Below you will find the contributions to the migraine and headache chat on February 16, 2015. You can read detailed information about this and all current topics on diagnostics and treatment at headbook.me

It wrote on February 16, 2015 at 1:56 pm

Nicole

Dear Prof. Dr. Göbel,

It often happens that I wake up in the morning with a severe tension headache.
Accompanied by nausea and sweating. I have never taken a headache pill due to fear of an allergic reaction. I have a penicillin allergy. And I once heard that you shouldn't take a headache tablet with the active ingredient ASA, which is contained in many headache tablets. Is that correct? For information, I have to say that I have been taking an anti-depressant (Paroxat), 30 mg daily, for 13 years due to my panic disorder/anxiety. I tolerate it very well. What about the interactions when taking a headache tablet? Had abdominal surgery last year. I was given the painkiller Arcoxia, 60 mg, as a pre-medication. Couldn't I also take Arcoxia for my severe tension headaches? Or could she recommend another medication?

Kind regards,
Nicole

 

 

wrote on February 16, 2015 at 5:46 pm

Hartmut Göbel

Dear Nicole,

Before treatment is suggested, you should first have it clarified exactly what types of headaches you have. The temporal behavior and the accompanying symptoms can also be easily reconciled with a migraine. In this case, it might be more effective if you were given a special migraine attack treatment in the form of a triptan. If you have a penicillin allergy, treatment with ASA does not have to be ruled out. There is no solid connection between these allergies. There is also no fixed interaction with taking Paroxat. Arcoxia is an anti-inflammatory COX-II inhibitor. Usually this medication is useful for long-term pain with inflammation, especially in the joint area. When used for acute headaches, it usually only has a delayed effect and cannot immediately relieve the pain sufficiently.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 4:34 pm

Laura

Dear Prof. Dr. Göbel,

I have basilar migraines, which are accompanied by severe neurological deficits.

This has happened several times at work (training to become a nurse) and recently at school.

Many people are already very scared.
How can I explain to you exactly what that is and

How can I behave in the most pleasant and correct way when I'm outside when faced with these failure phenomena?

Thanks in advance,
kind regards
Laura

 

 

wrote on February 16, 2015 at 5:47 pm

Hartmut Göbel

Dear Laura,

Basilar migraine is a particularly severe form of migraine with aura. You should carry an emergency card with you that describes both the diagnosis and the symptoms. Then when the migraine occurs, you can show it and people around you can be informed. You can also combine this emergency ID card with certain behavioral measures. For example, if you have speech difficulties and you cannot express what is happening, bystanders can get direct information here. Even if you are very tired or even unconscious, bystanders can quickly find out what to do.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 5:23 pm

Elizabeth F.

It's been almost 2 years since you diagnosed me with cluster headaches. I take -120 mg of isoptin twice a day (I can't tolerate more because of circulatory problems), and the attacks aren't getting any less.
My question: what can I do to reduce the number of attacks?

 

 

wrote on February 16, 2015 at 7:44 pm

Hartmut Göbel

Dear Elizabeth,

If the attacks do not improve with 2x120 mg isoptin, improved prevention must be found. A combination is possible, for example with lithium or with another preventative medication. It then depends on the type of attacks, their duration and their severity as to which further treatment options are considered. You should therefore come back for a follow-up examination in order to adapt the therapy concept to its effectiveness.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 11:52 am

Cuddle

Dear Prof. Göbel,
I have been suffering from chronic migraines and severe SK for a long time.
There is also constant neck tension. In 2007 I was in the Kiel pain clinic. For prophylaxis I take Trevilor 75, Ergenyl chrono 300 and Magn. Verla 300 3 times a day.
Unfortunately, now I can no longer distinguish between the types of headache.
It always starts with neck pain and tension and extends from the temples to the entire head. I just feel it as a lump of pain. I can often only guess what type of headache it is. Sometimes only Maxalt 10 mg helps me, then again only Ibuhexal 800 or nothing at all. The phases of the headache vary greatly. I usually have the pain for 4 days, almost every week. If I'm lucky, this time will be a little shorter. In addition, I'm hardly mentally resilient and I'm almost just tired. Since there was also a headache that was “somehow” different, I went to the orthopedist and received the following findings:
Steep posture of the cervical spine.
Bone marrow edema equifalent HWK 6 and 7, more in 6 than in 7 with irregular base and cover plates. Delicate line in T 1 in HWK 7 on the left dorsal side. In this movement segment there are also medial to bilateral recessal intervertebral disc herniations on the left, presumably partly covered by bony tissue with narrowing of the anterior cerebrospinal fluid reserve space without root affection. Main finding: In the cervical 6/7 segment, intervertebral osteochondrosis and broad-based intervertebral disc herniation with narrowing of the anterior cerebrospinal fluid reserve space. I am currently receiving intra-articular injections on both sides in C5/6 with hardly any noticeable relief.
I feel pretty helpless in this situation, especially since I feel like the doctor in question has actually given up on me.
Are the medications sufficient and correct in my case?
Would it perhaps make more sense to contact other doctors again or consider an inpatient stay in a clinic?
Can you recommend a pain center near Berlin?
Can I possibly do something differently myself?
Best regards and thank you for your attention.
Cuddle

