You ask . Our headache experts answer . reader mail
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 .
TOLOSA HUNT SYNDROME
I have recently been diagnosed with Tolosa Hunt Syndrome . I am hoping that you may have up to date information on this rare condition . I have just finished taking steroids and am suffering from the many side effects . Can you advise me how to manage this ? – Jan J , Perth , Australia
This is a rare syndrome of pain and paralysis of eye movements , associated with an inflammatory mass behind the eye . A rapid response to steroids , associated with improvement in the scan , is expected . If this is not the case , the evaluation should continue , which may include a biopsy to rule out other masses which could be causing the same symptoms .
There is little experience with agents other than steroids , but some have responded to azathioprine or methotrexate . If the dose of corticosteroids needed to continue to make you comfortable is otherwise unacceptable due to side effects , you should speak to your doctor about the possible use of these other agents . Even when these medications help , the response is not immediate and steroids may need to be continued . You might start this discussion early .
Mark Green , MD Mt . Sinai Medical Center
New York , NY
VITAMINS AND HEADACHE
Can you please tell me the best type of vitamins and minerals to take for headaches ? I have been taking a supplement of A-Z multivitamins and minerals for at least 90 days . What effects should this have on the body and the type of condition it should be in after 90 days use ? My diet is very good . I try to incorporate all the five food groups in my meals as well as a 10 minute daily exercise routine . I ’ m 5.7 in height and wear a size 8 dress in British size . I ’ m not sure whether my size plays a factor into the headaches I receive . Can you please offer some suggestions as to how to remedy this issue ? – Claudine J , United Kingdom
There are many supplements that are being used for the prevention and treatment of headaches . The ones with the most scientific evidence supporting their efficacy include magnesium , CoQ10 , and riboflavin . All three have been specifically tested for the prevention of migraine headaches . Multivitamins usually do not have enough of any of these supplements to help with headaches .
Up to half of patients with an acute migraine and 40 % of those with cluster headaches have been found to be deficient in magnesium . The recommended dose of magnesium is 400 mg a day and the types of magnesium that tend to be better absorbed are two of the so called chelated forms - magnesium glycinate and magnesium aspartate . Some patients have poor absorption of magnesium and may need to take 400 mg twice or even three times a day . Magnesium should be taken with food , which reduces the chance of it causing diarrhea . Some patients who do not absorb magnesium taken by mouth require intravenous infusions , which are usually administered monthly .
According to a very large study ( 1,550 patients ; mostly adolescents ), 35 % of migraine sufferers are deficient in CoQ10 . The dose of CoQ10 used in one of the studies is 100 mg , taken three times a day . Since CoQ10 often makes people feel more energetic , some cannot fall asleep if they take it at night . I recommend taking 300 mg once a day , in the morning .
Riboflavin , 400 mg daily was shown to help prevent migraines , although a clear effect occurred after 3 months of taking it . Riboflavin causes urine to turn a bright yellow color , so do not get alarmed .
Alexander Mauskop , MD New York Headache Center
New York , NY
www . headaches . org | National Headache Foundation 11