Migraine Headaches; Pediatric Tylenol; Medical Marijuana

Migraines affect many people, & those of us who have had one know how debilitating they can be!  Some get them while they are young & some when they are older.  Many women get "menstrual migraines," which occur monthly with their menstrual periods.  Others, like myself, get them with menopausal changes.  Some people get them due to food or alcohol.  These headaches often have "warning signals" such as neck stiffness, food cravings, emotional changes, & irritability which can occur 1-2 days before the headache.  Some people have an "aura" which occurs before the headache as well.  These can be visual, such as seeing squiggly lines or flashes of light, but they can even be as frightening as stroke-like symptoms, including pins-&-needles sensations, difficulty with speech, & even weakness in an arm or leg.  Once the headache strikes, it is generally on one side of the head, & the pain is usually throbbing or pulsating in nature.  There is usually an increased sensitivity to light & sound, as well as nausea & vomitting.  Some people feel light-headed or dizzy.  These headaches often last 4 hours to 3 days if not treated, & once they resolve, the person still might feel exhausted for a day or two. 

If you have a severe migraine, especially one with neurologic changes, you will want to see a physician to be sure it is not a stroke or brain mass, as your first episode will be frightening, even to your doctor!  However, once you are diagnosed with migraine headaches, you can rest pretty comfortably in knowing that your migraine will usually follow a predictable pattern... that is to say that although we can describe migraines in many different ways, each person's pattern will be unique yet reproducible!  So if you get neurologic symptoms followed by a severe headache, that is your unique pattern, & should not be frightening unless something changes

Once you have established that you have migraines, you can try over-the-counter medications such as Excedrin Migraine to treat them.  If this is not strong enough, you might want to get a prescription medicine such as Esgic Plus (which is similar to Fiorinal Plain), or perhaps Midrin.  If this is not effective, the doctor can prescribe stronger medicine such as a "tryptan."  These include ImitrexMaxaltAmergeAxertRelpaxFrova, & Zomig.  These stronger medications have become the mainstay of treatment for migraines as they work so well, but they can be very expensive... consider trying Imitrex as it has a generic, so it should be cheaper!  Also, there are various forms of these tryptans: some are pills to swallow, some are pills that melt in your mouth (good if you need to take a dose immediately & have nothing to drink), some are nose sprays, & some are even injected by the patient.  If you have cardiovascular disease (such as chest pain from your heart, previous heart attack or bypasses, stroke or near-stroke called a TIA) you should probably avoid the tryptans as they do change blood flow in your body & can trigger chest pain, heart attack, or even stroke.  Don't forget, some migraines respond well to Chiropractic treatment or Physical Therapy, so it is worthwhile to see one of these specialists for evaluation & treatment.  I have had therapy with great results, & since I had cold laser treatment by Diane Hartley at Hartley PT, I have not had a full-blown migraine!  Dr. Thorpe of Thorpe Chiropractic also does treatment for migraines, which likely involves treatment of the neck (cervical spine).

Now that we've discussed treatment of migraines, let's go backwards a bit to talk about prevention of migraines.  First, if you can identify something that triggers the headaches, try your best to avoid it!  If that doesn't work, you can always treat the headahces as above, but if you experience frequent or truly debilitating migraines, you should consider asking about something to prevent them.  These options include several blood-pressure medicines:  1) Beta-blocker medicine such as Corgard, & 2) calcium-channel blockers such as Verapamil.  These are very affordable, but they might both slow your heart rate (especially the Beta-blocker) & lower your blood pressure.  The Verapamil might also constipate you & can cause your legs to swell.  Your physician will be able to help decide if one or the other is appropriate for you.  Elavil is another very affordable option to prevent migraines.  It is an old tricyclic anti-depressant which works great, but which can cause constipation, sleepiness (so take it at night!), & weight gain.  To treat depression you would have to take at least 150 milligrams per day, but you only need 10-30 milligrams for headache prevention.  It also helps treat TMJ (temperomandibular joint dysfunction) & tension headache, both of which can somewhat mimick migraine!  Lastly, Topamax is an anti-seizure medicine which also prevents migraine.  It's downfall is the drowsiness it causes, thus it is sometimes called "dopamax."  If you try it, start with a low dose & slowly increase it, as this helps you tolerate that side-effect.  It is interesting to note that it causes weight loss, but desite this, very few people will take it long-term!

Obviously there is a lot to know about migraine, & a lot of choices when it comes to treatment &/or prevention.  Be sure to pay attention to your pattern, & then discuss with your doctor to choose the best option for you.  And remember, it might take several tries to find the best regiment for you!

Did you know that there was a change in the formulation of pediatric Tylenol?  Apparently there was some confusion because there were different strenghts of the Tylenol liquid which lead to over or under-dosing of children.  So Tylenol has been re-formulated to one standard concentration:  160 milligrams per 5 cc.  Note that 5 cc are equal to 1 teaspoon, so there are 160 milligrams of Tylenol in 1 teaspoon of the new suspension.  If you buy this strenghth, it can be used for newborns as young as 1 day old & 6 pounds to children 11 years old & 95 pounds. Of course, always speak with your physician before you give Tylenol to infants less than 3 months old, as these little guys often do not give us big hints that they are ill.  Something as simple as a low-grade fever can be a sign of a very significant illness, & as such would warrant further evaluation INSTEAD of simply masking the illness by treating the one symptom (fever) with Tylenol!

Lastly, someone brought up the issue of marijuana being used to help with chronic pain.  She indicated that she uses chronic narcotics for pain control, but when she had the opportunity to use marijuana, she was able to decrease the narcotic use.  She noted that this is legal in New York state, though it is not in Florida.  I am not aware of any legislation to legalize this in Florida, but I would love to see something other than narcotics available to help chronic pain patients!  As you likely know, Florida is the number 1 state for narcotic abuse, so there is no denying the problem we have with narcotics!  Though I have no proof of the safety of marijuana, I must say that I have no knowledge of a "pot-head" who murdered for his fix, much less one who "overdosed" & died getting his fix!  I hope there is more research being done, & I hope this is NOT going to be another situation where politics block access to good medicine!  Stay tuned, & stay involved!

Here's to our health!