Latest Breakthrough data shocks Medical Specialists and Scientists - Migraine does not start in the brain

Confused here was told imigran was NOT to be used for hemaplegic migraine! and there are warnings on the instructions so is this not for me!

Yes that is true - Imigran should not be used for HM. (For Info - I have added the list of those who should not use it)

Dr S is not saying try the meds - he is saying if you do take them then you get an answer easier. But you could try the pressure points to see. I will email him to see what he thinks of this and HM.

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Who should not use Imgran:

People who have had a heart attack.

Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina.

A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).

Narrowing of blood vessels in the extremities, eg legs (peripheral vascular disease).

History of stroke.

History of small temporary temporary strokes (transient ischaemic attacks).

Uncontrolled or moderate to severe high blood pressure (hypertension).

Severely decreased liver function.

People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.

A form of migraine associated with paralysis of the eye muscles (ophthalmoplegic migraine).

A form of migraine associated with temporary paralysis of one side of the body (hemiplegic migraine).

A type of migraine where there is a disturbance in brain function which initially presents with total blindness followed by dizziness, speach disturbances, ringing in the ears and double vision (basilar migraine).

Imigran tablets and Imigran Radis tablets are not recommended for children or adolescents aged under 18 years, or adults aged over 65 years, as the safety and efficacy of the tablets have not been established in these age groups. Adolescents aged 12-17 years can be treated with Imigran nasal spray, but only on the recommendation of a specialist or doctor with particular experience in migraine. See the factsheet on Imigran nasal spray (linked at the end of this page) for more information.

Imigran tablets contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.

NERVES THAT BECOME TENDER

The nerves that become tender in some migraine and tension headache sufferers are the supra-orbital and supra-trochlear (the one nearer the nose) nerves.

This picture (attached) is not very good, as they both usually start in the top of the eye socket, and not above the rim of the orbit as shown.
If these nerves are tender to firm pressure along the inside top of the eye socket and just above the rim of the socket, then you have nerve pain, and the medications are less likely to work.

Nerve involvement causes what is called ‘allodynia’. The skin becomes sensitive to touch, and one finds it uncomfortable to brush the hair, touch the skin of the scalp, wear glasses and ear rings, and a number of other unpleasant sensations.

The nerve tenderness disappears once the arterial and/or muscle pain is successfully treated.


IMPORTANT MUSCLE TRIGGER POINTS

Please note that this information is really very basic – to give a comprehensive description would fill a book – but this should be adequate to give most people an idea of where their muscle pain originates.

Red arrows
The red arrows point to those parts of the temporal muscle that are the most often found to be tender to finger pressure during a migraine or tension headache. They are along the line where the temporal muscle attaches to the skull. These areas are also often pressure sensitive when there is no headache, but they get worse during an attack.

Any part of this muscle can have tender areas, but the most common are where the muscle joins the bone.

The temporal muscle is one of the muscles used to close the jaw – you can demonstrate this by putting your fingertip on your temple whilst opening and closing your mouth – you will feel the muscle moving.

Note that in front, the muscle attaches just behind the eye. This is often where the ‘eye’ pain comes from.

Blue arrows
The blue arrows show where the neck muscles attach to the skull. These points are also often tender, especially when there is pain at the back of the head and in the neck.

This is great and substantuates alot of what I have spoken to my consultant over, with regard to the pinching of the Vertabral Arteries in my Cervical Spine......

Fantastic article but will read more tomorrow..

Graham

Yes I heartily concur..I have had trouble with tipping my head back..every neuro and my GP has spotted this and that it makes me dizzy/sick..I have had scans and xrays and physio but no one has been able to explain it...I always knew it was directly related to the migs.

I find this so interesting on every level and the more i read the more it makes sense to me and my symtoms.

Thanks for making such a useful contact and getting involved with Dr S Tracey..I feel much less of a 'freak' now.

Jane
x

Jane - please remain a freak - I would be lost without you

But yes, whilst it takes a lot of reading and thinking about, it does make a lot of sense. I have sent copies of the original papers to my Dr S and await his views. I also know of 2 others who are taking the papers with them to neuro appointments - it will be interesting to see what comes back.

