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Dr. Andrew Rynne

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Have migraines and cluster headache. How to get relief?

Answered by
Dr. Sudhir Kumar


Practicing since :1994

Answered : 5686 Questions

Posted on Wed, 2 Jan 2013 in Brain and Spine
Question: I have been told I have migraines and cluster headache, but it doesn't really fit because always bilateral. Main pain is severe stabbing behind nose, which lasts for many many hours, with some weird sensation in upper teeth and lower forehead. Also, I at other times get tingling in my scalp, nausea, bad headaches, sensitivity to noise, smells, etc. It is getting more frequent - 50% of time in last 2 months or so. I used to get visual migraine auras but rarely do now. I really need a diagnosis and also a treatment regime which will work. I have already tried triptans but they did not work for me. I have tried verapamil and it did appear to help, but unfortunately it made me unmanageably constipated, much worse than the opiates I took when recovering from hip surgery. I am worried about trying beta blockers because I already suffer from problematic fatigue.
Answered by Dr. Sudhir Kumar 7 hours later

Thank you for posting your query.

I can understand the discomfort you are having on account of your headaches.

I also feel, the most dominant part of your headaches are because of migraine. Bilateral headaches can occur with migraine. A feeling of nausea or vomiting, sensitivity to light and noise, getting triggered with smells, etc favour a diagnosis of migraine.

I presume an MRI scan of brain has been done to exclude any other problem, causing headaches.

I feel the best drug for you would be divalproex sodium. In addition to migraine, it has efficacy in cluster headache and on mood symptoms.

In refractory cases that do not respond to oral medications, Botox injections would be useful.

I hope it is helpful. I would be pleased to answer any follow up queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudhir Kumar 37 hours later

Thank you for your answer. It is helpful. I have read about treatments for migraine online and not come across divalproex sodium, but have now looked it up - very useful.

Of course I have heard of botox being used to stave off wrinkles, but I have not heard of it used for migraine. Where is it injected and how does it work for migraine?

Many thanks, XXXXXXX
Answered by Dr. Sudhir Kumar 1 hour later
Thank you for getting back.

I am pleased that my answer was of some help.

Regarding Botox injections for migraine, it is now a standard of care for migraine therapy. It is also approved by FDA for treating migraine.

The injections are given in scalp muscles (by using very fine needles), in front, sides and back of head. There are fixed points for injections and the procedure can be completed in 15 minutes in office setting. You can read more about it in my WWW.WWWW.WW
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudhir Kumar 41 minutes later

That is interesting about the botox injections. I will look at your blog.

I meant to say in my first reply that I have not had an MRI, but I doubt I will be offered one on the NHS in England unless they are worried about me or every single medication has failed to help.

I will try to get help now, and thank you very much again for your answer.


Answered by Dr. Sudhir Kumar 8 hours later
Thank you and best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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