verapamil

2 December 2020

Prednisone Still a Key Cluster Treatment

A new study out of Germany confirms that prednisone is still a key, though temporary, cluster headache treatment.

Prednisone is a corticosteroid which suppresses inflammation. It’s used for a number of conditions, including lupus, arthritis, and some skin conditions, such as psoriasis. And, of course, cluster headache.

Patients who are given prednisone don’t generally take it long-term, for a number of reasons. Commonly, it can lead to loss of bone density. But it also suppresses the immune system, which can cause more problems. So when a specialist gives you prednisone, you gradually taper off over time, and then gradually start on another medication, such as verapamil.

In the recent study in Germany, patients started on 100mg of prednisone for 5 days, gradually lowering the dose by 20mg every three days after that. They started with verapamil as well at 120mg a day, gradually upping the dosage to 360mg daily (120mg 3 times a day) after 19 days, and staying steady there. Patients on prednisone did have fewer attacks than those without it, as expected.

The patients taking prednisone didn’t experience more side effects than the placebo group (remember, both were suffering from cluster headaches and taking verapamil). However, the group on prednisone was more likely to report “palpitations”.

Prednisone has long been recommended for cluster treatment, and many patients have found it to work extremely well. There can be a bit of a rebound after going off the medication. And, of course, it’s only a temporary solution. We continue to hope that better, longer lasting treatments will be found.

4 August 2016

MUMS – Migraine and Arm Weakness

James Information 5

Migraine researchers are struggling with a type of migraine that is just starting to be understood, known as MUMS – that is, migraine with unilateral motor symptoms. One of the most unusual symptoms is a type of weakness in one arm.

MUMS has been connected in the past with hemiplegic migraine. That’s because the key symptom with hemiplegic migraine is a kind of temporary paralysis on one side of the body.

But there seems to be a group of migraine patients who fit or almost fit the description of hemiplegic migraine, and yet they have somewhat unique symptoms.

So what is the key symptom of MUMS? Every patients with MUMS has a kind of weakness or paralysis in one arm and/or hand. Commonly it’s a kind of weakness called “give-way” “give-away” “collapsing” weakness.

MUMS - migraine with unilateral motor symptoms

Give-way weakness is diagnosed when pushing on the arm is resisted, but the arm “gives-way” suddenly for no apparent reason.

Patients with MUMS also often suffer from dizziness, numbness, allodynia (painful/sensitive areas of the skin), visual aura and other visual problems, language problems, confusion, and pins and needles.

What makes things even more scary is that the arm weakness may continue even when patients are not in the middle of an actual migraine attack.

Some patients have been confused by the discussion around “give-way weakness” and “true weakness”. Some doctors seem to suggest that the weakness is somehow “imaginary”.

The fact is that, as with many migraine symptoms, no one is sure what is causing the weakness. It may be that it’s another symptom coming from activity in the brain, the same activity that seems to cause visual auras. It’s not voluntary or imaginary at all.

Because of some of the related symptoms, such as allodynia, the give-way weakness could also be a “protective” measure, to try to avoid the pain and discomfort of other symptoms (which can be quite severe and disabling in MUMS).

Whatever the case, experts are recognizing that MUMS is certainly a real and serious problem.

MUMS tends to show up later in life than hemiplegic migraine, usually in the patient’s 30s, as opposed to the 20s.

Many patients with MUMS, as with hemiplegic migraine, are initially told they’ve had a stroke. And MRI should clarify whether or not the symptoms are from stroke.

It’s very important to diagnose MUMS, because there are certain treatments that may be more successful with MUMS than with other types of migraine. For example, as with hemiplegic migraine, verapamil may help.

Of course any first-time symptoms like this should get you to emergency right away. Stroke should be diagnosed as soon as possible. If you do find out you have a type of migraine, early treatment is also very important.

Resources and sources:

20 June 2016

Yes, Children Get Cluster Headache Too

James Information, Resources, Treatments 2

Although cluster headache usually starts in your 20s or 30s, children can, and do, get cluster too. Usually the symptoms start after the age of 10, but children with cluster have been reported as young as 6 years old.

The fact that cluster headache is extremely rare in children is no comfort to children who get it and their families who are trying to help them. Although we’ve talked about cluster headache in children before, it’s time for an update.

As with adult cluster, more males are diagnosed than females. However, a surprising number of girls get cluster as well.

But one of the biggest challenges is diagnosis. A study in 2009 of eleven children found that, on average, their symptoms began at the age of 8.5, but they went two years without a proper diagnosis.

Sadly, headaches in children are often considered to be caused by “stress” or “attitude”. However, a specialist who know what questions to ask can get to the truth a lot faster.

Another challenge is that cluster headache is not usually constant. Attacks typically last from 15 minutes to three hours. But they also go into remission. Headaches may occur once or several times a day for a while, and then disappear for months or years.

Symptoms in children tend to be similar to those in adults. That would include agitation and restless movement, one sided pain, congestion, and facial flushing and sweating. (For more detail, see Cluster Headache Symptoms)

Treatments for cluster are also similar to treatments in adults, partly because precious little study has been done specifically for children. One study found that oxygen, methysergide, verapamil, zolmitriptan and dihydroergotamine were particularly helpful for children, but that paracetamol/acetaminophen, ibuprofen and codeine with paracetamol/acetaminophen were not particularly helpful.

For more information:

2 September 2013

What is Persistent Migraine Aura?

James Information 3

Persistent Migraine Aura (PMA)

persistent aura without infarction

Migraine aura (ie visual) which hangs around for more than a week (and could last for years).

Proper diagnosis:

To be diagnosed, it must occur in a patient who has had previous migraine attacks with aura. Death of brain cells (infarction), and other related disorders must be ruled out.

Symptoms

Aura symptoms, and especially visual aura symptoms such as:

Visual snow
Flashing lights
Patterns

Treatments

Drugs such as acetazolamide, valproic acid, furosemide, verapamil, and lamotrigine

Nothing has been found that works for everyone.
PMA can be very difficult to treat.

For more information, read Persistent Migraine Aura and Visual Snow? and Visual Snow and Persistent Migraine Aura â€“ tests and treatments

Selected References: The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008; The International Classification of Headache Disorders 2nd edition 2003; Is ‘visual snow’ a symptom of migraine? Dr Paul Shanahan; Is Visual Snow a Migraine Aura?; Migraine with Persistent Visual Aura: Response to Furosemide Clinics 2009; It’s snowing! Seven cases of persistent migrainous visual aura Saint Louis University; The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008

30 January 2013

Sex Headaches

James Information, Medications, Tips, Treatments 0

Orgasm headaches or sex headaches are technically called primary headache associated with sexual activity. But that should only be after careful tests are done – as soon after the headache as possible – to rule out more serious (in rare cases life-threatening) causes.

This graphic is a reminder to see a doctor right away, and that treatments are available. Read more about orgasm headache here.