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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Chronic Migraine, Toothache. Have Vascular Malformations In Upper Thorax. MRI Shows Bony Lesions In Skull And Spine. What Is The Treatment?

Hi, I have suffered chronic Migraine for ovre 30 years but for the last 6 months I have had more migraines than ever, a persistent daily headache, and toothache , I have even had the tooth extracted but am still suffering severe pain. I have had all the scans going. I have vascular malformations in upper thorax , mri s have shown bony lesions in skull and spine with further treatments and investigations pending. I have even had a mouthguard made by the dentist but after a few days of wearing this at night it has blistered my gums which adds to the pain. Don t know where to turn to.
Wed, 6 Feb 2013
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Neurologist 's  Response
Hello,
Thanks for posting this question in HCM
Let me tell you the causes of headache are many and one has to find out the exact cause. Headache can be due to migraine, cluster headache, brain tumor, infection, vascular malformations and so on.
I have noted all your problems
You need to be re-evaluated in a hospital/teaching medical university with Multidisciplinary facility where neurologist/headache specialist / dentist/ interventional radiologist will jointly evaluate you. Their clinical evaluation will determine if you need a brain MRI scan (I am not sure if you have done to rule out any vascular malformation in the brain too). Some people may harbor vascular malformations in multiple sites of the brain. If it turns out to be migraine (which is a diagnosis of exclusion), you will benefit with the following approach
1. Acute attack: simple analgesics. Sumatriptan nasal spray. Avoid the precipitating factor. Avoid stress, coffee and lack of sleep. Do regular exercises and good sleep hygiene
2. During the chronic phase: You may take one of these medicines: Amitriptiline, propranolol, topiramate, valproate etc.
The changes which are seen in the skull and spike are due to the presence of long standaing vascular malformaion.
Hope this helps
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Chronic Migraine, Toothache. Have Vascular Malformations In Upper Thorax. MRI Shows Bony Lesions In Skull And Spine. What Is The Treatment?

Hello, Thanks for posting this question in HCM Let me tell you the causes of headache are many and one has to find out the exact cause. Headache can be due to migraine, cluster headache, brain tumor, infection, vascular malformations and so on. I have noted all your problems You need to be re-evaluated in a hospital/teaching medical university with Multidisciplinary facility where neurologist/headache specialist / dentist/ interventional radiologist will jointly evaluate you. Their clinical evaluation will determine if you need a brain MRI scan (I am not sure if you have done to rule out any vascular malformation in the brain too). Some people may harbor vascular malformations in multiple sites of the brain. If it turns out to be migraine (which is a diagnosis of exclusion), you will benefit with the following approach 1. Acute attack: simple analgesics. Sumatriptan nasal spray. Avoid the precipitating factor. Avoid stress, coffee and lack of sleep. Do regular exercises and good sleep hygiene 2. During the chronic phase: You may take one of these medicines: Amitriptiline, propranolol, topiramate, valproate etc. The changes which are seen in the skull and spike are due to the presence of long standaing vascular malformaion. Hope this helps