Brief Answer:
Please describe the symptoms of your headache type

Detailed Answer:
Good afternoon. I am Dr. Dariush Saghafi and I'm a headache specialist with a private practice in XXXXXXX Ohio as well as being in charge of the Headache clinic at the XXXXXXX Stokes VA Medical Center in XXXXXXX I am never of the opinion that anyone has to "learn to live with headache pain" so long as the patients are also willing to do what it takes on their parts to get me the information I need to help diagnose and ultimately treat them.

First question would be for you to describe in as much detail as possible the characteristics of your ocular migraines as well as describing their average duration when you do get them, their average pain intensities on a scale of 0-10/10. Please keep in mind that my interpretation of a headache graded as a "10" is one whose severity of pain or of the symptoms (nausea/vomiting/sensitivity to light, sound, smells, etc) is so great that the patient MUST GO TO THE ER of a hospital. If the patient stays at home for the duration of the headache then, it must be graded as a 9 or below. So again, what is the average intensity of your pain with these headaches? What is the average duration of these headaches? What is the minimum and what is the maximum amount of time you've had a single episode of headache. Are you able to get more than one headache in 24 hrs.? If so, How many is your record?

Can you give me other symptoms such as tearing, redness, nasal stuffiness in the nasal passage on the same side as the eye that is affected? What time of the day do these headaches typically occur? Has the term "cluster" headache ever been thrown out there as a possbility?

Have you ever filled out a headache diary which has been SERIOUSLY reviewed and paid attention to by the doctor who then, has made reasonable recommendations using the information from the log in terms of medications and/or interventions?

Have you ever been recommended to try non-medication types of regimens to treat your headaches?

Was there any trauma to the area now affected by these headaches?

How about telling me a little about the medications or other interventions that have been tried? I don't need doses necessarily just medications in general...I'm particularly interested in knowing the recommendations of the neurologists you've seen. Do you currently follow with a neurologist? If so, what is your regimen?

I also need you to understand the following- this platform for medical opinions and questions does not provide specific treatments, medications, or protocols for a particular patient but rather the goal is to help with general explanations and direction that patients can then, take up with their primary or specialty doctors who are physically following or treating them. We do not nor can we prescribe medications through this software and once again you are asked to follow up specifically with your treating physcians for that sort of service.

Let me say also that if you'd like to direct any questions to me in the future and I do hope you will then, please write to me at:

bit.ly/drdariushsaghafi

Otherwise, if there is useful information in this response and you are so inclined would you do me a big favor by leaving me a little written feedback with a STAR RATING of this inquiry? I hope I've given you a bit of insight into your question.

Also, if there are no other comments or questions would you please consider CLOSING THE QUERY on your end so that the network can properly credit this work and archive it for future reference?

This query required 28 minutes of physician directed time for review, research, and final draft documentation for envoy.

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Brief Answer:
There are preventative and acute measures

Detailed Answer:
Thanks for sharing additional details. Although you may have OCULAR migraines typically that variant only affects 1 eye and you didn't really mention this problem affecting just one eye which then, may throw your diagnosis into another category of either retinal migraine or for those events where there is absolutely no headache at all you may be said to have either ABORTED MIGRAINE or ACEPHALGIC MIGRAINE. Do these interfere with your ability to carry on either work activities or social activities such as driving, eating, or being out with family or friends?

If so, then, I would argue that treatment should be sought and in fact, does exist in more effective forms now compared to 10 years ago since medications are available that can cut these aura and the headache off in less than 15 minutes.
In terms of prevention there are non-pharmacological means of trying to avoid such headaches. Here is a list of known or suspected triggers I give to all my migraine variant patients. Of course, it doesn't necessarily have a 100% hit rate for everyone but the majority of my patients who religiously follow these lists can document by way of their headache diaries definite decreases in either duration, frequency, or intensity of symptoms. I pass that list to you for your consideration:

Stress, Smoking (includes 2nd hand smoke from others), controlling High
blood pressure, regular Exercise (aerobic type better than static weightlifting
etc.), Bending over, High altitude, Dehydration, hypoglycemia (Low blood
sugar), Excessive heat (ambient temperature <85 deg F for least risk to suffer
headaches)

If I were in your position and I'd never have documented these headaches by way of a diary I would recommend doing that (even if they are infrequent) just to get some truer numbers when it comes to timings, other potential triggers that you may not have ever noticed, frequencies, severity of the headaches, recognition of characteristics of those episodes where headaches are present vs. not), etc.

I ask that all my patients fill out such diaries for analysis and think it is the very best way to approach HA's no matter how infrequent or unobtrusive they are.

