Migraines, MRI's, & MS

    
      Re: Migraines, MRI's, & MS
    


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Posted by CCF NEURO MD on May 19, 1997 at 14:38:02:

In Reply to: Re: Migraines, MRI's, & MS posted by Lin on May 17, 1997 at 14:37:52:

: : I am being treated for "probable" MS, relapsing/remitting
  : type, & have been since 1993. I have been using Betaseron for
  : almost 3 yrs, & feel I am getting a lot of benefit from it.
  : I have 2 questions: Firstly, what percentage of the population of
  : people who have MS show no lesions on their MRI's of the
  : brain & spinal cord? Secondly, I am curious about migraines. I
  : normally experience, on average, 1 or 2 a year, but since the
  : beginning of February, I have had 20...some lasting 2 days.
  : Each one I get is worse than the one before. Imitrex injections
  : help, but only after doing 2 of them, along w/Flexeril,
  : Ultram, & Fioricet w/out codeine. I do have spasticity in
  : the left side of the back of my neck. Could these migraines be
  : caused by the spacticity, the Betaseron, or is it a symptom of
  : MS that I've never experienced before? I have been seeing my
  : neurologist every 2 or 3 weeks about this, we are trying to find
  : someone else to see me, & MRI's done 3 weeks ago show nothing,
  : as usual. I am really getting to the end of my rope with this!!
  : Any suggestions you could offer would be most appreciated!!
  Just wanted to give an alternate email address, in case you need it,
  because my server has been having problems. This one works..thank you!!
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There have been studies that report approx. 80% of people with definite MS have lesions on MRI.  However, now that MRI technology is so advanced, neurologist believe the frequency is much lower.  In fact, they will question the diagnosis of a patient with a normal MRI.  
It is not unusual for people with migraines to have a change in the frequency of attacks. One should always have a comprehensive neurologic evaluation in these circumstances to make sure there is not another cause, as you have done.  Some people would suggest a  migraine prophylatic medication in instances where the migraines are as frequent as yours (such as propranolol, verapamil, tricyclic antidepressants or serotonin reuptake inhibitors- to name a few).  Many people report as you do that neck pain may trigger migraine headaches or tension type headaches.  Reducing the amount of spasticity combined with neck range of motion exercises may help.  Betaseron has been reported to produce headaches, but since you have tolerated it for 3 years, I doubt this is the cause.  
Management of headaches which are difficult to control are sometimes best managed by a neurologist/internest who specializes in headaches.  At the Cleveland Clinic there is a group of MDs who deal daily with patients with headaches.  To arrange an appointment, call 1-800-223-2273 ext 45559.  If you are outside the area call American Council for Headache Education - 609-845-0322 or National Headache Association-1-800-843-2256, they may be able to recommend a physician to you and your neurologist.  There is help for you, just hang on.