Migraines

Medical Q&A [Moderated]
1

Obviously not asking for a diagnosis via the interwebs but I would like to go over my recent medical…scam (that might be the right word to describe it)

Went to my PCP a couple of weeks ago and complained about my migraines becoming more frequent and severe. It used to be I would get a really bad migraine once a week and have minor headaches throughout but not I am getting migraines two-three times a week and headaches everyday. Doc prescribed Amitriptyline 25mg and that was not working, she told me to go up to 50mg

(the reason for the amitriptyline instead of other possibilities is that it also is a treatment for anxiety related to PTSD, that’s in my head I know but it is still something I deal with one day at a time.)

She referred me to an optometrist because I have the early stages of open angle glaucoma and wanted to make sure the pressures were not elevating which could be a cause for the increase in migraine frequency. (Pressures came back the same as my last exam Jan '18)

Next, I was referred to a Otolaryngologists, because I work and have worked in an environment with prolonged exposure to ear damaging sounds (gun fire, explosions, aircraft, heavy machinery etc.) Hearing came back to within normal ranges however, I do have tinnitus. I have to go back again to see this doc later on this month because he was concerned about my difficulty in hearing people talk with background noise. But all in all said he did not believe my increase in migraines were caused by my hearing.

Next PCP referred me pain management because I had a history of concussions, cervical and lumbar spine surgery and rheumatoid arthritis well the Pain management doc focused on my neck and asked if it was stiff often, and of course I said yes but its been that way for a while. Then I was made to do the usual walk through and twist this way and that way etc. The thing that got me on this one was the Doc pressed down on a pressure point (relatively hard) and asked it if hurt, I said a little bit but probably because you are pressing kinda hard.

So the end of the exam came and he said I had myofascial pain syndrome, and told me I needed to have trigger point injections as well as nerve blockers. Obviously my answer was absolutely not because something about a needle going into the side of my neck just does not seem appealing to me. Especially for something that I read and listened to you guys talk about not really being the answer (correct me if I am wrong in my assumption)

I did go back to my PCP and ask to speak with a neurologist again to reevaluate my migraines and see if there is anything they could identify as cause. I’m doing this because of my history with concussive situations but I will find out. Again not asking for a diagnosis but if you have any insight or readings to share that would be nice.

TL:smile:R does the biopsychosocial model regarding pain apply in the same manner to health issues such as migraines and more specifically the sudden increase in occurrence?

2

Yes, you are correct that the same model applies:

I would likely disagree with the approach of the pain management specialist in this situation. I agree with your plan to meet with a neurologist and see whether any other preventative/abortive therapies would be appropriate for you (in fact, it’s interesting you were not sent to the neurologist first, before all these other specialists). I would also certainly aim to address the other psychosocial factors, as described in the above linked articles.

1 Like
3

As always thank you for the information!

Reading through them I find it interesting that what I believed to be true was only partially so. Having thought previously that the biopsychosocial model might have some implications when considering my migraines I started doing a migraine journal. Documenting times, situations, thoughts, progression, and severity of the migraine. It is reassuring to know that I was on the right track with this. I’ve tried to identify if there was any substantial change in emotional state since the frequency has increased.

As mentioned I was prescribed the Amitriptyline 25mg and then told to go up to 50mg, my concern was dependency. Although I do follow the recommended dosage by my provider I always have reservations regarding prescription drugs (Personal bias I suppose).

I will have to ask my PCP when we have our next appointment why the neurologist was not the first choice. Given my medical history it wouldn’t seem like a difficult choice but maybe there is other information I did not consider.

4

I can relate to what you’re going through. I have suffered from complex migraines for quite some time. Mine would start with visual disturbances; auras, and culminate with numbness in my hands, face, tongue, and lips. I would have a lot of pain from the headache- they mimicked strokes. No amount of pain meds would help, and I too went through the gamut of medicines that didn’t help. In fact, most would exacerbate symptoms (such as anxiety, nausea). I had thorough workups by my GP, Neurologist, etc. I also suffer from tinnitus. There never was a diagnosis as to why I was getting migraines so frequently. I figured it had something to do with my cervical spine issues (deterioration, bulging discs). I have been fortunate not have a migraine for over a year, when I used to have them weekly. There are very debilitating. I attribute the reduction in migraines to strength training, but I cannot be sure.

Please keep me/ us posted on this, and I hope you are able to find out a proper way to treat this condition, or even better to eliminate them in frequency if not all together.