What causes debilitating migraine headache lasting for more than 72 hours?

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Posted on Wed, 17 Jun 2015 in Headache and Migraines
Question: Is it possible for this to happen? It feels so bizarre that I can't comprehend this.
I just went through Status Migrainus (sp?) -- started on Thursday, ended on Monday night. My nausea and abdominal pain were worse than the headache itself. I still have a headache, BUT: other serious medical problems I have are suddenly much better. That includes: my Parkinson's; my dementia and confusion; and even my mood. (My daughter has migraines, and says she usually feels better for the one day AFTER her migraine ends.) This makes no logical sense to me. Could you please tell me if you've ever heard of such a thing? And if so, what on earth could be the mechanism of action? (Maybe it's like having had a series of TMS treatments? But how would that help with the Parkinson's??)
doctor
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Status Migranosus

Detailed Answer:
Good evening. I am a neurologist and headache specialist. I must admit that you would be the very first patient I've heard of with migraine headaches (status migranosus to boot) who tells me that some other neurodegenerative condition or even multiple conditions have improved followed the period of the headache. I've done some substantial research in both textbooks on headache syndromes as well as on the internet and have not really found anything that discusses the improvement in medical conditions or diseases following migraines or status migranosus.

Could any of the medication you may have taken have anything to do with the improvement. Often times patients are prescribed antidepressants such as Paxil, Zoloft, and Prozac to fight headaches of a migrainous nature. Could it be that high enough doses of antidepressants of these types could improve your mood which may in turn improve symptoms confusion? Dementia (if taken at pure face value of what you say) cannot get "better" because by definition and scientific knowledge we know that dementia is a chronic neurodegenerative process so any improvement would be purely speculative and would have to be attributed to some other factor as opposed to the headache itself.

If anything, my patients always complain of the additional recovery time necessary to get out of when they have migraine headaches which can last hours to days.

Again, there are other medications that could possibly have been used and if so, perhaps those could be reasons. For example, Valproic Acid or Depakote is used in status migranosus as an infusion using high doses and is usually efficacious as a headache prophylactic, or in the case of status migranosus an acute abortive.

Also, other possibilities of feeling better after a migraine episode has passed could be happening if you are doing things such drinking nice tall, cold, glasses of water which could rehydrate your body and automatically make other body systems, memory, mood, etc. feel much better.

I like the thought of analogizing your headache to TMS series of treatments, however, I don't think that is likely since severe headaches tend to drain metabolic energy. All of my patients have always had at least 1-2 days of convalescent time that they've needed after having migraine headaches let alone an episode of nearly 5 days of status migranosus.

Another possibility would be that the improvement is merely a "placebo" type of effect and you should actually wait until a next episode to see if you have a repeat of how things went.

I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 36 minutes of physician specific time to read, research, and compile a return envoy to the patient.

And so, I think it's marvelous that you had a noticeable improvement in some of your medical conditions following a bout of status migranosus. It's just not going to be anything that I think has an easy solution aside from what we know of how migraines function (or rather cause DYSFUNCTION!) and burn lots of energy and steam. This tends to drive people down, cognitively not as sharp, and it can be complicated further by the intervention of urinary tract infections, etc.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 13 hours later
Dear Dr. Saghafi,

Thank you for your very detailed and thoughtful answer.

For what it's worth, both my dementia and Parkinson's began following a period of hypoxia (I wasn't intubated when I should have been). I don't see how that could be relevant, though.

I, too, searched on the Internet to find any case like mine, and came up with nothing.

I was already on Lexapro 10 mg/d; and Lamictal 250 mg/d -- so no change there. I had actually stopped my Sinemet 25/100 mg aAM + 1/2 tab bid (I was being titrated upward) a few days before the migraine began, because it was making me SO nauseous. (Oral Zofran didn't touch the nausea.) However,I don't see how stopping my Sinemet could have made my Parkinson's better. It makes no sense to me.

I had no history of migraine; in fact, I've hardly ever had a headache. However, I've wondered if this could be relevant: in early February, I had a terrible episode of vertigo (lasted 2-1/2 hours; I couldn't move an inch). The next 2 days after that, I had very severe headaches. (I wondered if they could be migraine.) Since then, I had unpleasant (not the type where you have to go to bed) migraines intermittently. I also developed nausea, which seemed to always worsen significantly after I took my Sinemet. (I was on an upward titration. That's why I stopped the Sinemet, when my nausea became unbearable last Thursday.)

