QUESTION: I am desperate for answers and seriously need some guidance. I am a ranger on a game farm and rarely have the luxury of visiting the city hospitals for tests and specialists, but am on the brink of losing my job due to debilitating headaches.
I have had these headaches for a couple of years; they come around about once a month, sometimes twice a month and sometimes only every two to three months. They last for three days in most cases, crippling me as I am forced to lie down or sleep in a dark room. I often wake up in the morning to find it is still there, with the intensity varying as the day progresses.
I have taken paracetamols and Adcodol Brufen (which seems to lessen it), and yesterday I took Prednisone too.
The headache is usually over my left eye, with some pain down my neck occasionally – also on the left side. Some mornings I experience nausea and have suffered insomnia occasionally, but mostly before the headache starts.
I work in a reserve, so I spend a fair amount of time outdoors and the rest on the computer. I eat pretty well and drink about two litres of water a day. I am reasonably healthy with no history of smoking, and occasionally enjoy a glass of wine. I don’t take any other medication but sometimes experience seasonal hay fever and sinusitis.
My family has been telling me for ages to see a specialist. I have been to doctors, but they just give the medication I mentioned or tell me it’s my sinuses and give me medication for that.
ANSWER: This is not an issue to be taken lightly, and your detailed description brings two immediate conditions to mind. When we look at headaches there are vital differentiating features that influence our management. The onset, duration and course of the headache is useful information to your physician, as is any family history that might be relevant to the condition.
There often is an overlap of syndromes, too – and not every patient’s headache fits perfectly into the textbook definition.
From your explanation it sounds like you could have a crossover of two possibilities: these are likely familial hemiplegic migraines or cyclical/catemeneal headaches. Familial hemiplegic migraines can actually resemble mild stroke symptoms with loss of sensation or weakness of the face, arm and leg and are self-limiting, with resolution only when the headache disappears. There is a strong family link to these syndromes.
Catemeneal headaches are cyclical and associated with the menstrual cycle. The periodicity and association in time helps us with this diagnosis.
A classic migraine involves a severe headache which can be unilateral or bilateral, with associated nausea and vomiting as well as visual scintillation; people describe light flashes or zigzag patterns and even tunnel vision with pain.
Interestingly, you even get migraine syndromes where the dominant feature is the aura, with no headache at all.
Treatment
Unfortunately one needs to look at prevention rather than cure. Things that trigger headaches are food, lack of sleep and infection. Also, you should have a brain scan done due to the persistent nature of your headaches, and the young age of onset.
Strategies to combat migraines
The most useful tool is a detailed
, accurate headache diary, which can help you see a pattern or trigger. The onset, duration and progression of headaches need to be recorded, as well as the associated symptoms. List all medications taken and their effect.
Lifestyle guidelines
* Get regular, routine and sufficient sleep.
* Drink less than 2 cups of tea or coffee a day.
* Drink at least two litres of water daily.
* Never miss meals.
* Avoid alcohol if you think it is a trigger.
* Exercise daily – a brisk 20-minute walk will do.
* Avoid all other painkillers for headaches (except aspirin, if you can tolerate it), as there is always the risk of triggering rebound headaches.
Natural methods
There is valid research that shows that riboflavin (also known as vitamin B2), taken regularly at a high dose, reduces the frequency of migraines. The dose you need is 400mg once daily, but be warned: it does make your urine electric yellow. This is quite harmless, but you must check with your GP first, as people with cataracts should not take high doses of riboflavin.
The second supplement which has been shown to reduce the frequency of migraine is co-enzyme Q10: studies suggest taking 150mg per day may reduce headache frequency by 50 percent or more after a few weeks. Both supplements are available as over-the-counter products at good pharmacies.
Migraine medications
Medication, like the Triptans and Maxalt RPD wafers, are useful if given early during attacks, but the mainstay of prevention is sodium valproate and topiramate.
There are studies showing the efficacy of using beta blockers as prevention in a small percentage of patients. Extensive work has also been done with the use of high doses of aspirin at the onset of migraine, with variable results.
But if this fails, do not despair. The final strategy would involve a request to your GP to consider further medications, perhaps under the guidance of a specialist migraine clinic.
Certain foods trigger migraines
* Aged cheese and other tyramine-containing foods.
* Bread, crackers, and desserts containing cheese.
* Food additives.
* Cold foods, especially after exercise.
* Peanuts, peanut butter, other nuts and seeds.
* Pizza and potato chip products.
* Chicken livers and other organ meats.
* Smoked or dried fish.
* Sourdough bread, baked yeast goods such as doughnuts, cakes, home-made breads and rolls.
* Certain fresh fruits: ripe bananas, citrus fruits, papaya, red plums, raspberries, kiwi, pineapple.
* Dried fruit (figs, raisins, dates).
* Soups made from meat extracts or bouillon (not homemade broth).
* Cultured dairy products such as sour cream, buttermilk, yogurt.
* Aspartame and other artificial sweeteners.
* Caffeine found in chocolate and cocoa; beverages such as coffee, tea and carbonated soft drinks.
* Certain medications
Cape Argus
* 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.