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KarayanMD
KarayanMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 754
Experience:  Board Certified Neurologist with Subspecialty in Clinical Neurophysiology. Private Practice.
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Im only interested in hearing from a North American doctor

Customer Question

I'm only interested in hearing from a North American doctor please and thank you.
Submitted: 1 year ago.
Category: Neurology
Expert:  KarayanMD replied 1 year ago.

KarayanMD :

Hi. I am a board certified neurologist in California. How can I help you today?

Customer:

Hi I was just wondering what you call a migraine that doesn't resolve?

Customer:

Are you there?

Customer:

Hello????

Customer:

This is probably the worst service I've ever gotten from justanswer.com

KarayanMD :

Hi are you there?

KarayanMD :

My apologies you were offline when I gave my initial welcome.

KarayanMD :

A migraine which does not resolve can be given several terms.

KarayanMD :

One is status migrainosis, a migraine which goes on for many days and often needs more aggressive treatment.

KarayanMD :

Another term used is chronic daily migraine or chronic migraine, which are migraines that occur daily without any major improvement.

KarayanMD :

Of course, if someone is having a new daily persistent headache, then excluding causes other than migraine should also be considered, as a person with migraine can possibly have other types of more serious headaches in addition to the migraine.

Customer:

I got a migraine on Aug. 4, 1998 which never resolved. They tried everything and everything made it worse. What would you call a migraine like that?

KarayanMD :

A chronic migraine.

KarayanMD :

Have you tried Botox by any chance?

Customer:

Have you ever heard of the same headache going on for 15 years without a break at all?

KarayanMD :

Yes, although most cases of migraine are not daily, some patients unfortunately have daily headaches that do not go away.

Customer:

Have tried lidocaine, demerol, statex, anti seizures, prednisone, you name it but because of the horrific results and the hypersensitity I've developed since that time to seemingly everything I wouldn't even dare try Botox..

KarayanMD :

It is obviously not the norm, but it is possible.

Customer:

Yes but when you say daily headaches and the word headache to me implies a beginning, middle and end to one am I correct in that presumption?

KarayanMD :

Well, Botox works by a different mechanism, is relatively safe without usually major side effects, and is FDA approved for chronic daily migraine.

KarayanMD :

No not necessarily.

KarayanMD :

In a patient with intractable daily headaches, it definitely makes sense to try Botox, and I do have quite a few patients in my clinic who failed multiple other treatments without effect and find Botox to be quite helpful.

KarayanMD :

Of course, the treatment needs to be repeated every 3 months if it is effective.

KarayanMD :

The odds of it making your headache permanently worse are very very low.

Customer:

The types of migraines I used to get were complex, where you would get auras and numbness of one arm, then the same part of the face, then a feeling like you were doing to lose consciousness, you'd sleep wake up and it was gone,...is that a complex migraine?

KarayanMD :

A migraine with aura is termed a classical migraine.

KarayanMD :

A migraine with neurological symptoms in the middle of the headache such as numbness can be termed a complex migraine, that is correct.

Customer:

but you did not read the whole thing or I forgot to mention that I would also get slurred speech like I was having a stroke...

KarayanMD :

Botox can be used for patients with both types.

Customer:

that is a complex migraine yes?

KarayanMD :

The slurred speech would also characterize it as complex migraine.

KarayanMD :

Assuming it was not a stroke.

Customer:

I don't think it was a stroke since I used to get migraines from taking Paxil....

Customer:

hold on.... still typing...

KarayanMD :

Sure.

Customer:

Then one day back in 98 I got the headache but didn't get the aura, or anything that normally went with it like nausea as well.

Customer:

They tried anti inflammatories, narcotics, stuff you put in your nose.... and everything made it worse.

Customer:

Then in Sept. of that same year after 3 weeks of so I was prescribed Lorazepam....

Customer:

On day 6 of taking that I was sitting in a restaurant and felt like sparks in my head but no pain....

Customer:

when I got home that night I finally got the numbness on the left side of my arm, then my face and lip, then the visual aura, then the need to sleep immediately.

Customer:

when I woke up 3 hours later, it was gone, the headache i'd had for 3 weeks was gone ....I was ecstatic... but it was 3am and I had plans for the next day and new I would be too exited to sleep.....so I took a quarter of a melatonin and zap, the headpain went back up to a 10 out of 10 and since then it never went away...

KarayanMD :

I am sorry to hear that.

KarayanMD :

I can understand your frustration.

Customer:

Then in 2003 a pain doc prescribed topomax which over months made the pain go down to a 2 out of 10........

Customer:

However....

KarayanMD :

If I were in your shoes, I would definitely consider Botox especially if everything else has failed.

Customer:

I needed to take antibiotics for some infection, which made the pain go back up and it blew the topomax away. I was never able to take it again without it also making the pain worse....

Customer:

the topomax.

Customer:

I will never try botox, because when I tried the lidocaine it bumped the pain up so high that I tried to kill myself.....

Customer:

and lidocaine should not do that but it did....

Customer:

I can't take the chance that there's only a 3 percent chance that botox will do that because chances are I'm in that 3 percent..... you see.

KarayanMD :

Botox is completely different than Lidocaine.

Customer:

So anyway over time and actually taking ambien over a period of years ended up bringing down the pain to a reasonable 8 out of 10....

KarayanMD :

It is FDA approved, Lidocaine is an experimental therapy.

KarayanMD :

I have not head of Botox causing suicidal thoughts.

Customer:

it would be the pain causing suicidal thought and not the medication...

KarayanMD :

I see.

Customer:

if you have pain that's a 50 out of 10 you are going to want out of your body pretty fast, that's anybody...

KarayanMD :

If the pain became unbearable for some reason, you could always goto an ER as the last resort if it became necessary.

Customer:

what can the ER do if I can't take any pain meds?

KarayanMD :

However, I do understand your perspective as well.

KarayanMD :

You cannot receive IV narcotics?

KarayanMD :

Dilaudid and Morphine can be used as a last resort but can be effective.

Customer:

I cannot take any pain meds, cannot take antibiotics, you name it, other than ambien to sleep and I've spent my life savings on it I can take nothing.

KarayanMD :

I am sorry to hear this. Is there any other question I can help you with today?

Customer:

dilaudid , statex, morphine, oxycontin, etc. all made the pain worse...

Customer:

well what I wanted to know was what causes a migraine to not resolve and what is that name for that specifically?

KarayanMD :

Chronic migraine is the name.

Customer:

why do some migraines resolve and what causes others to not resolve?

KarayanMD :

The thing that causes that can be theoretically a permanent disruption and perhaps hypersensitization of the trigeminal autonomic system.

KarayanMD :

Of course, this is theoretical and these situations are not often studied given there are not too many patients in your situation.

KarayanMD :

One could also question whether there may have been injury to the pain areas of the brain if the headache that did not improve was related to meningitis or something like that.

KarayanMD :

Best wishes. Please click on accept if I have answered your questions in a satisfactory way. Please let me know if you do have more questions.

Customer:

thank you.

KarayanMD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 754
Experience: Board Certified Neurologist with Subspecialty in Clinical Neurophysiology. Private Practice.
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