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13 Apr 2006

24 Hour Headache
Please can you help me. I have been suffering from headaches for almost ten years now. They last for 24 hours and up to 6 months at a time. My GP has prescribed every migraine, anti - epilepsy, beta blocker and pain tablet availible and no longer knows what to give me as nothing even budges the headache. Sometimes it gets so severe that it feels like someone is twisting my brain and trying to pul it out of my skull. I have also noticed that my one pupil is bigger than the other one. I have had a black and white MRI scan done a year ago. It indicated that I had either a sub - arachnoid cyst and/or focal atrophy due to a head injury(I do not recall ever being dropped on my head or sustaining any other form of head injury). But the radiologist report was not very specific.

When I was a young girl I consulted with a Ear Nose and Throat specialist. He did an MRI scan on me back then and on the medical report he wrote he indicated that I must have broken my nose at some time in my life ( I was not aware of this either). He said that there was alot of secondary thickening of the tissue in my nasal cavities and they would eventually grow totally closed. I would develop breathing problems later in life.

I am so tired of having a headache everday and wish for a headache free day. I wish the doctors could get to the root of the problem as it is hindering my normal every day activities.

My GP has referred me to a DR PIERCY MILLER practising from BEDFORD GARDENS. Apparently he is distributing a medicine to treat everyday headaches (the medicine has not yet been approved for dispensing). I have not yet consulted with hime as this concerns me.

Answer 1,281 views
Headache expert
Headache expert

01 Jan 0001

Dear Head Banger,

Prophylactic or preventive medications may sometimes be effective in certain headache or migraine sufferers, but the results have generally not been encouraging. There is also the very real problem of side effects, which can be more unpleasant than the headaches. A large percentage of people who have been diagnosed preventive medications stop taking them either because they are not effective, or because of the unpleasant side effects. I can’t comment on the medicine that Dr Miller is dispensing, unless you find out the name of the drug. Is it a preventive drug, or is it a “rescue” drug that you take when the pain comes?

If it is a rescue drug, then please be warned that one of the main problems with taking painkillers for headaches is that it often leads to Medication Overuse Headache (MOH). MOH is a problem that occurs in headache sufferers who have to take painkillers on a regular basis - the headaches become more frequent and more severe! Because of this, the patient increases the dosage and takes the drugs more often, and a vicious circle is set up, making the headaches worse and worse. This can happen with any of the painkillers, but is far more likely to occur when the medication contains more than one drug, and especially if it contains caffeine or codeine. When the three are combined in one pill, there is an even greater likelihood of MOH developing. The worst culprit is a substance called ergotamine, which is sometimes included in the “migraine kits” commonly available from pharmacies. Please examine the box or insert of the medications you use, and check what they contain, or ask the pharmacist. And remember - MOH can also occur with prescription headache medication.

The answer though is not to rely on medication or painkillers! The correct way to deal with the problem is to have a proper diagnosis of the causes of the headache. If the causes are treated, the headaches no longer occur, and it is no longer necessary to rely on potentially harmful “rescue” medication.

To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.
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