Migraine and headaches: ‘Ask the Experts’ Wednesday at noon

Welcome Readers! At NOON today we’ll be talking to neurologist Kamel Ben-Othmane about migraine and headaches. Please feel free to post your questions now, ready for him to respond.

I have received several e-mailed questions and will be posting them soon. If you can’t stay for the chat, after 1 p.m. go to www.dailypress.com/health and click on Archived Live Web Chats for the transcript of all our Health chats.

Our doctor will be here at NOON to start answering your questions. Feel free to submit them now.

Dr. Ben-Othmane, please let our readers know when you;re ready to start answering questions. We already have a dozen in the queue for you.

Readers: A reminder that you can always find the transcripts of previous health chats at www.dailypress.com/health and click on the tab, Archived Live Web Chats.

Hi, I am Dr Kamel Ben-Othmane, I am a neurologist with Hampton Roads Neurology, part of Riverside Medical Group. I am looking forward to answering your questions regarding migraine and headaches in general.

Welcome Dr. Ben-Othmane, could you answer Jenny B’s question about her 11 year old daughter being affected by cold fronts.

I’m hoping you’re a fast typist Dr. Ben-Othmane because we have so many questions!

I’m trying to group all the “weather” questions together for your answer.

Jenny B. Motrin is fine. If the headaches don’t respond to motrin or other simple analgesics, you may want to talk to her pediatrician and consider other treatment options such as triptans. This class of medications is usually more eefective for migraine.

RS, very much so. Weather/pressure changes are very common triggers, precipitating factors for migraine.

Thanks Joanne for the recommendation!

So, what can people do when the weather precipitates a migraine?

Pat R. Nothing specific. You need to treat them the same as you usually do. You need an abortive medication, a rescue medication and if they are frequent a preventative medication (a medication you take daily to make the headaches less frequent, less severe and more responsive to treatment.

Joanne, thank you.

Doctor — could you expand on what an abortive medication is, a preventive and a rescue. And are there limits on how long one should stay on medications? We have questions about Topamax coming up.

Dr. Ben-Othmane has already answered Pat’s question above — just so that readers can follow his answer.

An abortive medication is a medication (prescription or over the counter) that you take as needed to stop a headache when you have one. Typically is a triptan (imitrex, maxalt, zomig…). But other classes of meds can be used. A rescue medication is a medication that you would have with you and use when your main abortive drug didn’t work. A preventative medication is taken daily.

What do you think of Topamax? Several readers have asked

Jill. There is no particular medication that is best overall. Every one is different. Over the counter anti-inflammatory meds (ibuprofen, naprosyn, tylenol) are fine if they work. Triptans are more effective. Fioricet and narcotics can be used but are more likely to cause rebound and addiction.

Jill, Topamax is a good migraine preventive medication. It is by far the most commonly used medication to prevent headaches.

Doctor – could you address the issue of estrogen — and whether birth control pills should be used?

RS. You dont have to stay on BC pills if you are on topamax but you can. The effect of BC pills on migraine is variable. Topamax can reduce the effect of BC pills at high dose, but not at the usual headache dose of 100mg/day.

Many migraine patients will see improvement of the headaches after menopause, but not always.

Readers, we’re chatting with Riverside neurologist, Dr. Kamel Ben-Othmane. He’s answering questions about headache and migraine. It’s obvious from the number of questions that this is a widespread problem. Please be patient while he gets to your question.

Pat R. With chronic migraine, the focus should be on preventative therapy (sometimes a combination of more than one drug is needed). We also use nerve blocks, botox injections, biofeedback etc.. Limiting the quantity and frequency of abortive medications used is also important.

Readers: If you can’t stay for the whole chat — we’re here until 1 p.m., then check back at www.dailypress.com/health and click on the tab Archived Live Web Chats to find the transcript.

Lori. If the headaches remain a problem and you GP has no other suggestions, seeing a specialist may be a good idea.

And vertigo — is it related?

And here’s an emailed questioned: I have been diagnosed with a mixed headache syndrome, which I understand is a form of migraine headaches. I have had daily headaches for about a year and a half. Some of them are debilitating and others are not. How long should I treat with a neurologist for them prior to considering pain management. I am tired of living with pain and the meds that we have tried so far, i.e. neurotin, maxalt, and others, do not seem to work.

Elaine, sometimes estrogen therapy helps, but not always. Hormones play an important role in migraine but they are not the only factor. Topamax didn’t work for you, but fortunately there are other treatment options.

Dr. Ben-Othmane is answering questions as fast as he can. Thanks for your patience.

