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    Hi everyone-Introduction
    Timothy Collins, MD posted:
    Just a short note to let everyone know that I'm finally able to sign on and participate.

    As my bio says, I'm a Headache Neurologist at Duke University--I've been on the faculty for over 10 years, and working in the pain clinic for 7 years. I've been interested in and treating headaches for most of my medical career, and hope to help everyone here understand and control their headaches better.

    I will be checking in on the discussion lists every couple of days,

    Caprice_WebMD_Staff responded:
    It's great to have you with us, Dr. Collins! I am sure many here will benefit from your expertise.
    KatHall responded:
    I am newly diagnosed with migraines and have a question: why would migraines suddenly begin so late in life (57 yo) even with a family history? I have had HAs all my life but not these debilitating, vertigo-related type migraines I'm being treated for ... just curious what your opinion might be.
    tdhai responded:
    My daughter has had an ANS device implanted for migraines in Chicago, but we live in NC. I have heard that DR. Huh also does this surgery at Duke. Is that true. Is he the only Dr. that does it and what is his record in this area of practice? Thanks for your help!
    MSGSensitive responded:
    I've been looking for research/info on any link between anemia and migraines. I was diagnosed with menstrual migraines over a decade ago. Over the years the migraines have gotten worse in terms of intesity and duration.

    Recently, I was told I was anemic. When I regularly take an iron supplement my migraines greatly improve. I still get them, but the pain is much reduce and they last only half the time. When I forget to take my iron, the migraines are much worse. I've deliberately experimented with this and noticed a strong correlation.

    My family doctor has no information on the subject.
    Timothy Collins, MD replied to MSGSensitive's response:
    MSGsensitive (great user ID btw): I am not aware of any research on migraine and anemia, but I've noticed the same thing in several patients in my clinic.

    Because of the possible link, we usually make sure our patients have had a blood count (CBC) at some point in the recent past. (along with Thyroid function tests and blood chemistry)/
    swayze responded:
    I started with a headache on 3/26/2010 It has lasted over a week I have went to the doctor who then sent me to the emergency room they did a ct scan and spinal they found nothing they did give me medication for the pain.
    This pain is in the temples over the eyes on top of my head and goes down the back of my head to my neck. It is now 4/3/2010 the pain isn't bad but still have the shakes and twitches in my arms and legs and my speech sometimes I can start to say something and it is like my mouth can't move and I have to wait a few seconds for it to unstick if that makes any sense. I'm not sure where to turn to next the only thing the doctors office and tell me is to go back to the emergency room and let them give me meds. to relive the pain. I don't want that I want an answer as to what the heck is going on with me I have never had a headache that lasted a week ever please help me
    JARhodes responded:
    Hi Dr. Collins,

    I've had both chornic headaches and migraines since I was about 10 years old. They have come and gone with varying intesity throughout my life. Usually it would only be a few headaches a week and 1-2 migraines a month, but lately have become unbearable.

    It started a few weeks ago when I started feeling very weird, but didn't have a headache. My muscles felt like they weren't working properly. I took a nap and when I woke up, I felt like I couldn't stretch out my arms and legs. I had had a bad h/a all week long and my right arm had been tingly and numb all week, but this had escalated. By the time a friend came over, my face was twitching on one side, I couldn't use my right arm and my muscles were on fire. I went to the ER and they did a CT and blood draw. In the CT is when the migraine hit and the nausea, etc. They gave my IV fluids and morphine, phenergan, etc and told me my migraines had advanced to being complex migraines.

    I followed up with a neurologist a 2 days later and an MRI 3 days later (no tumors, just the lesions). I'm already taking topamirate, elavil, celexa, magnesium, b-complex, midrin and we are trying different abortive meds but nothing seems to be working. The daily h/a are getting worse and worse with daily nausea, my R arm is still numb/tingly (3 weeks later), and I've started getting really bad vertigo daily.

    I've called my neuro a few times and left messages that I think something else is wrong and all I get is a call back to come pick up a different abortive sample. Do you have any suggestions on how I can better communicate with my neuro b/c apparently I'm not getting through to her.

    moxie1956 replied to JARhodes's response:
    To Swayze & JARhodes~~I am no expert, sorry to say. But, I feel so bad for you to be suffering so, and to not have received an answer to your entries.

    I, too, have sufffered with migraines since I was first diagnosed at 10yrs. My mother did not believe a child could possibly have a headache, let alone a migraine, so there was no treatment.

    I am now 57yrs, and I have chronic sinusitus, chronic migraines, and seasonal allergies. I no longer try to discern what kind of headache I have so I can give it its applicable medicine. Instead, my neurologist has insisted I medicate with one of the 3 abortive meds prescribed, or any combination thereof, IMMEDIATELY, no questions asked!

