Menu

topiramate

A Nail in the Head: Short-lasting Unilateral Neuralgiform Headache Attacks

1

An article with “short-lasting unilateral neuralgiform headache attacks” in the title isn’t necessarily going to catch your attention, but if you’ve experienced this type of headache, you know it’s not something that can be ignored.

Earlier this week we saw a video of Rev. David Wakefield, who has both chronic cluster headache and SUNCT, a form of the headache we’ll be talking about today. If you missed the video, see New Device Approved by FDA to Fight Cluster Headache (video).

SUNCT and SUNAWhat is officially called short-lasting unilateral neuralgiform headache attacks is actually one type of chronic daily headache. The headaches last only seconds or minutes (as long as ten minutes), but they are very painful and hit you at least once a day. The pain is on one side of the head, and the eye on that side will usually get red and watery.

As the title to this article implies, the pain is often described as “stabbing”, like a nail in the head.

With the red eye and tearing, the diagnosis is usually SUNCT, which stands for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. That’s the version that Rev. Wakefield deals with.

If there is tearing (watery eye) or red eye, or neither, the diagnosis may be SUNA, or short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms. These headaches are accompanied by other symptoms that may occur in SUNA or SUNCT, such as congestion, facial sweating, and drooping or swelling or the eyelid.

Because of the congestion and tearing, SUNCT or SUNA may actually be misdiagnosed as sinus headache (more commonly, migraine is misdiagnosed as sinus headache – see Sinus Headache – Did You Really Beat It?).

Technically, the condition is considered “chronic” when it continues for a year or more, with less than a month pain-free.

Treatment of SUNCT and SUNA

There are some treatments that seem to help some people, but there have not been enough clinical trials to come up with consistent solutions (if they exist – treatment may be a very individual thing, especially until our understanding of the condition grows). Because the attacks are so brief, abortive treatment (stopping individual attacks) is not a major focus. Intravenous lidocaine or a phenytoin injection are sometimes used to try to stop a series of attacks.

To prevent attacks, medications such as lamotrigine, carbamazepine, gabapentin, and topiramate seem to help some patients, and nerve blocks may provide temporary relief.

Sometimes a certain cause is found for these symptoms, in which case treatment will vary. For example, compression of the trigeminal nerve or a structural lesion.

For more information, see:

New Study Questions Preventative Migraine Drugs for Kids

, 0

Just how effective are migraine drugs for kids? A new study is raising some interesting questions about whether or not we should be relying on them.

The study, published in the New England Journal of Medicine, tested topiramate and amitriptyline, both common preventatives. 328 children and adolescents were involved in the trial, which randomized, double-blind and placebo-controlled. A 24 week trial of the medications took place, and a 28 day window of results was compared – once before the medication, and once at the end of the 24 weeks.

The goal was to see a reduction of symptoms of at least 50%. So – how did the medications do?
Amitriptyline trial
As you can see, 52% of those on amitriptyline had a 50% or more reduction in symptoms. Pretty good. Let’s check out topiramate:
Topiramate trial
Even better – 54%. But here’s the problem. Being an well-designed trial, some of the patients were given a placebo – they didn’t take any medicine at all. How did these patients do?
Placebo success
That’s right, the ones who thought they might be taking medicine, but weren’t – they did the best of all.

To further complicate matters, some of the patients experienced side effects from the topiramate and amitriptyline – in some cases, quite serious ones.

Now before we completely write off preventative drugs for children and youth, there are some things to consider. First, this trial only tested one formulation and dose each of two drugs. There are a lot more options out there.

Second, it could very well be that some of these children were greatly helped by the medication who would not have been helped as much by the placebo. Remember, many patients saw a significant reduction in symptoms, and in some cases the medication may have helped with that.

But although this should not be a reason to write off preventative medications for children with migraine, it should suggest that you’ll probably want to try other treatments first – especially non-drug options. Diet, exercise, and certain complimentary treatments are excellent options for children. Take for example biofeedback, physiotherapy and certain supplements.

For more information, see the study abstract here: Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine

Also see: Dealing with child migraines? and Pediatric Migraine Medication

Child Vertigo

Good News for Children with Vertigo

, 1

What causes vertigo in children? Common causes would have to include the inflammatory diseases known collectively as otitis media. Otitis media will often go away by itself, and the symptoms can be managed by mild pain killers. In some cases, antibiotics may be needed. If the disease keeps returning, your doctor may recommend “tubes” in the ears to help drain the fluid. (More about Middle Ear Infections)

But next to that, there are many children who have vertigo which is harder to diagnose. If the eardrums look normal, and there are no inflammatory diseases, what’s the solution?

