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What, Me Migraines?
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What, Me Migraines?

I'm 43 years old, and since at least early adulthood (and maybe before), I've had not infrequent headaches. I'd pop an analgesic and all was well. They often would occur on the left side of my head, although not always. If I had to guess what triggered them, I'd say driving fairly long distances (over an hour), visiting the in-laws ;-) , or staring at a computer for too long. They generally were in the 4-5 range on the pain scale. I didn't really give them much thought.

In May of last year, I had about a week of little aches on the sides of my head on which I was lying.  So, if I was lying on my left side, I'd feel I little ache on that side, and the same thing for lying on my right side.  Well, that concerned me, so I called to make an appointment for a physical, which I hadn't had for a few years, at which time I could discuss the headaches. The earliest appointment I could get was for July. By the time July came around,  those aches were gone, and the regular headaches resumed their occasional-up-to-a-few-times-a-week status, so I didn't even mention them.

I had another couple weeks of everyday headaches last October and went to the doctor. She thought they might be tension headaches and prescribed Flexeril to take at night. After a few nights, the headaches dissipated back to their occasional status.

I had some headaches this past February but also noticed feelings of lightheadedness that generally were not concurrent with a headache. Back to the doc, who wanted to make sure that I didn't have any vascular issues that would cause my brain not to have sufficient oxygen. Off to the cardiologist I went, only to discover that, heartwise, I'm in great shape. Shortly after that, the lightheadedness tapered off, and I was back in whatever business I was in before.

So...this past May, back come the daily headaches--again, mild to moderate, no auras, no nausea, no vomiting--back to the doc, and then to a neurologist. At this point, I was getting somewhat concerned, made the *huge* mistake of consulting Dr. Google, and then became *really* concerned. I mean, all these headaches could only mean brain tumor, right? I knew I didn't have migraines, they didn't have the characteristics of tension headaches, and didn't seem to fit more exotic causes.

Well, the neuro asked me about my headache history, poked, prodded, pushed, pulled, and hammered me (with that little reflex-testing-hammer thingy) through a neurology exam, and proclaimed his diagnosis--migraines.

Really? But I thought only women get migraines? My wife gets them, auras and all, but I'm not a woman and I don't have visual disturbances. He stuck with his diagnosis and asked me if I'd be willing to try medication. I wanted to know the side effects because I really never felt debilitated by the headaches and wasn't willing to have medication-induced unpleasantness replace discomfort. Well, we talked about Topamax, I agreed, and I was set up (by my GP) for an MRI.

I'll cut out some details except to say that, between the neuro exam and MRI, I pretty much freaked out. Don't know if was the med, my own anxiety, or a combo, but I really felt a sense of doom. The MRI, however, came back clean except for some vascular changes that my neuro initially said could be due to migraines but later said were within "normal." Anyway, I was relieved! And I immediately stopped the Topamax (with the neuro's consent). Although I had only taken it for five or six nights, the headaches did seem to be milder than usual.

I was looking for a way to deal with mild migraines, if that's what they are, and decided to try biofeedback. I went to my first appointment a couple of weeks ago, and the therapist hooked me up to a computer and said that my neck and upper back muscles on the right side were slacking off and forcing the left side muscles do the work. This would explain the left side headaches.  I'm still early in the biofeedback game, so we'll wait to see how well it works.

Now last week, I had some pretty long headaches, one of which made it up to a six on the pain scale.  I decided to try the Topamax again, and so far, I've had fewer side effects.  However, I'm beginning to get really anxious again about the possibility of of tumor.  It was done without contrast because the insurance company wouldn't pay for it (sheesh, I should have just shelled out the extra $$ myself).  The neurologist didn't comment on the fact that it was done without contrast.  In fact, because I was so freaked out, I drove to his office directly from the MRI place, CD of images in hand, and dropped it off for his review so I wouldn't have to wait for the radiologist's report.   I have another follow-up appointment this Friday and really need to determine whether contrast makes much of a difference in diagnosing primary brain tumor.

