Page 14 - Boca Club News - September '20

Page 14, Boca Club News
Health & Wellness

Medical Matters: Headaches

By Richard Nagler, M.D., a member effective oral Ubrelvy (70 % of cases) and Nurtec ODT, with no pain-free periods, strictly unilateral, very severe,
of Broken Sound Club and retired where a single orally administered tablet easily dissolving and may mimic cluster headaches and migraines. Tearing
physician. After graduating from in the mouth prevents migraines in 86% of patients, with and redness of the affected eye, nasal congestion, a droopy
the University of Pennsylvania infrequent nausea as the only side effect. eyelid, narrow pupil and extreme restlessness occur. It
and New York University’s School Cluster headaches develop in patterns that can last daily involves inflammation and irritation of the trigeminal nerve.
of Medicine, Dr. Nagler served for weeks or months followed by periods of remission The most important distinguishing feature is the dramatic
his internship and residency at with no headaches for long periods of time. They are very effectiveness of the anti-inflammatory drug Indocin in
Baltimore City Hospital and Johns painful on one side of the head. They come on quickly, relieving the pain.
Hopkins. He followed that with a often awakening the person from sleep with no warning There are many other underlying causes of chronic
Fellowship in Gastroenterology at Yale University School and include nausea, tearing in the eyes, pale skin, flushing headaches, and for that reason anyone who suffers from
of Medicine, and was then Chief of Gastroenterology at of the face on the affected side, drooping of the eyelid, and them must be carefully evaluated. Of vital importance
Fitzimmons General Army Hospital in Denver. He returned a stuffy or runny nose. They are more common in men ages is to obtain a careful historical account of the patient’s
to the Yale Medical School for one year as an Assistant 20 to 40. The cause is unknown. Because they come on lifestyle involving caffeine usage, smoking, sleep apnea,
Professor of Medicine before opening his own successful suddenly, a fast-acting treatment is needed. The best is for anxiety, depression, and obesity. A thorough evaluation of
private practice in Internal Medicine and Gastroenterology. the patient to inhale pure oxygen, which affords dramatic symptoms which involve any headache that recurs more
During that time, he also served for ten years as Chief of relief. The problem is having access to oxygen, which than two to four times a week should include noting if the
Medicine at Huntington Hospital in Huntington, N.Y. can be provided by having a small portable unit available. patient is taking pain relievers most days and more than the
Almost every person suffers from occasional headaches, Ergotamine, as well as intranasal lidocaine, Verapamil, a recommended dose, any significant change in the headache
but 45 million of us have a problem with chronic headaches, short-term course of prednisone and lithium may prevent pattern, whether the headaches are disabling, and do they
which are often disabling. These are defined as any type of attacks. A nerve block of the occipital nerve with an worsen despite medications. Are the headaches sudden and
headache that occurs at least 15 times a month and continues anesthetic, combined with cortisone, is effective. There severe, is there fever, a yellow or green nasal discharge,
for six months or longer. are surgical techniques being tried with occipital nerve facial numbness, a stiff neck, double vision, a seizure,
Tension headaches are the most common type found in stimulation, deep brain stimulation, and neurotransmitters weakness, numbness, difficulty speaking and was there
our country. They produce a mild to moderate dull aching implanted in the brain and operated by the patient with a head injury with a concussion? A complete neurologic
pain described as a pressing or tightening sensation on a hand-held device. As in the prevention of migraines, examination followed by skull and cervical spine x-rays,
both sides of the head, the back of the head and across the Emgality injections are effective in preventing cluster sinus x-rays and a CT scan or MRI is essential to rule out
forehead. Other associated symptoms include a stiff neck headaches as well. brain tumors, brain aneurysms, strokes, extremely common
and shoulders and scalp tenderness. Symptoms may wax Hemicrania Continua is a form of chronic headache sinus headaches, cervical arthritis and spinal disc disease.
and wane and are rarely incapacitating. These headaches are
often precipitated by stress, anxiety, depression, sleeping
disorders and skipping meals. Treatment usually involves
over-the-counter NASAIDS, such as Advil, Motrin and
Aleve, as well as Tylenol, which have a moderate beneficial
effect. Prescription medications---such as Naprosyn, anti-
depressives, anti-convulsive drugs, massage, acupuncture
and biofeedback---are useful, while opiates, initially
effective, tend to lose that benefit with longer term use and
are very addictive.
Migraine headaches are very common, with 47 million
people affected--women predominating two to one,
especially between the ages of 10 to 40. Many have a
chronic problem with at least 15 episodes a month. For
many patients they are disabling. Migraines are usually
severe, mostly occurring on one side of the head with
a pulsing throbbing sensation associated with nausea,
dizziness, vomiting and sensitivity to light, smells and
sound. Lack of appetite and constipation occurs. It is
made worse by any form of movement, or even modest
exertion. About 20% of these persons experience an aura
before the headache begins, usually of visual phenomena
such as floaters, flashes of light, moving or zigzag patterns,
and even loss of vision with blind spots. Some sufferers
experience tingling and numbness over the hands, face,
lips and tongue on one side of the body. Abnormal bursts
of energy, neck stiffness, yawning and frequent urination
are seen.
Many of these people have other problems that
exacerbate their migraines, including fibromyalgia, sleep
apnea, depression and anxiety. They often suffer from
medication overdose. There is a genetic predisposition
to develop migraine headaches. Hormones such as
estrogen and serotonin are involved as supported by the
fact that migraines lessen or disappear after menopause.
Most migraine headaches are triggered by red wine,
artificial sweeteners, aged cheeses, nitrate preservatives,
monosodium glutamate, chocolate, dairy products, alcohol
and birth control pills. Other triggers are over-exposure to
bright light, loud noise and strong smells. Avoidance of
these triggers can be effective in preventing migraines.
Treatment: Over-the-counter medications such as
Tylenol, Advil and Aleve are of minor use, but prescription
medications for hypertension, such as Inderal, colgard,
tenormin, lopressor and verapamil are more effective.
Imetrex orally or by injection is 70% effective in prevention,
with some undesirable side effects in about 20% of patients.
Anti-seizure and anti-depressant medications, lithium,
magnesium infusions, riboflavin and vitamin B 12 have
some benefit. Adequate hydration and yoga are helpful.
Botox injections around the head and neck given every 12
weeks have been shown to significantly reduce migraine
headaches in 66% of people.
However, most encouraging is the recent development
of several newer modalities of a much more effective
treatment for migraines. They include Emgality, which is
injected monthly and has been proven to cut the frequency
of these headaches in half in 60% of patients. However,
there are limitations in its use due to adverse reactions
at the injection site and severe allergic reactions that can
occur in some patients. More exciting is the dramatically