 

 

wrote on February 16, 2015 at 6:30 pm

Hartmut Göbel

Dear cuddles,

You describe a very complex course of the disease. I can't discuss this in detail here. However, it becomes clear that you need further intensive treatment, possibly also under inpatient conditions. You should see yourself at a specialized facility that can treat various pain conditions in a multidisciplinary manner. If necessary, they will also recommend inpatient treatment to you. You can find outpatient treatment centers on our homepage https://krebsklinik.de .

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 11:56 am

Constance

Do you already have any knowledge about neurostimulation technology? (Vagus nerve stimulation) “non-invasive”?
Have any successes been achieved?

Thank you for your reply

Constance

 

 

wrote on February 16, 2015 at 6:31 pm

Hartmut Göbel

Dear Constance,

There are a number of so-called uncontrolled individual case reports on the treatment of migraines and other diseases. Controlled studies comparing the treatment with other treatment methods have not yet been published. The effect has not been sufficiently proven and the procedure is not approved and health insurance companies do not reimburse it.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 11:58 am

Aurora Borealis

Dear Prof. Göbel,

Thank you very much for taking the time to answer our questions again today.

I have had migraines for 29 years and have only been taking triptans to treat attacks for 17 years because they are the only acute medication that works reliably for me.

Due to a lack of effective prevention, I have been in MÜK for 10 months. Hormonal fluctuations are my strongest trigger and three triptan days in a row are enough for me to get into MÜK.

Recently I made two unsuccessful attempts to take a medication break.
Once inpatient with four days of cortisone, the second attempt was outpatient with 16 days of cortisone. On the 18th day I took a triptan again. Unfortunately, this break wasn't enough either. On top of that, taking high doses of cortisone for a long time gave me a thrombosis in my lower leg, which is now being treated with the anticoagulant Xarelto 2 x 15 mg daily and compression stockings.

Now, fortunately, I will be going to the pain clinic in March for another break from medication.

Even the two cortisone-supported breaks were difficult and very scary for me. Because of the thrombosis, I am not allowed to receive cortisone again. But a break without this support seems unimaginable to me. The fear of the expected pain is almost overwhelming. Due to the long MÜK time and the unsuccessful breaks, I lack any recovery, I am simply mentally worn out, my ability to suffer tends to zero because the necessary substance is missing. At the same time, my sensitivity to pain now seems to be enormously increased.

Now to my question: Are there ways to arrange the medication during the break so that I can sleep as much as possible despite the extreme pain? Would the use of magnesium as an infusion also be considered? Vomex and Melperon don't work for me at all.

Thank you very much in advance for your answer!

Aurora Borealis

 

 

wrote on February 16, 2015 at 6:33 pm

Hartmut Göbel

Dear Northern Lights,

Based on your descriptions, you should not try to take a break from medication on your own before your inpatient stay. In fact, the complications you describe can occur. In addition, if the medication break is not effective, it becomes increasingly difficult to achieve an effective treatment result. During the inpatient treatment you will be supported and accompanied in the implementation. If you have severe transition headaches, you will of course receive all possible therapy options to alleviate them and make them bearable. This usually works very well.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 11:59 am

Peter

Dear Prof. Göbel,

In one of the last chats you wrote: “Anything that helps against acute, primary headache attacks can also maintain a headache caused by medication overuse.”
What about non-oral medications in this context, such as lidocaine injections into trigger points in the neck or using peppermint oil or Versatis patches (which I was prescribed for atypical facial pain).
Do these medications also have to be counted as painkillers within the meaning of the rule of 10?

Thank you for your answer and best regards to Kiel.
Peter

 

 

wrote on February 16, 2015 at 6:35 pm

Hartmut Göbel

Dear Peter,

Lidocaine injections into trigger points or the use of peppermint oil do not cause medication overuse. Peppermint oil is actually a special exception; it can relieve pain without causing central sensitization in the sense of a medication overuse headache. However, injections with local anesthetics should not be used long-term and should only be used for a briefly described period of time.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:01 pm

Marlene

Dear Prof. Göbel,

I would like to thank you very much for allowing me to ask you a question today that always bothers me.
Due to chron.
Migraines, tension headaches and atypia. I have had facial pain every day for several years. Unfortunately, acute medications (including triptans and opioids) are not effective for any form of pain. There are no errors in taking the medication, such as insufficient dosage or taking it too late or even a mosquito. The following possible causes for the ineffectiveness of medications have been mentioned in the headbook and in the specialist literature
:
Metabolism in the liver that is too rapid
Receptors responsible for absorbing medication have stopped working due to the constant pain.
Can you confirm one of these statements or do you have another explanation for the lack of effectiveness of the medication?
My most important question, however, would be whether, regardless of optimizing prophylaxis, there is a way to find out why and then fix the cause.

