My husband suffers from migraine headaches every year in October. They last for the better part of the month. When October ends, so do the headaches. Pain killers don’t seem to help. Do you have any suggestions?
Migraine headaches are periodic or paroxysmal, throbbing headaches, usually one-sided, and often accompanied by nausea and vomiting. They are about three times more common in women than in men, almost always begin in adolescence or young adulthood, and continue until middle age, when they generally become better by themselves.
In about one third of cases, the actual headache is preceded by an aura, a change in sensation which is usually visual, often consisting of shimmering lights which move across the field of vision. The headache begins immediately or shortly after the aura subsides.
For many years migraines and the somewhat similar cluster headaches were thought to be caused by changes in blood flow to the brain. Sophisticated studies of blood flow that are now possible have not supported that theory. Some blood flow changes have been seen during the aura phase, but people who get migraines without an aura apparently don’t have any such changes. The newest theory is that some stimulation of the ganglion at the base of the brain, which supplies nerves to the brain’s arteries, may be causing the headaches.
Some migraines are mild enough to be treated with simple anti- inflammatories such as ibuprofen. Most are too severe for this treatment alone and other medications have been developed, some quite recently. The oldest, and still very effective treatment, is to use one of the ergot alkaloids, which may be given orally, as rectal suppositories, or by injection. They are most effective when used as soon as the aura begins. Taking these drugs, at least in pill form, after the headache has begun is less effective. They can also be used prophylactically to prevent headaches from developing.
A drug available only in recent years, sumatriptan (Imitrex), is very effective in stopping migraines. It has usually been given by injection, and kits for people to use to inject themselves at home are available. A pill form of sumatriptan has recently come on the market. It is less effective than the injection, and does not act as quickly, but should be useful for people who can’t stand to give themselves an injection. Two newer triptans are now out in pill form. They don’t seem too offer much more relief than sumatriptan. There have been many reports recently that spraying lidocaine, a local anesthetic, into the back of the nose on the side of the headache will quickly stop the headache. No easy-to-use spray is on the market for this purpose yet, but it probably won’t be long in coming.
Many drugs, particularly propanolol (Inderal), verapamil (Calan and others), amitriptyline (Elavil), and other antidepressants have been used on a regular basis to prevent the headaches. They are not effective in stopping a headache once it has started. Some ergot type drugs have also been used prophylactically.
The man described in the letter above with headaches only during the month of October may actually have cluster headaches. As the name implies, these headaches come in clusters, may be seasonal, and are similar to migraines in that they are one-sided with throbbing pain. They are often excruciatingly painful: Sufferers may describe them as the worst pain they have ever had. They typically start during sleep. Men are more commonly affected than women, and long periods with no headaches, followed by short periods with headaches almost every day are usual.
Treatment for the acute headache can be with an ergot drug or sumatriptan as for migraine. The lidocaine in the nose treatment is also often effective, as is breathing pure oxygen by mask. Prophylactic treatment should be started as soon as a cluster starts. An ergot drug or verapamil, also used for migraines, may be effective, as may be lithium or prednisone, a cortisone-type drug, administered in high doses and then quickly tapered down.
With all the choices now available sufferers of both migraines and clusters should be able to get relief, and hopefully prevent their headaches in the future.