    It took me a while to concur bc migraine meds are so much more $$$ than sinus or allergy, but now, I do comply with an immediate does of any one or combo of any of the 3 abortive meds, and usually meet with desirable outcomes, less severe, less duration. For me, that means getting a migaine 4 days out of 7, duration now is about 2-8hours, and severity (pain) is about 4-5/10 on pain scale.

    This is a dramatic improvement over what I used to experience: migraines 300 days/yr.; some lasting up to 3wks without reprieve; and insane pain, 7-9/10pain scale, with me slamming my fist into my temple as hard as I possibly could. Of course, sometimes ER visits were necessitated and infusions were administered bringing pain level down to about a manageable 5-6/10, better than nothing!

    Now, I've also been on a "preventive" prescription, Gabapentin, which has been increased gradually over a period of 2yrs, now up to 2400mg/daily. It is largely responsible for really bothersome cognitive impairment, dizziness, and loss of balance (I often walk with a cane now). When Gabapentin is no longer effective, I don't know what I'll do! Topiramate caused hallucinations---very scary---so I was taken off after only 1mo use.

    That's my story. You probably didn't need to hear another story, but somehow I keep hoping you might read in someone's testimony of an idea which you had not yet considered, and that after you try it for a while, might actually bring you desirable results. I pray so...
    moxie1956 replied to moxie1956's response:
    Ooops! I am not 57; I am 54! What a funny mistake, especially since my birthday was 4/19/56!! haha, LOL
    djarbach responded:
    Thank you Dr. Collins...

    My headaches started very suddenly while I was driving my car. I blacked out briefly but made it home ok. The pain continued for 2 days and i was not able to get out of bed. After a trip to the ER, ct scan and various other tests they found nothing. Thought it was menegitis but that was neg as well. Needless to say that when they did the tap my headache was instantly GONE! I was referred to Dr. William Herzberg in Vancouver, WA. He put me on Topomax and it did not stop the headaches. He diagnosed me with Pseudo Tumor Cerebri and within a years timeframe I had 7 spinal taps with 2 hospitalizing me due to too much fluid removal. He was difficult to work with and did not have a good bed-side manner. His only reasoning for my migraines was due to being overweight. After the 7th tap I did look into WLS and was approved. Since 2006 I have lost 150lbs and feel great! I did have 1 headache after the surgery and it was relieved with a tap in the ER, I refused to go to Dr Herzberg again!

    Present day we are located in Clinton, IA and if my headaches continue I will need to seek out another neurologist. Sorry for the long gist of it but would like to know if you could recommend someone in my area. I do not want to continue taking OTC as they are hard on my pouch, the longer I take them.

    Any help or suggestions would be greatly appreciated.
    Timothy Collins, MD replied to djarbach's response:
    Sorry I don't know any one where you live right now. Most important part of seeing your doctor is to find someone that you can work with. There are personality conflicts (between the Dr. and patient) that are can be hard to get around, but if you can't work with your doctor , or really don't like something about them, you should try another MD.

    Pseudotumor cerebri always has HIGH spinal fluid pressure on spinal tap (It is the only way it is every diagnosed). It is usually treated with Diamox, and when that fails, some sort of shunt. Weight Loss surgery is another good option.

    If your spinal fluid pressure is normal now, then you headaches are "regular" migraines. If the pressure is now normal, your headaches are much more likely to respond to the usual migraine type medications.
    freerxdiscountcard responded:
    Hello Dr. Collins. I would like to know if anyone gets a severe migraine during intercourse. My wife gets them often during but most severe after intercourse.

    Free prescription drug discount card
    mlsmith1746 responded:
    I am a 40 year old female, married with 1 child and live 1 hour north of Memphis, TN. I have been with the same orthopedic manufacturing company since 1988 and in my current role in Procurement since 2005.
    My Mom said she can remember me having migraines as a small child, vomiting and having to be placed in a dark room since. Of course the Pediatrician said they were sinus headaches. There are also several of my family members that also have migraines.

    I have been seeing the same neuro for 15 years after the neuro that I was seeing was not helping me at all. I have been diagnosed with status and complex migraines. My medication list: topomax, inderal, treximet, relpax, maxalt, migranal nose spray, phenegran, demerol, fentora, skelaxin, zanaflex & ambien. I have monthly occipital nerve blocks, 6 week- myoblocks, 3 month- dysport injections, injections as needed-dilaudid, nubain, torodol, phenegran. I have also been seeing an Acupuncturist.
    I have currently been fighting a migraine since June 1st. Nothing has helped-I have had some relief but no complete relief. I have not made a trip to the ER during this episode. In October I made 3 trips to the ER-treated like I was just there for drugs and they finally admitted me for 7 days.

    My MRI was normal however they are telling me that my red blood count is extremely high-maybe due to dehydration but it could also be causing my migraines. If this is the case, I will need to begin having 1 pint of blood drawn periodically.
    My migraines are intensifying lasting for weeks to months. Do you treat patients with similar migraine patterns? Should I be doing something different? Thank you for any guidance that you can provide.

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