Thank you very much for your answer and all the best to you and your team.
Kind regards Marlene

 

 

wrote on February 16, 2015 at 6:37 pm

Hartmut Göbel

Dear Marlene,

In fact, in very rare individual cases there are patients for whom acute medications do not work or do not have a sufficient effect. Nature is very diverse; the body has different receptors and metabolic processes. The reasons you mentioned may actually apply in individual cases. However, there are various ways to optimize the effect of medication in attack therapy. This includes, in particular, special preventative measures through behavior and medication. Effectiveness can often also be achieved through the selection of acute medication and the way in which it is used. So there are usually always ways to achieve a treatment result.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:01 pm

ivitho

Hello Prof. Dr. Göbel,

A few months ago, in consultation with my treating anesthetist/pain therapist, I stopped topiramate (dose 50 mg in the morning and 50 mg in the evening). I discontinued it very slowly, as prescribed. The first 2 weeks. I also felt fine after completely stopping it. But then it suddenly collapsed. I had the most horrible migraine attacks imaginable for 16 days straight. The pain and side effects were so severe that I hardly knew how I was going to get through it. The triptans could hardly do anything and by the end I was so physically and mentally exhausted that I was completely exhausted. My anesthesiologist couldn't explain this violent reaction. But I started taking Topi again after 16 days because my family doctor strongly advised me to do so and the migraines and their accompanying symptoms suddenly subsided. I gradually got better again. I now take a dose of 25mg in the morning & 25mg in the evening. I'm currently coping well with this and no longer have to take triptans except for 2-3 times a month. Why did I react so violently? Didn't I follow the plan when we stopped, taking down a dose every week? I'm now terrified of trying again, if it makes any sense at all. My pain therapist says that I have been taking topiramate for so long and that I might have to stop taking it after 2 years. I don't think that's a good idea. I can't go through that again. Do you really always have to stop topiramate after a certain period of time, even though it helps so much?

Thank you very much for your advice.

 

 

wrote on February 16, 2015 at 6:47 pm

Hartmut Göbel

Dear Ivitho,

The long migraine status after discontinuation of topiramate does not necessarily have to do with discontinuation. Many other reasons could also be responsible for this. Even the very sudden improvement after resuming treatment does not have to be due to renewed medication with topiramate. During any course of migraine, long, serious attacks can occur completely unexpectedly, a so-called status migraenosus, which does not respond to anything and does not want to stop. However, there always comes a time when these attacks stop on their own. So you don't have to be afraid that when you stop taking topiramate, the migraine will suddenly break out again and again in the way you just experienced.

On the other hand, there is no specific reason that topiramate should be stopped after a certain period of time. Basically, topiramate is a long-term medication that can be used for years, if not decades. If you feel safer with a low dosage, there is basically nothing wrong with using it for a longer period of time. You can then very carefully make a further reduction over a longer period of time. As you taper off, you will then notice that the course does not have to worsen given the appropriate circumstances. There is a lot to be said for continuing with a preventive medication that is tolerable if it gives the patient the security of protecting themselves from migraine attacks.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:02 pm

Martina

Dear Prof. Göbel,

I suffer from tension headaches and chronic.
Migraines and would like to hear your opinion on whether a constantly elevated heart rate can be the reason for the frequent pain or whether it can make it worse. My blood pressure is normal, or sometimes low, and my pulse rate is at rest at an average of 100.
As a possible reason for the assumption that the increased pulse causes or worsens the headaches, I read the following: When the heart beats slower, so do the headaches Painful impulses are “sent” more slowly.
Since I cannot take beta blockers due to serious side effects, it would be very important for me to know whether there is a connection between pulse rate and headaches.

Thank you very much for your answer. Martina

 

 

wrote on February 16, 2015 at 6:38 pm

Hartmut Göbel

Dear Martina,

There is not necessarily a connection between pulse rate and headaches. Only with an extremely slow pulse or a very fast pulse can a headache become worse. A resting heart rate of 100 is not unusual. The change in pulse rate is unlikely to affect the headache.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:04 pm

Tina

Dear Prof. Göbel,

I have been suffering from chronic illness for several years.
Migraines and tension-type headaches. During this time, I had more and more problems lying flat, so that I can now only lie or sleep with my upper body elevated (almost sitting). When you lie flatter, the pain increases considerably (stronger pressure). I happened to read in your book that in cluster patients the pain also increases when lying down, due to the inflammation of the venous blood vessels and the difficulty in draining the venous blood in this position.
Could this also apply to chronic migraines and would ASA 100 be helpful as a blood thinner in this case? If this is not the case, what possible reason could there be for these difficulties?

