Re: 9 Month Migraine 24 Hours/Day

Posted By Richard Price on February 01, 1999 at 09:36:29:

In Reply to: 9 Month Migraine 24 Hours/Day posted by Chris on January 27, 1999 at 13:06:57:






My wife has similar situation to an archived posting about a long term headache following a lumbar puncture ad blood patches, in her case a myelogram. However, her symptom is a migraine with nausea, photophobia and other typical migraine symptoms 24 hours per day since March 18, 1998. The neurologists have prescribed various medication protocals, including bilateral occipital nerve blocks and hospitalization for thorazine and DHE treatments, without any relief.  Now she is undergoing withdrawal from her current medicines in a pain clinic while undergoing pain managment training.  First, will this migraine ever go away and any guess at how long it will take?.  What was the outcome of the archived posting "Can a Blood Patch Cause a Headache" (1997) (may not be the exact title).  I assume from the archived posting that morphine was helping this patient, but in my wife's case morphine only "took the edge off" same for dilaudid.  She only took them for a short time and was most recently on Duragesic patch, serzone and depakote.  She is more than happy to get off the medications even with the pain.  Her migraine is located primarily in the base of her head and radiating up the back of the head.  The pain is a steady pressure like pain not throbbing. Activity does tend to make it worse, but it is not positional. Over the past few weeks the pain became more intense and covered more of her head. The Duragesic (100ug/hr)patch took the edge off in the beginning, but was not offering any relief before she was admitted to the pain clinic. Her MRI, CT and Cisternogram should nothing.  CSF pressure was 11, considered by the doctor to be within the normal range.  Her current course of treatment is a two week withdrawl (withdrawal) period, pain managment training and start sansirt (sansert?).  Any suggestions?  I can give you a more detailed case history or her doctors' phone numbers.  Thank you.

Dear Chris,
I was very sorry to read about your wife's headache problem.  The archived posting you referred to ("Can an Epidural Blood Patch Cause Headache?) was mine.  In June 1992, my wife had spinal anesthesia before a Caesarean section.  She developed a post-dural puncture headache with the classic symptoms: her pain was intense whenever she was sitting/standing, but it subsided when she lay down.  Three days after the onset of this headache, her anesthesiologist performed a blood patch, stating that this procedure would "take the pain right away."  It did not do so.  Instead, her pain changed: it was present and severe regardless of her position -- standing, sitting, or lying down.  Because the pain profile changed upon the administration of the blood patch, I have always suspected that the blood patch caused the "position-independent" headache.  My wife has been examined by numerous physicians since that time, and aside from 10 minutes of complete relief of symptoms following a lumbar puncture (mysteriously, the pain returned full force following that brief period), nothing has helped her.  As you indicated in your posting, my wife was on morphine, but it did not help her.  The physicians raised the dosage as high as they dared, and then stopped the treatment when there was no response.  In fact, my wife has been on virtually all of the medications you listed in your posting.  Nothing has helped her pain, which continues to this day.  We have visited doctors across the country -- from New York City to Albuquerque, and including both Johns Hopkins and the Mayo Clinic.  No one has been able to explain how a blood patch can result in the kind of pain my wife is experiencing.  However, judging from some of the E-mail messages I have received from other patients who are suffering from head pain following a blood patch, my wife's case does not appear to be unique.  Anesthesiology textbooks seem to be very high on the blood patch as a treatment for post-dural puncture headaches, and the statistics cited therein appear to be very positive for the procedure.  Still, I am skeptical.  My wife opted for spinal anesthesia because she wanted to see her baby being born; she may never again look at that child except through a mask of pain.  Was the procedure worth it?  I do not believe so.  According to the medical literature, many women have had spinal anesthesia and subsequent blood patches, without complications.  That's small consolation to my wife, whose pain has continued unabated for 6 1/2 years.
I have observed something else that I want to share with you.  In visiting four nationally known headache clinics with my wife, I noted that, over and over, doctors changed her pain medications very quickly -- sometimes after only two, three, or four days.  I asked a leading pain neurosurgeon about this two years ago, and if my memory serves, he indicated that such medications should ideally be tried for 30 days in order to give them a fair chance of working.  Of course, that's a bit difficult to do when you've traveled many miles from home to get to a clinic.  But I cannot help wondering if one of the many, many headache medicines my wife has tried might have proven efficacious had she been allowed to give it a longer trial.  You might ask you wife's doctor about this in order to see what current medical thinking is on this subject.
I do hope your wife finds help for her headache problem.