I'm still feeling significantly better today; I'm walking much better than I have in months. I love it! However, I wonder if it's a case of "Cinderella after the Ball". (Do you know that fairy tale?) I'm not letting myself live in dread, for when all the problems come back. Instead, I am rejoicing in having this strange respite -- no matter where it's coming from.
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Snapple Fact #819

Detailed Answer:
Well there young lady....and I say YOUNG LADY for a reason.....1. You are a mere 7 years my XXXXXXX and I consider myself VERY VERY young....HA! Don't you consider yourself the same? And if that's the case THEN, my question is, "Do you really have Parkinson's disease?" You mention that your symptoms of Parkinson's occurred after an episode of brain anoxia. Why were you anoxic and for how long were you without oxygen before being intubated? If that event was truly the mark of the problems of memory loss and Parkinson's then, I would suggest to you that you may not be suffering so much from DEMENTIA or PARKINSON'S DISEASE but rather you are suffering from anoxic brain injury resulting in some cognitive difficulties...after all you are typing your questions quite clearly and accurately so whatever the cognitive issues are I'm not detecting much problem so far. You could also get a neuropsychological battery performed to find out if you've suffered anoxic brain injury consequences which most commonly do revolve around short term memory issues. The Parkinson's you refer to after the anoxia can also be seen as PARKINSONISMS as opposed to PARKINSON'S DISEASE. Sinemet basically does not work very well for these types of cases because your movement disorder is based upon the sensitivity of the brain to low oxygen tension and the development of rigid limb movements and slowness which are commonly seen in such events. Sinemet rarely if ever would be indicated in such cases and in fact, could make things worse if not diagnosed properly.

So perhaps, you're feeling better by not taking Sinemet for PARKINSON'S because whatever the movement disorders were....if they were due to lack of O2 to the brain then, Sinemet is unlikely to help with that as much as physical therapy or similar. It would not XXXXXXX to hear that someone would do better off such unnecessary medications. Perhaps, the anoxically injured area that was affected in the brain is beginning to rehabilitate and other parts of the brain (if there was damage) is beginning to take up the slack....or something like that.....

As far as your terrible vertigo....that duration of vertigo (2.5 hrs.) is consistent with a condition of Meniere's disease. Have you been checked for that. Having said that there is also something called MIGRAINOUS VERTIGO which are a type of headache that combines vertigo (can happen at the same time of the vertigo...but mostly happens at a completely random other time from the vertigo...).

So Meniere's disease as well as Migrainous Vertigo would be 2 things to think of.

SNAPPLE FACT #819- Kids grow fastest during Spring---- Why is this the case? Quite honestly....I haven't the foggiest notion....although I think it kind of makes sense..right? From an evolutionary point of view I suppose if babies would tend to be born in the winter time (assuming we're thinking that people are most apt to get pregnant in spring/summer) then, having the kids grow the fastest in spring makes sense since you want them to be as big as possible and able to take better care of themselves by the time weather changes, right?

What does that have to do with anything? Well, for one thing I was just drinking the bottle that had that fact on it and I thought it was cool.....BUT other than that I think it goes to your Cinderella at the Ball analogy because, YES, I certainly do know the story....in fact, my kids must think of me as the evil Mother reincarnate based on all the yard work I give them to do....poor babies...for all the college tuition I pay FREE for them! LOL.....but the point is that I have no better explanation for why you could be feeling better etc. after Status Migrainosus or better after stopping medications for PD (though I did explain that a little up above) than why SNAPPLE FACT #819 is true! LOL.....

At any rate, young lady....stay young and well and please don't forget to give me your favor of a high STAR RATING if you like what I've said thus far...even if the jokes are bad.....and don't forget a bit of written feedback.

BTW, I have another request to make of you.....would you be willing to also rate me on HEALTHGRADES.com. I feel that all of the questions they ask there are pertinent and relevant to answering questions on HEALTHCAREMAGIC so I'd greatly appreciate that favor of yours if you chose to take a few extra minutes on that website. My website there for you to click on easily would be:

http://www.healthgrades.com/physician/dr-dariush-saghafi-yqhxj?officeCode=FLNRR

And you can even see a picture of me which is fairly recent so you can compare how young we may even be! HAHA!

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for future reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 70 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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