What can I do for exertional migraines?

[dan531]

I have been diagnosed with exertional migraines. I have exercised my whole life, but now it has become difficult to do.
This headache seems to have started in 2003 when I ran up to the top of the Hancock building (94 floors). I believe it triggered something in my head. When I weightlift it feels like my head will explode and then it won't go away all day and I feel light headed. I also developed high blood pressure when this started. I am currently on neurontin, which helps a little and I take verapamil for my blood pressure. I am wondering if anybody has experienced anything similar and if they were able to solve it.

[dan531]

Thanks for responding doctor. In regards to my blood pressure, it has been under control since I was put on Verapamil.I have been to 3 ENT's, who have all ruled out any inner ear problems. My headaches are on the top of my head, and are with me all day but are made worse when I weightlift. I have had an MRI and an MRI with contrast, both of which were ok.
My neuro-opthalmologist had me on topiramte, but it didn't help. I am currently on neurontin and its helps slightly. My neuro-opthalmologist says I have Vestibulo-Occular Dysfunction, which was caused by 8 years of constant headaches and light headedness. Is there anything else I can do?

Thanks,
Dan

[Dr Sharma]

Hi there. You need to be examined by a physician for control of hypertension. Migraines can be controlled by avoiding triggers if known, preventive medicines like topiramate and drugs for control of an attack as if triptans, ergots etc. consult a physician for evaluation. These headaches could be due to stress, anxiety, migraines or tension headaches, sinus headaches radiating to the ear, headache usually front of head, on one or both  the sides of temples along with nausea, vomiting, irritability, low blood pressure, sensitivity to lights, sound, etc. aura associated with migraines could include blind spots, blindness in half of your visual field, paresthesia, weakness or visual hallucinations. Your vision needs detailed testing by an ophthalmologist. Hypertension and hypotension need to be checked. An MRI brain is warranted to rule out any intracranial lesion particularly aneurysm and MRI spine for ruling out cervical spondylosis and degenerative disc disease.  Temporal tendinitis mimics migraines including TMJ pain temporal headaches, tooth sensitivity, neck and shoulder pain. Treatment includes injecting local anesthetics and other medicines, moist heat muscle relaxants and NSAIDs along with physiotherapy. Multiple sclerosis would also need to be excluded. Treatment for migraines include drugs that prevent the attack like anti convulsants and drugs which treat an attack like triptans, ergots etc your queries should pertain to all these possible differential diagnoses. Trigeminal neuralgia needs to be considered. If the neurologist and radiologist are suspecting a cerebral aneurysm, they can confirm with cerebral angiography and clipping of the aneurysm could be done. Hope this helps. Take care.