Thank you for your answer and best wishes to you and your entire team. Tina

 

 

wrote on February 16, 2015 at 6:49 pm

Hartmut Göbel

Dear Tina,

Typically, migraine sufferers feel better when they lie as flat as possible. For other headaches, elevating your upper body can improve the pain. This applies to cluster headaches or headaches with increased intracranial pressure. In the case of headaches caused by arterial hypertension, the headache can also be improved by elevating the upper body while lying down. You should therefore have yourself carefully examined again to clarify whether such conditions exist.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:08 pm

Tobi

Dear Prof. Göbel,

I would like to contact you again today with a question.
In the chat from November last year you gave me the advice to include the occasional use of tizanidine in acute cases in the rule of 10 to be on the safe side.
In contrast, when it comes to taking Orthodon, you answered that this regulation does not apply.
My question now is what the difference is between these medications that causes this different handling.

Thanks for your answer.

 

 

wrote on February 16, 2015 at 6:50 pm

Hartmut Göbel

Dear Tobi,

A reliable statement is not possible for either tizanidine or Ortoton. Ortoton contains the active ingredient methocarbamol. It is a muscle relaxant that acts centrally, is very poorly researched and causes a general depression of the central nervous system. Studies on the long-term effects and use for headaches are not known. For this reason, it cannot be said with certainty whether a medication overuse headache is occurring. The same applies to tizanidine. For this reason, to be on the safe side, you should use the rule of 10 for both medications.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:10 pm

Jedida

Dear Prof. Göbel,

After taking a medication break at your clinic, I now strictly adhere to the 20/10 rule.
When I have a migraine, I first take Naproxen plus Sumatriptan 100. So far it has always worked quickly and reliably. Towards the end of the attack I only take iboprofen so that the migraine doesn't end with sumatriptan. Lately I've had the feeling that sumatriptan doesn't work as quickly, sometimes not at all. Can I try another triptan to “quickly stop” an attack? Which one can you recommend to me? I took Maxalt a few years ago, but found the effects of sumatriptan to be more reliable and the side effects to be fewer. Thank you for your help!

 

 

wrote on February 16, 2015 at 6:51 pm

Hartmut Göbel

Dear Jedida,

In fact, it does happen from time to time that the response to a triptan changes. It should then be considered whether so-called triptan rotation, i.e. switching to a different triptan, could achieve better effectiveness. Triptans with rapid effectiveness are in particular Rizatriptan, Almotriptan, Zolmitriptan or Eletriptan. However, this can be different in individual cases, so you always have to try it individually to see how effective it is.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:10 pm

Morning fresh

Dear Prof. Dr. Göbel,

In your current book from 2014 (“Successful against headaches and migraines”) you write on p. 266:

“The company pregnancy register does not yet indicate a significantly increased risk of miscarriage when using sumatriptan in the first trimester of over 1000 pregnancies (as of January 2013). For the other triptans, the data (…) is not sufficient. However, until sufficient experience is available, triptans must not be used during pregnancy.”

Does the last sentence refer to all triptans or is Sumatriptan 100 excluded from this?

(Last autumn I was pregnant until the 11th week of pregnancy; during this time I unfortunately had a lot of very severe migraines; in consultation with the neurologist and gynecologist, I also took Sumatriptan 100 - “of course” with no good feeling - because Vomex also often didn't help or, for example, I was driving alone and couldn't take Vomex because of the fatigue that then set in.)

Thank you for your reply!
Susison

 

 

wrote on February 16, 2015 at 6:53 pm

Hartmut Göbel

Dear morning fresh,

Sumatriptan was the first triptan and there is therefore very long experience with its use during pregnancy. In summary, the data show that there is no significantly increased risk from taking sumatriptan during pregnancy. There is not yet any correspondingly extensive long-term experience with the other triptans. Therefore, their use during pregnancy cannot be recommended. Nevertheless, women are becoming pregnant again and again while taking a wide variety of triptans, the pregnancy registers will be continued and over time more detailed statements will be possible.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:19 pm

Tessa

Dear Doctor. Göbel,

The new therapy device VITOS from the company Cerbotec is mentioned in the current migraine magazine; it was presented at the pain congress last October!
What do you think?
Does it make sense to try this device? After all, there was a study by the University Hospital of Munich Großhadern! All prophylactic medications have failed for me so far and a year ago I went to see them in Kiel, which did me a lot of good!!
At the moment my seizures are increasing again. I have not yet been prescribed
botulinum toxin A. Would the device be an option?
What do you think about it? Thank you for your answer and the time you take for us!

Kind regards
Tessa

 

 

wrote on February 16, 2015 at 7:06 pm

Hartmut Göbel

Dear Tessa,

The study you describe was carried out on a very small group of patients. A general statement is not possible, and there is no study that I know of that has been able to repeat the study results. The manufacturer lets you test the device free of charge for 30 days. The press release states that if it is ineffective after this time, it can be returned without incurring any costs. From this point of view, it seems justified to try this procedure. If you have the criteria for chronic migraine, treatment with botulinum toxin A is also a treatment option that can be considered.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:25 pm

Harry

Dear Professor Göbel,

I have two questions today that concern my acute headache situation.

