HeadWise HeadWise: Volume 4, Issue 1 | Page 12

reader mail You ask. Our headache experts answer. headaches for about 10 years. I suspected the headaches were worse around or before my menstrual cycle, but my doctor never seemed to see any association. Eventually he referred me to a neurologist who diagnosed me with migraine. My neurologist put me on amitriptyline and then nadolol, with Amerge® being the “heavy” drug that I take when an out-of-control headache is coming on. I recently went off of amitriptyline and nadolol, as it has been three years and I HEADACHE AFTER MENOPAUSE I am a chronic migraine headache sufferer since the age of 15. I was assured that once I went through menopause it would all go away. I have now reached that age, and while they have reduced, I still have at least one migraine per week. However, I now experience another type of headache on a daily basis. This type of headache does not respond to drugs. The pressure I feel on my head when lying down for Amerge when I need it, which is about every two weeks. It seems someone should have an answer for me. Eighteen years is a long time.–Susan S. more than a few hours, no matter what type of pillow or mattress, gives me a headache. This has led to restless sleep and reduced performance at work and even the need to call in sick. The majority of women who suffer from migraine will have worse headaches around menses and ovulation, evidence of a hormonal trigger. Your situation is unusual because of the onset of migraine at age 37, which is much later than usual. Migraine attacks are often more frequent during menopause, presumably because of varying hormone levels. Sometimes the headaches are better when taking a low, steady dose of estrogens, but some women will have worsening of their migraine with taking any extra estrogen. Remember, however, that the hormone cycle is just one of many possible triggers. Taking a daily preventive medication will often reduce the frequency and severity of attacks, though apparently amitriptyline and nadolol didn’t do much in your case. If the headaches are occurring only every two weeks and you can control them with a triptan, then a daily preventive may not be indicated. Perhaps it would be worth trying a different triptan other than Amerge to see if you get more reliable relief. Robert Kunkel, MD Emeritus staff Cleveland Clinic Cleveland, OH NHF President (1994-2005) A NEW TYPE OF 12 HeadW ise™ | Have you ever heard of this? Is this normal for headache sufferers?–Allison P. The development of “new” or “different” headaches in a post-menopausal woman or older gentleman provides a measure of concern for those of us who specialize in headaches. The absence of a response to medication also is a bit disquieting. This presentation is not particularly compatible for a post-menopausal migraine variant and should trigger further testing to determine the root cause. Although these headaches may be merely secondary to some mechanical compression of nerves in your upper neck or skull base from degenerative disease–arthritis, for example–a brain scan and other testing are necessary to exclude more ominous options. I would advise you contact your physician with these complaints as soon as possible. Robert Kaniecki, MD Director, The Headache Center Chief, Headache Division Assistant Professor of Neurology University of Pittsburgh Pittsburgh, PA HEADACHES AND Volume 4, Issue 1 • 2014 142651_A_NHFHeadWise–June.indd 12 6/2/14 8:10 PM