• I read that a hole in the heart can cause migraine. Is this true?

    Some normal people have a persistent opening between the right and left atria of the heart (a patent foramen ovale) which usually closes around the time of birth. More people with this get migraine when compared with people with a closed foramen ovale all though the reason for this is still unclear.

  • I read about a new tablet for migraine mentioned on page 14 of headlines, issue 84. Is it available in New Zealand?

    The tablet contains sumatriptan (Imigran) with naproxen sodium (Naprosyn). Imigran is available in 50 and 100mg tablets and a 6mg self-administered subcutaneous injection. Naproxen sodium is one of several non-steroidal ant-imflammatory agents, others being Nurofen, ibuprufen, diclofenac (Voltaren) and Synflex. While the combination of a triptan with a NSAID is useful, I think it is better to take them seperately so that the dose of each and their timing can be prescribed appropriately for each patient. The combination tablet is not available in New Zealand.

  • Can you tell me what are pain-less migraines?

    Migraine is a condition with three parts - headache, aura and nausea/vomiting. Recurrent episodes of typical migrainous aura (most commonly a visual distubance) occurs most commonly after menopause, particularly in the 60's. Recurrent episodes of nausea/vomiting (bilious attacks) occurs in childhood. Usually, patients do have headache at other times.

  • I get sharp stabs of pain in different places over my head at different times. My GP calls them ice-pick pains. What causes them?

    The cause of ice-pick pains is not known. They occur more frequently in people with migraine but they do not occur at the same time as the migraine headache. Usually, they are a nuisance and do not require treatment.

  • I have had 11 Ocular Migraines in a month.Never had so many in one period.Would Betaloc CR47.5 make it worse?

    I would not expect Betaloc to exacerbate ocular migraine. Ocular migraine is rare, with symptoms being caused by dysfunction of one or other retina. More commonly, visual symptoms are caused by changes in the visual cortex of the brain. Ater the menopause, the visual symptoms (sometimes referred to as an aura) can become more frequent but the headache often becomes less severe. Sometimes, hypertension can exacerbate the visual symptoms.

    A cacium-channel blocker such as Verapamil is used in some patients.

  • In the past four months, I have had more frequent attacks of migraine and now my scalp gets sore to touch with the attacks. Am I developing a brain tumour?

    Sensitivity of the scalp is an under-recoginised feature of migraine, ususally starting an hour or so after  the onset of the headache. It is on the same side as the headache and commonly in the temple or futher back on the side of the head. This over-sensitivity to touch and or pressure may be similar to the hypersensitivity to bright lights, nosie and strong smells that often occurs with migraine. Often medications such as imigraine may be not effective if they are not taken before the scalp sensitivity develops. You are not developing a brain tumour.

  • I have had migraine, usually occuring with my period for about ten years. In the last year I have been getting several attacks of migraine in the course of about 2 weeks. My doctor has diagnosed cluster migraine. Is this different from my ordinary migraine?

    Migraine quite often occurs as a few attacks in a relatively short time with a much longer interval between the bouts. Cluster headache is an entirely dfferent disorder and another name is migrainous neuralgia. This is an excruciating pain of abrubpt onset, usually felt around the eye and it can occur at the same time each day. The pain lasts half to four hours and is associated with watering and sometimes redding of the eye but there is no nausea. The attacks occur in clusters over a few weeks within intervals of months with freedom from the pain. A further difference frommigraine is that it affects very much more frequently than women. The similarity btween the two disorders is that they both respond to similar medications.

  • I have had migraine for many years but in the last year I have been getting stabbing pains in different parts of my head which worry me. Do I need to have a head scan?

    You are probably having so-called ice-pick pains, which occur particulary in people who have migraine but not at the same time as the migraine headaches. The sharp stabs of pain can be felt in different places at different times and occur for no good reason. They do not indicate any problem inside your head and you do not need a head scan. Usually no treatment is required for this sort of head pain

  • My 13-year-old daughter has recently started having migraines. Is she old enough to take medication for migraine?

    Yes - she will need to take control of her migraine herself. She should be able to have medication with her all the time so that she can take the medication at the onset of symptons. The medication could be paracetomal, Neurofen, or Imigrane.

  • I have migraine for years. They usually start with sparkly vision, but in the last attack I found I couldn't speak properly. Does this mean there is something going wrong with my brain?

    Visual symptons are the commonest sort of brain disturbance in migraine. Sensory symptons such as tingling/numbness in the one hand or side of the mouth are quite common, and difficulty in understanding speech and inability to say the words you want to also occur, but are less common. All of these symptons are due to a wave of altered excitability spreading over the cortex of the brain. It is not due to a spasm of the brain arteries.