I am having headache even after taking Prednisone pac. Why?

Question

Hello doctor,

I am 70 years old, male with history of migraine for 40 years. The last few years for stress, I have taken 60 mg Cymbalta twice daily. My headaches sometimes give me the aura and sometimes slight dizziness for 10 to 15 seconds with headache to follow. Over the years I have tried all kinds of medicines like Paxel, Topamax, etc. Maxalt and this sort of medicine have not worked. My headaches were pretty well controlled with Cymbalta and Gabapentin twice per day. I went off the Gabapentin three years ago and only experienced 3 to 4 migraines per year. My headaches have a history of pain 3/4 on 10 but long duration 7 to 30 days. A few years ago a headache specialist prescribed Prednisone pac which generally works. I have had two migraines this month, this one started with mild dizziness for 10 seconds followed with headache. I started with three Prednisone for four days and restarted the Pac beginning with 6 tablets day one, five tablets day two, four tablets day three, etc. Also had Toradol shot three days ago. Headache is mildly better but not gone. Any ideas to abort?

Answer 1

Hi,

Welcome to icliniq.com. First of all, one needs to confirm that it is indeed migraine. I would recommend the following: 1. Do magnetic resonance imaging (MRI) brain. 2. If MRI is normal, ask the neurologist to consider starting Valproate 500 mg once a day. If the migraine is resistant to all medicines, occipital nerve stimulation can be considered.

Answer 2

Hi,

Welcome back to icliniq.com. I understand your point of view. I would always repeat an magnetic resonance imaging (MRI) of the brain with contrast or angiogram or venogram as may be needed and confirm there is no other cause of headache. Sometimes we tend to label headache due to other causes as "migraine". If we identify something on the MRI that can be attributed to your headache and can be treated differently, it will be worth doing the MRI. If the MRI is normal, which is likely to be the case here, we can try other medications such as Valproate, etc., to control migraine episodes. The last resort would be to consider a trial of occipital nerve stimulation.