I'm still puzzled about the diagnosis, though. Are these really migraines? Sometimes I'll get a localized ache for seconds, minutes, or occasionally longer, but they feel more like spasms rather than a solid, constant ache (although I'll get that, too). They come and go. They're usually not that bad.  It's usually not particularly throbbing or pulsatile, but it will increase with head and body movements and changes in position. Sometimes, like now, it feels more like a tension headache in the back and side of my head. Sometimes they start for no apparent reason. Sometimes they start after moving. Sometimes I wake up with them (not usually), sometimes I'll have them in the morning, sometimes in the afternoon, sometimes in the evening. It just doesn't *sound* like migraines that one hears about from friends or sees on commercials.  My posture is bad, and I'll work on that as maybe the head forward posture and rounded shoulders are contributing.  Basically, I'd like to ways to reduce or eliminate the need for meds, especially the heavy-duty ones, if possible.

Anyway, I'd appreciate any comments from migraineurs or doctors about whether the diagnosis seems consistent with your experience and whether my anxiety about the non-contrast MRI missing something significant is unjustified.  I have a feeling that even if I wanted to have a second one, with contrast, the neuro would have a hard time justifying it without some major symptom changes, and I don't know if that much has changed since I last spoke with him (other than the fact that I seem to be feeling more pressure changes from exertion, head, or body movement).

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Well, first off, I believe more women than men suffer migraines, but it is very possible for men to have migraines and there are men who do.  Migraines often are one side or the other, though occasionally can take in more territory and be bi-lateral.  There is often pain behind one eye.  There can be throbbing and if bad enough, a person can get nauseated.  Common migraines come on with no aura, while "classic" migraines have visual disturbance warning migraine is coming.  Years ago, I was diagnosed by a neurologist as 60 percent common  migraine, 40 percent muscular headaches, although occasionally, I think I get a visual disturbance warning.  

High blood pressure can be a cause migraines & since they mentioned vascular changes in your MRI- did they suggest you do any blood pressure monitoring to see if you often get high blood pressure?   Also, since you really are interested in getting an MRI with contrast, you might try a different approach in trying to get one.  Between the vascular changes noted on your MRI without contrast, your previous light headed feelings and even your one sided muscle slacking offness, you might inquire as to whether you might have suffered a TIA (transient ischemic attack) and whether an MRA/MRV would be possible to see if you had one.  You might also, if you have not gotten it lately, request a lipid panel to see that's normal, as high numbers can increase risk for stroke.  

And if any pituitary endocrine hormones are tested and come back abnormal, to detect a pituitary tumor, which can be a source of headaches, it takes a specially dedicated pituitary MRI, which you would want to be "dynamic" in method, 3 Tesla MRI machine (best imaging) if possible, and with and without contrast.  Hopefully, you don't have one of these, though they are not very rare.

Other thoughts- a lot of what you describe sounds like it could be musculoskeletal in nature and your neck forward position and posture could be key factors.  One parent was recently told about their neck forward position that it's like holding a gallon of milk straight out from your body, having that neck forward like that, putting a strain on muscles.  Have they done an x-ray of your neck to check for nerve encroachment?  Also, waking in the morning with headaches, if you did this daily, you might look into getting a sleep apnea test, because many who have too many periods of not breathing in the night (a risk factor is if you are carrying extra pounds) can get headache in the morning.  

Another thing is your TMJ condition- do you clench or grind your teeth at night?  If your temporal mandibular jaw joint is not in good shape, laying on your sides can lead to headache (in addition to a neck not in good shape).  Also, when you get tense, do you work your jaw muscles, clench, or grind?  This can be a source of headache and actually can lead to migraine headaches as well.  I wear a hard, flat planed splint each night and it helps my wake up in the morning headaches not to be as intense.  You mentioned too long on the computer- eye strain or sensitivity to the light can potentially also lead to headache.
Thanks for your response!  See, this is one of my concerns:  You went through a list of possible headache contributors, but my neurologist just said "migraines" and discussed one medication.  Even my biofeedback therapist said that it could be combination of muscular/tension and migraine issues.  At my first neuro appointment, I even mentioned by bad posture (which the health psychologist at the biofeedback place pointed out during the evaluation) and the fact that the back of my neck is often stiff, especially during some of the headaches.  The neuro didn't really comment on that.

Regarding BP, at each GP visit over the past year, at the cardiologist visit, and at the first neuro visit, my BP was fine.  In fact, the neuro ruled out BP as a cause of the white matter changes.  After the second visit, he also ordered some additional bloodwork, but I can't remember exactly what it was.  I haven't heard back yet, so I assume everything was negative, but it's on my list of things to discuss at Friday's follow-up appointment.

