HeadWise HeadWise: Volume 6, Issue | Page 10

Tired of searching the internet for answers ?

It ’ s time to learn from those in the know . In every issue of HeadWise ® , our experts respond to reader-submitted questions about migraine and headache disorders .
CAROTIDYNIA VERSUS MIGRAINE My migraines are often accompanied by severe pain in my throat / neck , which my neurologist has termed carotidynia . Is this a form of migraine ? The throat pain can strike before the headache , or occur alone . Triptans help , and I take a steroid when the throat pain hits – but is there another pain reliever that would be more effective ? – Deborah S .
Carotidynia is not a form of migraine . It is an inflammatory condition of the carotid artery which is associated with tenderness over the artery . Also , pain is relatively constant , not episodes like migraine . Migraine can cause pain into the throat so it still could just be a variation of migraine . It could not be diagnosed without a lot more information including an examination , but talk to the doctor whether this could be migraine . If frequent , they might want to try some migraine preventive agent . Triptans and steroids help many causes of pain , so a good response does not help in the diagnosis .
Mark Green , MD Mount Sinai Medical Center New York , NY
TREATMENT WITH TRICYCLIC ANTIDEPRESSANTS I have had luck with nortriptyline and imipramine in the past , but for short periods – 3 months for nortriptyline and 5 months for imipramine . My primary physician suggested doing a rotation of antidepressants since they do not seem to work for long periods for me , even after increasing the dosages . Do you know of any success stories with this type of regimen and are there any downsides to trying it ?
– Mindy D .
We frequently rotate the tricyclic antidepressants in certain patients . These drugs would include protriptyline , nortripyline , doxepin , and amitriptyline . I would continue that method if it works . There are no down sides to this form of treatment . I started prescribing tricyclic antidepressants for headaches in the early 1960s . Side effects from these agents , such as dry mouth and constipation , can be remedied .
Seymour Diamond , MD National Headache Foundation Chicago , IL
LONG-TERM BOTOX THERAPY I have been using Botox for migraine for about 17 years . After my last dose , I had all the symptoms of an allergic reaction . Can you become hypersensitive after so many years ? – Dasha I .
What is meant by an allergic reaction ? If this means a rash or hives , yes it is theoretically possible but we have not seen it in our own clinic experience . If you have been using Botox injections for 17 years , I must assume that is has been used outside of the usual 31 site injection paradigm , since it has only been approved for chronic migraine less than 4 years ago . If there is a question about an allergic reaction , hold off on future injections until you see an allergist who could do a skin test before proceeding . Since Botox is a very expensive drug , it would be a shame to waste a 100 unit vial , so perhaps your physician could give or sell you a small quantity in a syringe to bring to the allergist for testing .
Edmund Messina , M . D . Michigan Headache Clinic East Lansing , MI
10 HeadWise ® | Volume 6 , Issue 1 • 2016