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HeadWay, Issue #033 -- Connecting-the-dots
April 21, 2006

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In this month's issue:


Nortriptyline for chronic pain

Say what?! Trigeminal Neuralgia

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I've been learning a lot about some of the basic problems we face as migraine and/or headache sufferers.  One of these is that we often don't realize the extent of the problem.  What?! you're saying - You mean it's worse than I think??!

Well, maybe, maybe not.  It's not that it's worse than you think, it's just that it may affect more parts of your life than you realize.  If you've been "just getting by" rather than fighting back, this may be the motivation you need to look for help.

I've been trying to read and review some of the books you've chosen as your favourites at the Reader's Choice Awards.  Right now I'm reading a book called Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, by Dr David Buchholtz of the John Hopkins University School of Medicine.  Actually, this was a Bronze Award winner, and it just got bumped off the list.  However, overall it's still in the top 10.  I haven't finished it, so there's no review yet.  But I thought the descriptions of migraine symptoms were so good that I would include them here.

Sometimes we don't realize what all is connected to migraine - here are some symptoms patients have described.  This is adapted from chapter 2:

  • In or around your head:  pressure, fullness, tightness, heaviness, thickness, numbness, soreness, swelling, burning, buzzing, vibrating, boring, piercing, drawing, expanding, tingling, trickling, dizziness, bubbling, crawling, yawning, flushed skin, warm, tender, bruised, sensitive, on fire, shifting, rushing, cloudy, dull, foggy, fuzzy.  You may have trouble concentrating, spaciness, difficulty finding words, forgetfulness, altered perception, loss of consciousness, seizures, mood changes, fright, lethargy, fatigue, depression, or simply not being able to think right.  The pain may be explosive, unbearable, jackhammer, fire-hot spike, jolting, flashing, sudden, ice-pick, pulsating or pounding.  You may be congested, have ear fullness, popping or clicking.  You may have trouble breathing or chest pressure.  You may have a bulge in your temples, you may have bloodshot, swollen or tearing eyes, or circles under your eyes.
  • Your neck may be stiff, achy, sore, tight, tense, knotted, spasming, weak, creaking, cracking, crunching, grinding or popping.
  • Visual symptoms include seeing zigzags, flashing lights, spots, dots, specks, flashing lights, sparkles, lightning, squiggles, geometric shapes, jagged lines, chicken wire, rings, ripples, spiraling, strings, halos, heat waves, clouds, cobwebs, bugs, amoebas, tadpoles, fish scales, TV static, holes, Picasso faces, ghosts, double images, tunnel vision.  It can be bright, lively, colourful, scintillating, fleeting.  You may be sensitive to light, have a drooping eyelid, blind spots, or even blindness.
  • Other disturbances include nausea, constipation, diarrhea, paleness, sweating, chills, fever, stomach pain, difficulty speaking, unsteadiness, veering, swaying, falling, vertigo, lightheadedness, wooziness, heaviness, clumsiness, tingling, pins and needles, coldness, itching, vibrations.  You may have sensitivity to odors, or you may smell something that isn't there.  

  • The point is that migraine may be impacting your life far more than you realize.  That being said, there are a couple of things we should note.  First, you may only have a few of these symptoms - everyone is different, and everyone describes the same symptoms differently.

    Second, remember that many of these things may indicate a serious or even deadly condition.  Don't just assume you have migraine if you haven't been diagnosed - be sure to see a doctor and have her rule out other diseases and disorders.  Finally, remember that the connection of these symptoms to migraine is little understood.

    More on basic migraine symptoms.

    I did finish one book review - read about Headache Through the Ages by Dr Seymour Diamond and Mary A Franklin.

    Nortriptyline for chronic pain

    Nortriptyline (sometimes misspelled as nortriptilyne) is a tricyclic antidepressant which is sometimes prescribed for migraine.  Actually, it's been used for other chronic pain conditions as well.  Sometimes Nortriptyline is prescribed for tension headaches, if they are frequent and severe.  It's commonly sold as Aventyl or Pamelor.  It works in the chemicals of the brain by inhibiting the reuptake of norepinephrine (noradrenalin) and serotonin.

    Nortriptyline is used as a preventative, and it may take several weeks before you see improvement.  It's very important to talk to a doctor who knows your medical history before you start or stop taking this drug.  Drowsiness and dizziness are common side effects.  This is not usually the first drug you will try, there are more common options and options with less side effects.  The good news is that it doesn't cause dependence like some drugs, and you usually don't need as high a dosage as you would if you were being treated for depression.

    Read more about Nortriptyline HClicon, a generic version.

    Read more about migraine preventatives.  Also, check out this article from Mayo Clinic on the use of tricyclic antidepressant for chronic pain.

    Say what?! Trigeminal Neuralgia

    Trigeminal Neuralgia, also known as tic douloureux, involves a sudden burst of pain in the face, head and jaw.  It's in this particular location because the pain is following the trigeminal nerve in the head.  The cause of Trigeminal neuralgia is not known, though it may have to do with a loss of the protective layer over the trigeminal nerve (the myelin sheath).  Both men and women suffer, but most commonly women over 50.

    Read more about Trigeminal Neuralgia.
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