  1. Can you simply say that if triptans work great and antidepressants don't help at all, then the diagnosis is migraines?
  2. Does a headache that occurs noticeably frequently and at the same time (around 9 p.m. +/- 1 hour every day) point in a certain direction from a diagnostic point of view?

Thank you for your answers

 

 

wrote on February 16, 2015 at 7:07 pm

Hartmut Göbel

Dear Harry,

Thanks for the precise question. In principle, one cannot conclude a specific diagnosis based on the effectiveness of triptans or the lack of effectiveness of antidepressants. The diagnosis of “migraine” is determined by the headache phenotype, the appearance of the headache characteristics. There are migraine attacks that cannot be influenced by triptans; on the other hand, there are migraine attacks that even respond to inactive medications (placebo).

Headaches that occur at certain times can point diagnostically in a certain direction. An example is the so-called “sleep-related headache”, which occurs during sleep. Cluster headache attacks can also occur in a fixed rhythm at certain times. This also applies to medication overuse headaches, which occur at a certain point in time when the medication is taken in a certain way when the effect of the medication wears off. Overall, there are a variety of options. However, in each individual case it must always be clarified exactly what other characteristics of the headache exist in order to reach a diagnosis. Furthermore, various types of investigations also need to be carried out.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:27 pm

Xandrian

Hello Prof. Dr. Göbel,

I have my migraines very well under control. I treat this with topiramate (2 x 50 mg) and acute medication with Allegro. The frequency of attacks fluctuates seasonally between two and eight per month (the latter is a peak period) and has been relatively similar for years. The rule is about four attacks.

The switch to Allegro took place about three years ago after Sumatriptan and Novratriptan had no effect at all and only had a very slow effect. An interim trial with sumatriptan also showed that it sometimes took ten to twelve hours for a slight effect to occur. In some cases there was no improvement at all with the medication.

Recently the attacks have become more “aggressive”. In other words, the pain is stronger and the Allegro often seems weaker and more delayed. Does the body get used to it?

My fear is that another medication will more or less lose its effect, as is already the case with the two above. If so, is this normal and should you be prepared to have to change your medication every few years because it simply no longer has any effect?

Thank you for your answer and best regards
T. Bauer

 

 

wrote on February 16, 2015 at 7:09 pm

Hartmut Göbel

Dear Xandrian,

If migraines have been ongoing for a long time, especially with very aggressive attacks, it may happen that after a certain period of time the migraines no longer respond as well to a specific triptan. Then you should actually consider changing a triptan, the so-called triptan rotation. You can also change the prevention to restore the effectiveness of the triptan. Combining the triptan with, for example, an anti-nausea agent and an anti-inflammatory painkiller can also be considered. Often it is less the decrease in the effect of the medication than the increasing chronicity and aggressiveness of the actual migraine attacks.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 7:33 pm

Xandrian

Good evening!

Thanks for the detailed answer.

Greetings from Bayreuth

 

 

wrote on February 16, 2015 at 12:38 pm

Phylli

Dear Prof. Göbel,

I have often read that a ketogenic diet can relieve migraines and headaches.
After an adaptation phase, the brain cells could be supplied with ketone bodies. Simply reducing carbohydrates (avoiding bread, pasta, rice) brought little relief.
However, the amount of carbohydrate consumed by eating vegetables and fruit was too high to reach ketosis. In your opinion, would it be advisable to further reduce carbohydrate intake?

I have been suffering from migraines, tension headaches and MÜK for many years (now taking daily painkillers and/or triptans). I was referred to your clinic in October and am looking for a way to bridge the time until admission, as I wake up at night due to the pain and have to take medication again.

Thank you for your answer and warm greetings from Saxony.

Phylli

 

 

wrote on February 16, 2015 at 7:14 pm

Hartmut Göbel

Dear Phylli,

There is no known scientific evidence that any type of diet or diet can improve migraines. This is especially true for the ketogenic diet. According to scientific findings, reducing carbohydrates is detrimental to migraines. The nervous system needs a sufficient supply of carbohydrates in order to be able to convert the appropriate energy into the nerve cells.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 12:38 pm

Lulu

Dear Prof. Dr. Göbel,

I had Botolinum Toxin injected for the second time on Monday, February 9th, 2015. As of Tuesday I'm still having problems with my neck - can't move my head down and sideways without pain. I also had another severe migraine attack for two days starting on Wednesday, which completely paralyzed me. Is the neck pain still within the normal range after a week and should I expect that after every injection a) a migraine attack of this type will occur again and b) the problems with the neck as well?

Thank you for your reply!

