QUESTION: I would like your advice with a problem my daughter has had a few times, and with which she presents regularly at the emergency room. She has suffered from severe migraines since early childhood, a condition that was passed on by her father and has made her life a living hell at times.
Her diagnosis was accurate and she has attended the headache clinic and had several consultations and some minor surgical procedures done. She takes Amitriptyline at night as prophylaxis and has an arsenal of analgesics, all the common ones for self-treatment.
The problem arises when the pain is out of control and I fear sometimes she might do herself harm, as the pain appears to be unbearable.
We do understand that casualties are busy and staff are dealing with life-threatening events. However, to just offer her Panado and Brufen, which she already has, seems totally inadequate. She gets told that there is nothing else that they can give her when she arrives. Can’t emergency centres screen for migraines quicker so that sufferers can get help sooner?
How can I advise her on the way forward if I am concerned she is addicted to pain-killers or that she can cause other health problems due to all the drugs in her system.
ANSWER: Headache is not always a simple clinical condition to treat due to the fact that the symptom is part of many different illnesses. The truth is that the impact of this on our lifestyles can be devastating.
The latest evidence-based research shows two medical treatments that are useful in migraine prevention, these are Sodium Valproate and Topiramate. The use of beta blockers for prevention is effective in less than 10 percent of migraine sufferers. This should only be considered when the frequency of migraines specifically is regular and influences your daily functioning – work, home and play.
When one manages to decrease the amount of medication needed for acute attacks with effective prophylaxis – we can help the issue of medication-overuse headaches.
Medication-overuse headaches and migraine can be quite complex to manage but need rigorous follow-up and strict guidance by an experienced neurologist or physician. No medication is without side effects and it certainly sounds like she suffers terribly. I would suggest a follow-up consultation as soon as possible as clinical syndromes can change and there might be more complex issues at play here.
Migraine prevention encompasses many disciplines besides drugs. Things like mood and sleep, as well as stress-coping mechanisms are vital. The role of diet is something I talk on regularly to headache sufferers.
Regarding the prioritising of emergencies in any casualty – a triage system is in place to protect the patient and the health-care provider.
This system is transparent in revealing which patient should be seen urgently due to various parameters, like blood pressure, observations and pain scores.
Unfortunately even this system is only as good as the trained individual running the triage.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus