But a few weeks may have passed by then. Can you say anything about the influence of topiramate on the embryo if you accidentally took topiramate in the first 4-8 months of pregnancy? I would just like to be informed. But neither a gynecologist nor a neurologist can give me factual information here.

      Question 2: Despite being 42 and still having good fertility, the topic of having children is not yet off the table.
      If I still decide to try to get pregnant. Would I stop the topiramate? How should this be done? My neurologist talked about tapering it off within 8 days. I found that pretty quickly. And now I'm missing another timetable. My neurologist can't give me one and unfortunately neither can my gynecologist. Which beta blockers would be an alternative? Are there any without weight gain? I've tried anti-depressants before. Unsuccessful, but there are certainly several options. Can you even get pregnant with beta blockers or anti-depressants? What risks do these entail? After all, you have to do everything once you're pregnant? Which would be absolutely fine for me, since I've already read on your website that 70% of all pregnant women are usually migraine-free.

      Thank you for your reply.
      Kind regards,
      SHilmer

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:06 p.m

          Dear filmmakers,

          You can take a pregnancy test immediately after missing your expected period. These are now very sensitive and can detect pregnancy at this point. In principle, it would be better not to carry out treatment with topiramate if you want to become pregnant. There is always a risk of a malformation in the child. There are no set guidelines for discontinuing topiramate. In my opinion, there is nothing wrong with stopping topiramate completely immediately. In the worst case, a migraine attack can occur. Slow discontinuation applies particularly to epileptic seizure disorders. There is a risk that an epileptic seizure will occur if you stop taking it abruptly. Of course you want to avoid this. For a complex therapy adjustment, you would need to have a personal examination and advice. This cannot be done within the chat.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Jade1986
      Jade1986
      January 11, 2016 at 4:12 pm

      Hello and thank you for the live chat option.
      I'm getting my first Botox treatment on Wednesday, at the same time I was diagnosed with insulin resistance by a diabetologist and should take metformin. He couldn't tell me if there were interactions with Botox/triptans, only said ibuprofen wouldn't be good as it increases the need for insulin. Are there any known interactions between Botox treatment, triptans and metformin?

      Best regards
      , Jade1986

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:07 p.m

          Dear Jade,

          There is no known interaction between Botox treatment, triptans and metformin.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Royan
      Royan
      January 11, 2016 at 4:20 pm

      Hello Professor Göbel,
      I am now 47, have suffered from severe migraines for decades, and “on the side” I also have type II diabetes, Hashimoto’s, fibromyalgia and a lot of other things.
      The majority of my severe migraine attacks are on my left side; an attack on my right side is very rare. For a few weeks now I have been having increasing problems with the teeth on the right side, some of which have really crumbled and had to be extracted, which means that I no longer have any teeth in my lower jaw on the right side, for example.
      Shortly after the tooth extractions on the right side (last on December 29, 2015) I have the feeling that the migraines will improve (so far there has been one “small” attack this year).
      Until now, I have always assumed that with migraines the “problem” was to be found on the side on which the migraines occur.
      Could it be that it's different for me or that the "problem" on the right side is leading to the severe migraines on the left side? I should also mention that I usually have a paradoxical reaction to many medications. VG
      Royan

        • Profile picture of Hartmut Göbel
          Hartmut Göbel
          January 11, 2016 at 8:08 p.m

          Dear Royan,

          Migraines are caused by an innate peculiarity in the way stimuli are processed in the nervous system. It has nothing to do with a specific site. Migraine patients often experience increased activation of the chewing muscles. One also speaks of so-called parafunctions. These include jaw clenching, grinding, tongue thrusting, etc. These functions are an expression of increased activation of the motor nervous system. The cause can again be seen in stimulus processing and control. A change in migraine through various manipulations is always conceivable. However, this has nothing to do with the actual cause of migraines.

          Kind regards
          Hartmut Göbel

    1. Profile picture of Bettina Frank - presenter
      Bettina Frank – presenter
      January 11, 2016 at 4:47 p.m

      Unfortunately the chat has to be closed earlier today because an unusually large number of questions were posted. Answering the questions takes several hours and at some point you have to draw a line. Please understand this measure and DO NOT ask any further questions. Thanks!

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