 

 

wrote on February 16, 2015 at 7:15 pm

Hartmut Göbel

Dear Lulu,

Muscle pain after treatment with botulinum toxin is the most common side effect. They can be explained by the fact that pain-promoting substances that were previously trapped in the overactivated muscle fibers are released into the muscle through relaxation and cause muscular pain there. As a rule, this phenomenon lasts around 10 to 14 days, then these substances are broken down and the effect of botulinum toxin begins. Basically, the appearance of muscle pain in the sense of a feeling of sore muscles is a rather positive sign and means that the treatment is starting to take effect.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 1:10 pm

Catingrid

Have a nice day Mr. Dr. Göbel!

I have been suffering from migraines and tension headaches for over thirty years, and most recently from MÜK on top of that. I therefore had myself treated at their clinic and am really more than satisfied with the treatment, their competent and friendly team of doctors and their functioning concept!

I've been back home from her clinic for a week now and have successfully continued my break from painkillers.
I am more than happy to be out of the MÜK. Now my question:
I was put on Trimipramine 50 mg in your clinic after I became far too tired from Doxepin and had massive circulatory problems. I tolerate the trimipramine better, but since then I have suffered from terrible nightmares almost every night. I have therefore reduced the dosage to 25 mg for three nights. Now I sleep better again. I would like to know whether the lower dosage of 25mg can work sufficiently against pain or whether I should try to increase the dosage again to 50mg more slowly. Or whether it would be advisable to switch to another antidepressant and which one would you recommend to me?

Thank you in advance and greetings from Berlin from Ingrid

 

 

wrote on February 16, 2015 at 7:18 pm

Hartmut Göbel

Dear Catingrid,

Thank you very much for your comment and your explanations. I very much hope that there will be further stabilization. Very often, severe adjustment problems occur when taking a medication break, especially in the first 10 to 14 days. Many patients confuse the symptoms during a medication break with side effects of the newly started medication. It is sometimes very difficult to understand that the problem of a medication break arose from the excessive use of acute medications in advance, but is not caused by the accompanying therapy or the new preventive therapy.

The massive circulatory problems must not have been caused by trimipramine, but are actually typical during a medication break. Nevertheless, the situation can be improved through implementation. It is often the case that in the first few days and weeks of switching to a preventive medication you only experience side effects, and the effect only sets in over a longer period of time. This also often leads to misunderstandings. Nightmares and sleep disorders are also typical side effects of a medication break. It can be assumed that these will improve over time and normal sleeping patterns will return without being disturbed by nightmares. In principle, you should not change the accompanying medication frequently for preventive purposes, as the effect is often lost and no reliable statement can be made about its effectiveness. The dosage of 25 mg is sufficient if carried out consistently over 3 to 6 months. However, this must always be clarified in individual cases. However, it is better to have a low dosage than to be unable to cope with a higher dosage and then stop taking it too soon.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 7:29 pm

Catingrid

Thank you very much for your enlightening explanations, Mr. Göbel. Then I can/will now stay on the trimipramine with peace of mind.

 

 

wrote on February 16, 2015 at 1:14 pm

Alice15

Dear Doctor.
Göbel, I have 2 questions for you:
before and during a migraine attack, inflammatory areas form under my scalp that are sensitive and painful.
The spots spread and then condense into a bump, like a pimple, painful and slightly reddish. When you scratch it, like a skin pimple, some blood comes out. Then it fades away. It is very uncomfortable, inflammatory and a foreign body feeling. So far I've only read about it from Oliver Sacks. Is there any way to mitigate this other than ice? Migraines often occur when the weather changes. Is there a way to relieve or cure the sensitivity to the weather.
I currently have
up to 6 migraine attacks on Monday and cannot tolerate medical porophylaxis. I'm taking Naratriptan. Thank you

 

 

wrote on February 16, 2015 at 7:23 pm

Hartmut Göbel

Dear Alice,

Her description is very unusual and cannot be classified without direct examination. I don't know Oliver Sacks' description, but I would be grateful if you could send me the exact reference here. Migraines when the weather changes can be alleviated through behavioral measures as well as preventive medication.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 1:21 pm

Eveken

Dear Prof Göbel,
Is there a connection between sudden hearing loss or the risk of sudden hearing loss and migraines?
Years ago I had a sudden hearing loss (during my period with subsequent migraines) and for the last 2 days I have had a dull feeling in my right ear (reminds me of the sudden hearing loss).
I just got my period and a migraine is coming! Do you know anything about this?
My sister and brother also had sudden hearing loss in the past!
I'm not stressed at all right now.
This can be ruled out as the cause. Thank you for your willingness to answer questions from us headbookers.
I am incredibly grateful for this forum!!!