The first time I went to my GP for the headaches, the doctor ordered a neck x-ray.  The results were mild osteoarthritis in the lower cervical spine.  I mentioned this to the neurologist too but forgot to mention that I hear a bit of crunching or cracking sometimes when I turn my head.  Again, I don't know if this stuff has anything to do with the headaches, but it at least seems worthy of consideration.  

And regarding the posture, a few years ago I bought a DVD called "Power Posture" which is a series of excercises devoted to, of course, improving posture.  I did it for a month or so and, like other things, gave up on it.  Due to my recent problems, I figured I'd take another stab at it.  I watched the introduction again in which it discusses the importance of good posture and the potential problems associated with bad posture.  The doctor who created the program stated that for each inch that the head is held forward out of alignment, the neck muscles have to apply 30 pounds more pressure.  He said some people reach three inches forward (I'm sure I'm one), which makes the neck apply 90 pounds of pressure to keep the head up.  Of course, all of this strains the upper back and can affect the lower back, too.  But that's another story...

And TMJ...in the past, my dentist pointed out that the teeth on my left side are worn down more than those on my right side and asked if I grind my teeth at night.  I don't know if I do, and my wife doesn't know either.  I don't really have headaches when I wake up, nor is my jaw sore.  Still, the left side is a hot spot for my more typical headaches.  And at my last appointment, the dentist noted that my bite is a "little off" when I first bite down but then settles okay.  He didn't seem concerned.  

I didn't mention headaches to him because I didn't want to lead him to a diagnosis.  Sort of like a neurologist seems to want to diagnose migraines and prescribe meds; a biofeedback person will diagnose muscle imbalances; a dentist will diagnose TMJ; a chiropractor will diagnose neck alignment issues; an acupuncturist will diagnose chi issues; an eye doctor will diagnose eye strain.  Maybe it's a little of everything.

Oh, and the sleep apnea?  I've been thinking about that too.  I've always been at a normal weight, but I've also always woken up during the night.  I just thought it was normal and what was what people do--wake up and go back to sleep.  I never had a problem going back to sleep until now due to the anxiety.  My wife has never said anything about any weird sleeping characteristics of mine.  Of course, when I do wake up, it's often due to her snoring (and then in go my earplugs).  But I can't always blame it on her.  Maybe I do have apnea.

Anyway, thank you so much for your reply.  It gives me a lot to think about and a lot to talk about with the neuro, if he's willing to talk about it. Depending on how the appointment goes, I'm seriously considering getting a second opinion.  You' ve sort of confirmed my feeling (which is admittedly not based on any medical knowledge) that my issues might be more complicated than simply calling them migraines (and I know that migraines aren't necessarily simple).  It *appears* that the Topamax has some attenuating effect on the headaches, so that might be evidence of migraines.  I'm just not convinced that's the whole story.

May I ask if you have a medical background?
Hi...if u have a copy of the MRI and the report I would take that info and get a 2nd opinion....if u do not have both, I would request them from the facility where the studies were done.

There r some issues many NL's and radiologists consider an incidental finding and I would be curious if u had ne such findings.

I was dx'd with migraines for yrs...and then found I had another issue altogether.

DO u ever get dizzy when u bend over or squat down and get up too fast....walking into a darken room.....get HA's or pressure with straining...even with a BM?

If not....u r most likely  getting migraines...but if u do...get that second opinion.

Good luck
I have the CD with the MRI images, but I don't have the radiologist's report.  If I do get a second opinion, I will definitely have both with me.

Regarding dizziness after standing up, isn't that postural hypotension?  It's kind of funny but I have experienced that, but not lately.  Rather, I tend to feel pressure changes more acutely from standing, sitting, bending over, exertion, straining.  This usually doesn't cause a headache, but it can't make one temporarily worse.  It's my understanding that those symptoms are consistent with migraines (among other things) but not with tension headaches.
Well, as a teen, I completed vocational nurse's training and got my LVN.  But I let it go inactive and eventually let it expire because I'm disabled.  I've been suffering from migraines since age 11 and chronic migraines since 1996.  I also have TMJ issues, with arthritis in both joints and disc displacement.  The TMJ problems are one of my migraine producing triggers.  I think you meant to say to Selma that your headaches temporarily increase with changes in position and straining- this can happen with migraine headaches.  I call it a surge when positon changes affect my headache.  Sometimes, it can throb, but often it feels more like a surge in pain.  

