HeadWise HeadWise: Volume 1, Issue 3 | Page 9

might be necessary to use other pain relievers, such as narcotics or ultram. Any decisions involving treatment should be discussed with your physician, who will weigh the risks and benefits of each therapy. – Vincent Martin, MD, University of Cincinnati College of Medicine, Cincinnati Hazy Outlook I have had chronic migraine for 17 years after getting a complete hysterectomy. I have a hyperexcitable nervous system with two main triggers. One is environmental—such as air flow, wind, cold, heat, humidity, etc.—and the other is certain visual stimuli—such as attempting to wear prescription eyeglasses or contacts, using a magnifying glass, watching a flatscreen TV, using a computer screen, etc. I have natural monovision and diminishing vision in each eye due to aging. Plus, I now have cataracts in each eye. Is cataract surgery feasible for a person with a hyperexcitable nervous system and visual triggers? Looking through prescription glasses, contacts or a magnifying glass—for literally only minutes—causes a migraine, so I am afraid having a permanent unclouded lens implanted will also t rigger a migraine. And since this lens is permanent, I am afraid the migraine will be 24/7 with no way to stop it. My ophthalmologist says my brain might adjust after surgery, but there is no guarantee, and the surgery is permanent. My neurologist and neuro-opthalmologist are aware of my problem but don’t have a solution. Do you have any recommendations regarding the feasibility of cataract surgery or other options for a patient such as myself? – Maureen B. Pumping Iron I get headaches whenever I lift weight above my head or strain my shoulder muscles in any way with weight lifting. What do you recommend? – Steven T. Your headaches likely represent exertional headaches. These are typically throbbing and last from five minutes to 24 hours after exertion. Most of the time, these headaches are benign and are not associated with any underlying diseases. However, I usually recommend an MRI of the brain and an MRA (magnetic resonance angiograph) of the blood vessels of the brain to be absolutely sure you don’t have other causes for your headaches. The typical treatment options for benign exertional headaches are NSAIDS or beta-blockers prior to exercise. Another possibility is thoracic outlet syndrome. This occurs when the muscles in the shoulders contract and tighten down on nerves or blood vessels. The most common symptoms are pain and numbness in the arms. Headaches are rare in this syndrome and typically occur in the back of the head. Your physician can diagnose this by putting your arms and shoulders in different positions, and it can often be treated using physical therapy. – Vincent Martin, MD, University of Cincinnati College of Medicine, Cincinnati The typical treatment options for benign exertional headaches are NSAIDS or beta-blockers prior to exercise. The response to surgery is completely unpredictable. If vision is well corrected, surgery might give you less visual strain. At the same time, change in anything, including vision, can trigger attacks. Your best bet is to get optimal migraine treatment, and then get the vision corrected if you need it to see better, not for headaches. – Mark Green, MD, Mount Sinai School of Medicine, New York City www.headwisemag.org | National Headache Foundation 9