Kind regards,
Eva

 

 

wrote on February 16, 2015 at 7:24 pm

Hartmut Göbel

Dear Eveken,

A connection between tinnitus and sudden hearing loss as well as migraines is known. For this reason too, migraines should be taken seriously and treated effectively, and in particular adequate prevention should be implemented.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 1:23 pm

Ilona

Dear Prof. Göbel,
I had Botox treatment in October 2014.
My migraine attacks reduced significantly. Unfortunately, the triptans (Ascotop 5mg nasal, or Sumatriptan 100mg) no longer helped me during the last attacks. Is this known after Botox treatment? My pain pattern has also changed (headaches now starting at the back of the head).
Thank you in advance and best regards from Kiel, Ilona

 

 

wrote on February 16, 2015 at 7:25 pm

Hartmut Göbel

Dear Ilona,

Botulinum toxin has no negative influence on the effectiveness of triptans. It can always happen that a triptan is not sufficiently effective despite being effective for a long time. Basically, out of 10 attacks treated, at best only 8 to 9 attacks respond. You should therefore not allow yourself to be disconcerted by its ineffectiveness. It is possible that treatment with botulinum toxin can change the headache pattern.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 1:58 pm

Petra

Dear Prof. Göbel,

Since you can't take triptans for basilar migraines, what medications do you suggest for acute attacks?
For headaches? Against severe rotating/swaying dizziness? And as prevention? Why is there e.g. For example, is there so little information about basilar migraine on your homepage? This type of migraine is not that rare. Since I put a few of my own reports of my basilar migraine on my homepage, I have been receiving a lot of emails from other people who got this diagnosis after a long time in the wrong and who were also very desperate that there is so little information about this type of migraine and also doctors ( Family doctors and even neurologists don't really know this disease and prescribe triptans, which can cause strokes because they narrow the blood vessels.

Many greetings from Petra

 

 

wrote on February 16, 2015 at 7:27 pm

Hartmut Göbel

Dear Petra,

If you have basilar migraine, or as we now call it, migraine with brainstem aura, you should not take a triptan. The reason for this is that the basilar artery supplies vital regions in the brainstem. This artery is not paired, meaning there is no right or left basilar artery like other arteries of the cerebrum. For safety reasons, it is therefore not recommended to take triptans for basilar migraines. It is possible to take non-vascular active medications, for example non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen, alternatively Novaminsulfone or diclofenac can also be used.

I describe the treatment of the basilar artery both on our homepage and in my books and publications. Compared to many other types of migraine, basilar migraine is a rare subtype. However, considering the many people who are affected by migraines as a whole, basilar migraine is undoubtedly not a rarity either. It is therefore right to point out that more education and information is necessary.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 2:15 pm

Thomas

Dear Prof. Göbel,

Thank you for taking the time to help us pain sufferers.

After 20 years of NDPH, can headache without nausea, NDPH cause nausea without vomiting?
Eating has no effect on nausea. If so, how is this treated?
Medications taken so far without success: Iberogast, ranitidine, domperidone, pantoprazole, various probiotics, doxepin.
Although dimenhydrinate relieves the nausea, it makes me feel too tired. All examinations by the gastroenterologist were without findings.
There are no food intolerances. A gastroscopy and colonoscopy was carried out about 2 years ago. A tissue sample was not taken because the stomach and intestines looked good. Even stopping the medication (opioid) for 2 months was unsuccessful. About 1 month ago, Tilidin retard was replaced by DHC retard with the agreement of my new gastroenterologist. This caused the constant diarrhea to stop. I can eat everything again without stomach and intestinal pain. The nausea hardly got any better. Unfortunately, the DHC doesn't work as well as the tilidine for my pain.

Thank you very much for your answer.
Thomas

 

 

wrote on February 16, 2015 at 7:38 pm

Hartmut Göbel

Dear Thomas,

New-onset daily headache (NDPH) occurs like a chronic tension-type headache. Nausea and vomiting are not typical symptoms. Treatment with opioids should be avoided. As a rule, a treatment concept similar to that for chronic tension headaches is most likely to be effective. Nevertheless, this form of headache is very persistent, often chronic and difficult to influence therapeutically. Based on your statements, the exact course of treatment cannot be clearly commented on. However, you may have experienced a medication overuse headache due to the multiple use of opioid analgesics. I would suggest you go back to a specialized headache treatment facility and have the problem diagnosed and treated there.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 4:18 pm

Claudia Sibylle

Dear Professor Dr.
Göbel, thank you very much in advance for your loving effort in answering all of our questions.
My chronic migraines have been particularly bad in the last few weeks. As an additional variant, I developed severe sensory disturbances in my temples and around my eyes. Can these disorders come from migraines, or is the cause perhaps somewhere else? Since these also caused very unpleasant pain, the question arises as to whether there is a way to treat it.