White matter changes happen to everyone with aging, due to microvascular changes.  If you have more than usual for your age category, however, they need to be doing more monitoring of your lipid panel, including triglycerides, which can lead to plaque formation in the blood vessels, because that plaque formation can cause the ischemic changes in those small blood vessels in your head (lack of oxygen to them).   My parent with the neck problem had more than usual for his age some time back and more recently, had a TIA (mini stroke) and is now taking plavix to try to prevent a full blown stroke.  Since there are issues with cholesterolol medication (side effects and insurance), diet restriction and exercise is the plan.   Thankfully, you don't have the additional risk factor to be managed, like they do of hypertension, it sounds like.

Regarding the cardiologist- what tests did he run to decide you were a-okay in the cardiovascular department?  Did he do a nuclear medicine test to see if there were any areas lacking oxygen in your heart?  Did he order a lipid panel?  Did he do a doppler of your carotid arteries?

Sounds like you may also want your wife to check into sleep apnea, because often those who snore can turn out to have it.  If you or she feel tired in the day, that can be a sign of sleep apnea, besides morning headache.  

Your dentist is not helping you any by ignoring the worn down teeth on one side and the change in bite- TMJ problems can definitely lead to headache issues, playing right into your temporal regions of your head (sides) and even can give facial pain.  The dentist didn't even suggest a night guard?  I have something a little different, a hard flat planed splint to try to prevent the arthritis in my jaws from worsening.  I was advised I needed to be on a soft diet the rest of my life.  Currently, I'm looking into whether I should get a procedure one dr. recommended called arthrocentesis because my jaw problems are so bad.

Your neck is something you really want to take care of too- at least some physical therapy.  That neck forward thing they say has something in heredity and I have it too- but I need to fight it- I see my parent now unable to get their neck in proper position and they have nerve encroachment, arthritis like crazy and some of the balance issues they have might stem from it as well.  The physical therapist did not feel, even with traction at this point, could the head be in proper alignment again, though improvement was seen after some sessions and now a home traction unit is being used!
"I think you meant to say to Selma that your headaches temporarily increase with changes in position and straining- this can happen with migraine headaches."

Whoops, you're absolutely right.

"I call it a surge when positon changes affect my headache.  Sometimes, it can throb, but often it feels more like a surge in pain."

And that's how I'd characterize it.

For the cardio issues, we did a duplex doppler, EKG and an echo.  I also gave the results of the bloodwork that I had for my physical within the past year to the cardiologist.  My total cholesterol is 130-something (it's always very low--in fact, that's the highest it's been), and all of my other numbers were well within normal.  I exercise fairly regularly, so my resting heart rate in the low 50s wasn't a concern.  I haven't had any lightheadedness issues since February.

I wouldn't say that the dentist ignored the issues he pointed out.  Actually, I wasn't having major headache problems at either time he mentioned those issues, especially the one with the worn down teeth.  I think I also tend to favor my left side when I chew, so I don't know that I'm grinding my teeth at night.  As things progress, or regress, I'll either bring this up at my next regular appointment or make an interim appointment.  Honestly, as I alluded to in an earlier post, healthcare people tend to pounce with their treatment for whatever problem you have, and I'm never sure who's right.  Had I told the dentist I had headaches, I probably would have been diagnosed with TMJ and walked out (well, at least fitted) with an expensive appliance that might or might not address the problem--especially since, at the time, I didn't really know I had a problem.  Now, though, I'm more open to the possibility.

I'm definitely going to work on my posture.  I'm sure it'll never be great, but I do need to improve it.

Thanks so much for your responses!
I'm a teeth clencher myself (in my sleep).   May I offer some suggestions?  You might ask the dentist or a maxillofacial specialist for a TMJ panorex picture.   I recently got an MRI after years of suffering and found out about my jaw discs dislocations, as they can't see the discs on x-ray.  Also, you might try going on a softer diet, eliminating very chewy or hard foods and see if it helps any.  Also, have you ever had your ferritin (iron stores) level checked to see if you might have an iron deficiency?  Even with an normal CBC, a dip in iron can cause symptoms, as I can attest to.  And iron deficiency can cause dizziness, fatigue, and headache.      

Wow, sounds like you are really blessed with the cholesterol profile and blood pressure that's fine!  And you're welcome!
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