Recent data and information does suggest that we be more concerned and aggressive about treating the aura of migraine headaches as best as we can as it is becoming more apparent that such headaches represent risk factors for stroke in their subjects.

And so, again, you may wish to discuss this with your neurologist but I would suggest consideration be given to triptans in injectable, wafer, or nasal spray format as having the best chance of working in situations that are as short lived as what yours appear to be. There is another road to follow in terms of prevention for these types of headaches but that would require a long term commitment to a regimen which may be difficult to gauge in terms of efficacy for some time and again would require keeping track of things on a diary or log....first at baseline for a period of about 6 months and then, away you go on therapy for another 2 years with the idea of actually suppressing the headaches permanently if successful.

I am happy to share a copy of the headache diary that I use in my headache clinic at the XXXXXXX VA Hospital and in my private headache practice if you would like to consider using it or knowing more about it but I do believe these headaches can and probably should be brought under better control...not only for your comfort but to lower your risk for complications in the future, most importantly, stroke.

Once again any direct questions to me in the future will get to me if you write to:

bit.ly/drdariushsaghafi

Otherwise, if there is useful information in this response would you do me the favor of leaving some brief feedback with a STAR RATING?

Also, if there are no other comments or questions would you please consider CLOSING THE QUERY on your end so that the network can properly credit this work and archive it for future reference?

This query required 55 minutes of physician directed time for review, research, and final draft documentation for envoy.

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Brief Answer:
What is the actual timing on your episodes

Detailed Answer:
Good morning. Thank you for the additional information and sorry if I have been unclear on anything but perhaps if I simply bullet point what I'd like you to focus on that would be better than giving you too much of a discussion.

First of all I want to be clear that in terms of the type of headache you have, it's not clear TO ME that you have ocular migraines since those typically only affect one eye and typically there is no headache at all. It's purely aura and then, it's gone. Aura can last in ocular migraines up to 60 min. They often times DO NOT INTERFERE with a person's daily activities and most people can continue doing what they were doing even during such episodes.

You state that it is "both eyes and of course they interfere with daily activities." You also told me that USUALLY you get headaches afterward of a light or minor nature and sometimes not at all.

Secondly, the actual duration of these events is also not clear. In one of your messages you say they usually run 20-30 min. and then, in this last messages you changed that to 15-20 min. The difference of 10-15 min. in the total duration can make a difference to the recommendations of acute treatment as opposed to prophylactic treatment so that needs to be clarified more precisely.

And so here is my bullet list for you based on what you've said:

1. I believe in order for me to know exactly what type of headache you have and exactly how long they tend to last you will need to fill out a headache diary. Only in that way will we know whether or not acute treatment in the moment is worth trying or not.

2. Recent research information on migraine variants such as what you have is that AURA BE TREATED in order to reduce the risk of stroke for individuals. Again, if it turns out that they are simply too brief to reliably treat with a triptan (and there are triptan presentations out there that will extinguish auras and headaches in 10 min. or less) then, the recommendation is they be treated prophylactically. Again, just another a reason we utilize a diary though as you point out it may be days, weeks, or months between episodes.

3. It seems to me you're not clear on how to proceed since your neurologist(s) have convinced you for so long that these are really untreatable and you'll have to just "learn to live with it."

4. I'm saying that's not necessarily the case but for me to be more secure in that statement I would need more information on your headaches. This is difficult since you are not physically in front of me. However, I have offered to send you a log and spend the time necessary teaching you how to use it.

5. I think your best bet if you agree to do more investigation on this matter is to learn how to fill out the headache diary and then, find a HEADACHE SPECIALIST who is knowledgeable in the different approaches to treat these sorts of migraine variants which are shorter in duration, not predictable in their occurrence, and apparently occur relatively infrequently.

And by the way, I'll let you in on a little secret. I have first hand experience with these entities and completely appreciate their unpredictability and long duration between bouts. Mine on the other hand have NEVER been associated with a headache afterward and sometimes involve both eyes while other times only involve 1 eye. Their duration, like yours, is short lived...probably on the order of 20 minutes or less. they have not interfered with activities to the point of having to stop doing what I was engaged in to wait for them to disappear.

Once again, I give you my direct web address to send messages after this query is closed if you'd like to continue any discussions.

bit.ly/drdariushsaghafi

Otherwise, if there is useful information in my responses would you do me the favor by leaving some written feedback with a STAR RATING of this inquiry? I hope this last message more clearly presents my point of view on what is available in terms of treating this problem and the fact that I believe it is treatable.

Also, if there are no other comments or questions would you please consider CLOSING THE QUERY on your end so that the network can properly credit this work and archive it for future reference?

This query required 32 minutes of physician directed time for review, research, and final draft documentation for envoy.

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