During pregnacy, the treatment options for migraine are limited. Typically migraine improves on its own during pregnancy. Vicodin or percocet can be used infrequently. None of the preventive meds is completely safe, Magnesium 400 to 500 mg/day can be helpful. We frequently use greater occipital nerve blocks to prevent headaches during pregnancy.

Dr. Othmane has answered questions about weather-related migraine and different medications used. Read above for those answers.

Dr. Othmane — what about the vertigo/migraine connection?

Readers: We’re chatting with Dr. Ben-Othmane a neurologist who specializes in headaches and migraines. We’re here until 1 p.m. for your questions.

PJ. There is a condition called vertiginous migraine. Rarely vertigo can be a manifestation of migraine. However, if the vertigo occurs separately from the headaches it is more likely to be an inner ear problem.

O, please see answer to PJ question.

I see we have some food/meal-related questions. What’s your take on the connection with migraine?

I am not sure what spinal headache refers to. Often migraine start with or cause neck pain. Spinal tap headache, is a headache that can occur after a spinal tap and that’s different from migraine. Sometimes arthritis or other bony changes in the neck can cause headaches and that is also different from migraine.

Guest. Not unusual, hypoglycemia (drop in blood sugar) is a common trigger for migraine.

T Solomon. Sleep apnea can cause morning headaches. Do you snore? Do you have daytime sleepiness? If you do you may need to be evaluated for sleep apnea. Migraine and other headache types can also occur in the morning.

Dr. Ben-Othmane, we have several questions about migraine in MEN — are there different triggers than with women. Different treatments?

Pat, If MRIs have been negative, then he does not have brain tumor. If the headaches changed or worsened since the last imaging study, he may need repeat MRI/CT. Otherwise he may need more aggressive treatment if his headaches.

Robin, Definitely. Migraine has a significant hereditary component.

Readers: You have until 1 p.m. to ask your questions about headache and migraines from Riverside neurologist Dr. Ben-Othmane. He’s answered questions already about estrogen therapy, medications, weather-triggered migraine, and

Anne, not that I know of.

Anne was asking about “flaming red ears” being a symptom of impending migraine. The doctor’s answer –not that he knows of.

Bea, our offices are at 12200 Warwick Blvd, suite 110, newport news (ph#534-5100), 850 Enterprise Pkwy, suite 1400, Hampton and 7547 Medical Dr, suite 1300 Gloucester.

Doctor — could you give some tips on triggers other than hormones and weather?

David. That can be seen with migraines. However, cluster headaches should be considered given the pattern of seasonal clustering.

Could the sleep headache be from dehydration?

Jem. What you describing is the visual aura of migraine. It is possible that someone gets migraine without aura for years, then one day start experiencing mifraine with aura. It is not the norm, but is possible.

Nancy, this can happen. Migraine is unpredictable and the pattern you described is not unusual.

Readers- we have so many questions that I’m going to ask the doctor if he’ll answer some of them after the chat. I’ll publish the answers in the Daily Press in a follow-up article – you can find it online at www.dailypress.com/health

Tiffany G. Migraines are more likely to occur during menstruation due to drop in estrogen level. However, they can occur at any time of the month. You are simply, genetically predisposed to have them. You should consider preventive treatment if you can not find a good abortive treatment.

Melissa. Sometimes adding a second preventative therapy helps. Also consider nerve blocks and or botox treatment. Supplements that have been shown to help include magnesium, Vitamin B2, feverfew, petadolex. Also biofeedback and regular exercice. Avoid large quantities of caffeine.

Doctor — could you answer Terry’s question about the long-term risks, if any, of abortive meds.

Donnie. For some patients, certain foods can trigger migraine. The list is however long and can be found on the internet. If she can identify a spefic food (MSG, red wine..) that consistently trigger her headaches she can avoid it. In general limiting diet rarely pays off. Also please see answer to Melissa’s question.

We just have a couple of minutes before the end of the chat. Again, as we had so many questions I’m going to ask Dr. Ben-Othmane to answer some of them later and print them in the paper and online at www.dailypress.com/health.

Thanks so much for your participation and your questions. And Dr. Ben-Othmane for his expertise. His contact information is in this chat.

Kathy, this is something that can happen with migraine. Those headaches are more difficult to treat. Imitrex injections can sometime help in these cases. Also consider conditions other than migraine (hypnic headache, sleep apnea, glaucoma, HTN…).

We have to let the doctor go now. Thank you so much for your expertise. Look for the full transcript at www.dailypress.com/health under Archived Live Web Chats.

Thanks and bye! Join our chat on Friday at 11 a.m. on Boxing and how you can get fit and have fun.