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Question
Posted by: speedy | 2006/04/06

migraine


Dear Doc
I have been diagnosed with basilar migraine and have now been taking Topamax but I still have had a headache for about 5 weeks. It just won't go away. I have taken Tramal which does seem to lift the pain a bit but still it persists.
I can't carry on a full days work and only manage 3 hours a day and everyday sleep from about 1pm until 6pm, cook supper and back in bed at 8:30:pm.
I also seem to have lost my perception with driving. On a few occasions I have overdriven the stop street or road I was about to turn into (in other words went too far past it) It is quite scary.
How long does it normally take for a person to have a normal life again?
Thanks
Regards

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Our expert says:
Expert ImageHeadache expert

Dear Speedy,

Sorry for the late reply – I have been away.

Basilar migraines are known for their strange aura symptoms. Sometimes the strange visual aura can be two sided, and can be so bad it leads to temporary blindness. It's usually followed by incoordination (ataxia), double vision, vertigo, ringing in the ears, jerky eye movements, trouble hearing, slurred speech, and more severe versions of other migraine symptoms, such as nausea, prickly feelings on the body, sensitivity to light and/or sound, and trouble thinking clearly. This stage of the headache usually lasts about 5-60 minutes, but can last days in some cases.

Usually there's a severe throbbing headache at the back of the head on both sides (as opposed to the more common migraine symptom of one-sided headache, often in the temples).

The basilar artery is in the back of your head, and it was believed that the basilar artery migraine had its start in the basilar artery. Many years ago researchers thought that the main roots of migraine in general came from the expanding and contracting of blood vessels. Today, researchers are looking more at other causes. And so a basilar artery migraine or basilar migraine likely doesn't start in the artery at all. As with other migraines, the specifics of what is taking place are still somewhat of a mystery.

Prophylactic or preventive medications may sometimes be effective in certain headache or migraine sufferers, but the results have generally not been encouraging. There is also the very real problem of side effects, which can be more unpleasant than the headaches. A large percentage of people who have been diagnosed preventive medications stop taking them either because they are not effective, or because of the unpleasant side effects.

The best approach is not medication. One has to rather try and get to the root of the problem and find out where the pain is actually coming from (we know now that it doesn’t come from the basilar artery).

To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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