If you would like me to ask any specific question please do just shout.

It's just such a sensible thing. I do have all the nerve pain the Doc mentions and because I have this 24/7 it explains why the triptans don't work too often.

Nothing else has explained my problems as well as this and it's a relief on many levels.

Tracey I am glad you are still enjoying my 'freakishness' ..someone has to and you have known me so long now we enjoy our own special code of dislocated, backwards mig speak.

Dare I even hope that someone may be able to help me...I had completely resigned myself to the fact I was completely untreatable??

It seems too much to hope.

J

xx

When all else fails - there is ALWAYS HOPE xxxx

And yes you are quite right - the 'mig code of writing' is so easy to read to us and total garbage to others - you know I think it is a unique skill to be able to write whole sentences backwards

Sheena Here is the reply from Dr Shevel re HM.

He has also joined the forum under user name Shevel - so you can talk directly to him now
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Hello Tracey,

It is quite fortuitous that you asked me about hemiplegic migraine today, as I had a query from a hemiplegic migraine sufferer just before I received your e-mail.

The interesting thing though, is that this patient has in fact been taking triptans, and has found that the only thing that helps her is Rizatriptan. If, as in this patient, the triptan helps, then it is an excellent indication for the surgery.

With regard to triptans being contra-indicated for hemiplegic migraine, I am not advocating ignoring the instructions, but I do believe that the possibility of them causing strokes is theoretical. There are people such as the patient I mentioned above, who are not aware of the restrictions, and who do use triptans, but I am not aware of any case reports of strokes having been caused by their use. Of course, one can also test the arteries during an attack to determine whether the surgery is indicated.

Are there any of your community with hemiplegic migraine who, like the lady mentioned above, have actually used the triptans?

With regard to the genetic link, this has of course been established, and sufferers are more prone to auras, but the exact mechanism is not known for certain. As far as the pain is concerned though, it originates in the same structures as in other types of migraine.

Kind regards,

Elliot Shevel


Do any of you with HM use triptan?

A question for Dr Shevel please,

I suffered a stroke back in 2008 which affected the Cerabellar (CVA Substantive Cerebellar infarction), which left me with a left side weakness and various motor disfunctions.

Since then I was admitted to hospital with stroke like symptons, and not linking it to Hemepligic Migraines, my consultant noticed a shadow on one of my MRI scans of the lower part and brain stem, thus asking for another MRI of my Cervical Spine.
They then found a Central Disc Prolapse at C5/6 of the cervical spine, this has calcified around the Vertabral Artery and Nerves.
I have been told there is an operation available but are pretty unwilling to perform it due to risks.
Do you think this is the main cause for my migraines which occure anything upto 5 times a month and can last between 2 and 5 days at a time leaving me almost in bed unable to move my left side at all, I have constant dizzyness and the feeling of falling over all the time?
Thanks for your help.

Graham

Graham - I have sent the reply via PM

I do not think this is the same operation - but it makes some interesting reading.

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The ‘Discovery’ of the Migraine Procedure

The Migraine Procedure was discovered by chance in the USA in the year 2000. In a clinical study involving 314 patients, surgeons removed the corrugator muscle, a small muscle around the eyebrow, in order to eliminate ‘frown lines’. Prior to the procedure, 39 of the 314 patients had experienced migraine. One year after surgery, 31 of these 39 patients reported that their migraine had either disappeared completely or diminished considerably.

These findings prompted surgeons at the University Hospital in Cleveland (USA) to look more closely at the link between the corrugator muscle and migraine. Since then, a number of studies have been published on the efficacy of operative migraine therapy. In addition, patient data from the USA, Austria and Germany has demonstrated that:

• 35 per cent of patients experienced complete relief from migraine symptoms one year after the surgery.

• In a further 57 per cent of patients, the frequency of the attacks and the intensity of the pain were reduced by more than half following the procedure.