Best regards!
Claudia Sibylle

 

 

wrote on February 16, 2015 at 7:40 pm

Hartmut Göbel

Dear Claudia Sibylle,

The pronounced sensory disturbances such as hypersensitivity or muscle pain in the temples and around the eyes can be associated with chronic migraines. It is important to use prevention as effectively as possible. Unfortunately, the options for chronic migraines are limited. As a rule, the drug treatment methods for episodic migraines are not lastingly effective, otherwise a chronic course of migraines would not have occurred. If you have not yet had treatment with botulinum toxin, this could be considered.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 4:57 pm

Trumpet29

Dear Doctor.
Göbel, In the program “die Nutritiondocs” the claim was made that migraine sufferers should avoid/limit carbohydrates.
Based on your experience/knowledge, is this true? In a radio program about migraines it was said that 2-3 attacks a month is a lot!
Is that correct? Is prophylaxis with beta-blockers already indicated? If there were so few attacks, I would be happy! Thanks for an answer.

 

 

wrote on February 16, 2015 at 7:43 pm

Hartmut Göbel

Dear trumpet,

The statements in the program were somewhat misleading. On the one hand, it was advised to limit the diet containing carbohydrates, on the other hand, it was recommended to increase the consumption of vegetables and the like. What was probably misunderstood here was that there are different types of carbohydrates. Carbohydrates are converted into energy in the nerve cells. During normal functioning, the brain only uses carbohydrates for energy metabolism. Therefore, every brain, especially the brain of migraine sufferers, depends on an adequate supply of carbohydrates.

When it comes to nutrition, however, it is important to consume whole carbohydrates. These are found, for example, in potatoes, rice, baked goods, wholemeal bread, muesli, oatmeal or wholemeal pasta. However, low-quality carbohydrates such as nut nougat cream, jam, confectionery, milk chocolate and fruit gum should be avoided. This was not made clear in the broadcast, so several people noticed the misunderstanding.

2 to 3 migraine attacks a month can be a lot if each attack lasts 3 days or longer. Then you'll quickly reach 9 to 12 days. However, if these attacks respond to a migraine medication within 30 minutes, for example, the migraine is relatively harmless and can be easily controlled. Always remember that when statements are made in the media, things are usually presented in a simplified manner and do not apply to each individual case. There is simply no space in today's 2 to 3 minute articles to meet the information needs of migraine patients and their demand for detailed information.

The use of a medicinal prophylactic also depends entirely on the course and characteristics of the respective attacks as well as the duration of the respective migraine attacks. If you have 2 to 3 severe migraine attacks, for example with severe brainstem auras and insatiable vomiting lasting 3 days, this may require more than sufficient intensive prevention. However, if you have the same number of attacks and can stop them by giving 2 tablets of aspirin, the situation is completely different.

Kind regards
Hartmut Göbel

 

 

wrote on February 16, 2015 at 5:28 pm

Sugar swing

Dear Professor Göbel,

Thank you for this opportunity to ask you questions.
I have a question about acute treatment:
I had been taking paracetamol 500 as an amplifier for the triptan for years. It worked well in combination but didn't last very long. So I sometimes needed 6 paracetamol in a 72-hour attack and since I have chronic migraines, I end up using a lot of paracetamol.

That's why they advised me at the pain clinic to take Arcoxia 60mg instead (I can't tolerate naproxen).
I've already tried all the triptans - none of them work as well in combination with Arcoxia as with paracetamol. But I had stuck with Arcoxia because they said it doesn't damage the liver like paracetamol.

However, my neurologist sees it differently than you. He advises me to take paracetamol again because although it can damage the liver, Arcoxia can damage the heart. The risk would be the same for both and since paracetamol works better I should take it again.

I would now like to speak to you again because I really value your expertise and you expressed your opinion very clearly.
Thank you very much and have a nice evening!
Sugar swing

 

 

wrote on February 16, 2015 at 7:50 pm

Hartmut Göbel

Dear sugar swing,

The specific procedure depends largely on how many days you need the intake pattern you describe. If this occurs 1-2 times a month, you may consider doing this. However, from your descriptions and the reference to chronic migraines, it can be assumed that this is much more common. It is also possible that the 10-day rule is exceeded and this type of intake can cause chronicity into a medication overuse headache.

First and foremost, an attempt should be made to achieve optimized effectiveness with the triptan alone. Consideration may be given to changing the triptan. It is also possible to increase the individual triptan dose. For example, Zolmitriptan is available in 2.5 mg and 5 mg tablets. The drug Relpax can also be used not only at 40 mg but also at 80 mg. Although only the 40 mg tablet is approved in Germany, in other countries such as Switzerland there is also an 80 mg tablet.

First and foremost, an attempt should ideally be made to optimize the effect through monotherapy, ie by administering a single medication. Only if this is not possible can combined treatment be considered. Personally, I would primarily try to avoid taking high doses of paracetamol on a regular basis. Every medication can have side effects, and Arcoxia can actually be problematic if you have high blood pressure or heart disease. It therefore always depends on the individual case which additional medication needs to be considered. Finally, it must be pointed out that the effectiveness of monotherapy can be further increased by adapting preventive therapy.

What speaks in favor of Arcoxia is its better stomach tolerance after prolonged exposure. Overall, there are many options that need to be customized.

Kind regards
Hartmut Göbel