Well, we have good evidence that the most common cause of this vertigo is migraine. According to one study (see Various causes and clinical characteristics in vertigo in children with normal eardrums.), migraine and benign paroxysmal vertigo of childhood (BPVC) account for over half of the cases of vertigo, the rest being more tricky.

How can this possibly be good news?

Well, catching migraine early in life leads to some major benefits later one. Also, getting a proper diagnosis (as opposed to “just lie down if you feel dizzy… maybe it’s stress…”) can lead to much better treatment.

Child VertigoResearchers and health professionals are still trying to figure out what to do with dizziness in migraine, especially if it is a major and repeating symptom. Sure, we know some clear types of migraine where vertigo is common, but the rest of the cases are harder to classify.

So we have a category that we call “vestibular migraine”. In vestibular migraine, the vertigo is moderate to severe, and it happens multiple times. At least 50% of the episodes have some of those common migraine symptoms, such as a one-sided headache. But sometimes the vertigo just comes by itself.

Some of these attacks can last for hours – even days. And if the symptoms are severe (even if there’s no headache), the patient will be completely unable to carry on with normal activities.

But the good news is that these episodes can be treated with typical migraine medications and treatments (which also further confirms their connection to migraine disease).

Last month a report came out of Boston Children’s Hospital, illustrating some of their experience with children with vertigo, and in particular vestibular migraine (Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic.).

When the patients tried the following medications (all of which are drug types used for migraine), 80% or more were successfully treated:

  • tricyclic antidepressants
  • cyproheptadine (an antihistamine)
  • topiramate
  • triptans

Gabapentin, which is an anticonvulsant, was also used. It was effective in 25% of cases.

If your child complains of dizziness (and possibly nausea), and is also getting some headaches (not necessarily at the same time), talk to your doctor as soon as possible. If there is no obvious ear problem, there’s a good chance that migraine is to blame.

Because any of these diseases (migraine, otitis media, BPVC) can have a major impact on your child’s normal activities and development, it’s very important to get proper treatment as soon as you can.

Language Disturbances During a Migraine Attack: Poll

12

Do you have trouble speaking during a migraine attack? Well, most of the respondants to our recent poll do – at least some of the time.

The question was: Do you have trouble with speech during a migraine attack (trouble remembering words, slurring, etc)?

And here are the results:

Language disturbances during migraine (poll)In the end, 42% said “Always”. In fact, over 90% had experienced some language difficulty during attack.

Although those who had problems are the most likely to take part in the poll, this still shows that there are huge numbers of people who have issues like:

  • Trouble thinking of a word
  • Trouble saying certain sounds
  • Stuttering
  • Slurring

Problems like this are actually quite common in migraine. They also tend to be worse with certain medications, such as Topamax (topiramate).

If you’ve experienced language trouble in migraine, leave a comment and tell us what it was like. You’re probably not alone!

Topiramate + Nortriptyline (and another reason why treatment is not simple)

, , 1

We’ve talked about nortriptyline, an antidepressant commonly prescribed for chronic pain, and topiramate, an anticonvulsant often used for migraine in particular, in the past. As you can see from the comments people leave here, both have been a wonderful help – or haven’t been so great – depending on the patient.

It’s not unusual for someone to try one or the other, discover that they’re still having migraine attacks, and drop the medication permanently. But that may not always be the best option.

A study published in the Journal of Headache and Pain in 2010 tested both of these medications together as a migraine treatment.

Researchers started with patients that had experienced less than 50% reduction in symptoms with either topiramate (Topamax) or nortriptyline after trying either one for eight weeks. 78.3% of the patients improved more when taking both together than when taking just one.

It is not unusual for a combination of treatments to be better – sometimes drastically better – than one or the other. This is just another example.

When your doctor suggests you retry something you’ve already tried – but this time with something else, whether it be a supplement or drug or other type of treatment, don’t brush the idea aside quickly (even if the drug didn’t work in the past at all).

On the other hand, be very cautious if you have experienced significant side effects in the past. For example, when it comes to topiramate watch out for heart palpitations or chest pain, visual changes, weakness, confusion, or a loss of appetite. For nortriptyline, common things to watch for are depression, trouble breathing, seizures, fever, fatigue or weakness.

And remember, never change your dosage without checking with your doctor.

Thanks to:

Load More

Back To Top
The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.