The surgical approach to migraine therapy

Surgical migraine therapy involves relieving pressure on various branches of the trigeminal nerve. In many people it is the interaction of the corrugator muscle and the trigeminal nerve that leads to a migraine attack. The corrugator is positioned above the eyebrows and is one of the muscles responsible for forming ‘frown lines’ or other expressions in that part of the face. Part of the trigeminal nerve passes through the corrugator muscle: as a consequence of irritation of the nerve, a cascade of events is initiated which can lead to a migraine attack.

The surgeon makes a small incision along the eyelid crease in order to remove the pain triggering muscle – in most cases the corrugator muscle. The nerve in the muscle is neither removed nor damaged in the procedure. By removing the muscle, the nerve in the trigger area above the eyebrow cannot be stimulated and therefore migraine symptoms are eliminated.

Trigger areas on the temples can be treated surgically by the same principle. Pressure is relieved on the corresponding nerve through keyhole surgery, with the surgeon accessing the nerve via the section of the temple that is covered by hair. The third possibility is to relieve pressure on a nerve located in the neck.

It is vitally important that each case is examined individually and that each patient undergoes a botulinum toxin (Botox) test before they are considered for the procedure. If migraine symptoms improve by more than 50 per cent in the first eight weeks after the injection of botulinum toxin, this is a positive, prognostic indicator for the success of the Migraine Procedure.

In addition to relief from migraine symptoms, the patient will notice that the ‘frown lines’ between the eyebrows soften, and in most cases, disappear.

http://www.migrainesurgery.co.uk/therapy/migraine-procedure.html

This all looks soo positive.
How are you feeling now the botox has settled down a bit?
Sheena x

It a bit hard to say for use Sheena - as I had that big attack last Friday and I am not over it yet.

But so far the overall head pain is down. The aura is still the same with the added bonus that its also in my central face - today I can not feel my nose, roof of mouth, left cheek or left ear - plus I have a pressure headache in the forehead where the stuff went in. This might all be related to last Friday - so I am not yet giving it a thumbs up or down.

I spoke at length about this procedure with my neuro about 2 yrs ago..because they started using botox on this area first.

I really depends on where you pain starts from and what area is effected. Mine is predominately behind the eye then spreads, so I was advised this wouldn't work for me.

Well that's how it was explained at the time but I don't know now..all this extracranial stuff has got me thinking. I know the sustained pressure on my optic nerve has damaged it permanently but I suppose it is a case of whether that is the origin of the problem or a secondary factor?

I don't know?

I could see it being promising for some people.

Jane
x

It will be interesting to see what happens at this meeting..... has anyone tried the pressure point test?
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November 28 2011

NEW VIEW: Migraine specialist Dr Elliot Shevel believes the world is wrong about the way scientists approach migraines.

A TOP JOBURG migraine specialist heads for Vienna, Austria, next year to argue for a change in the way migraines are classified.

Dr Elliot Shevel, founder and medical director of The Headache Clinic, believes that the current International Headache Society’s classification of a migraine, based on symptoms, is wrong and should be amended.

The method has been in use for more than three decades, but Shevel says specialists should rather be looking at pinpointing where the pain is coming from rather than the symptoms – typically a throbbing, one-sided headache, nausea, sound and light sensitivity – the patient experiences.

The Headache Society is the official migraine research body of the World Health Organisation.

Specialists believe migraines originate from a problem within the brain, and that there’s no muscle component in migraines.

http://www.iol.co.za/the-star/migraine-theory-turned-on-its-head-1.1187508

Definately ashame about the big toe and very interesting about the Imigran - I was given this a few weeks ago and took it only once as it caused me to black out for starters but also gave me excruciating sinus pain - maybe from the constriction of blood vessels that didn't need constricting?!

I should be marking books but going to read all the articles posted so I can go fore armed to my appointment with the GP tomorrow. Hopefully he'll refer me to a migraine clinic but not sure the NHS will stretch to a trip to South Africa.

Happy reading If you have questions do shout.

Push for a consultants appointment - might take a while to come through - but they know so much more than the GPs.

Good luck and do let us know how you get on.

tee

I never believed they started in the brain. I believe they actually start in the stomach which is where the major group of nerve endings are.