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New neuro, what do you think of her 2 diagnoses?

I have chronic migraines without aura and CGH migraines due to deteriorating cervical disks. Both types of migraines have been getting worse over the past 3 years to where I have approximately 20 migraines a month. I'm lucky that they're managed by triptans and that my insurance allows me enough triptans (18/m) to treat them.

The neurologist that I've been seeing recommended that I go to a Botox neuro to see if we can knock the frequency down. The new Botox neuro has now diagnosed (1) migraine with aura because during the pain phase I sometimes see spots, wavy lines, or have general visual difficulties. I understand that aura is before the pain phase, not during. Are visual things during pain common for any migraineur? So, is that aura?

She has also diagnosed (2) medication overuse headache (MOH) for the triptans and other medications I take for osteoarthritis, degenerative disk disease, and fibromyalgia. I will agree, looking back, that I should cut back on the triptans, but I'm still below the 6/week. She sent a message to my rheumatologist and PCP that I'm taking too many meds and gave specific recommendations on what should be changed. Rheumatologist and I discussed it, I take next to nothing in controlled pain meds, and Cymbalta daily. He agrees that my cutting back on the triptans is the way to proceed. Cymbalta is working really well for me and changing it to Lyrica, doesn't make sense right now.

Long long story and I'm sorry for that, but I was a little blown away by her aura diagnosis and then wanting to completely revamp my meds. So, do I have migraine with aura? And regarding MOH, am I being sensible by focusing on the triptans?

Thanks so much for your help.

  1. Hi LAnnSmith,

    Welcome to the discussion forum - we're glad you're here!

    It may be difficult to distinguish when aura ends and pain begins, and it's entirely possible to have aura symptoms during the headache phase. It sounds like your new doctor may be on to something.

    The thing about moh is it can make our migraine attacks more difficult to treat and we can end up in a daily cycle of pain that too is hard to break. Taking migraine medications (triptans) and/or pain medications, whether they are over-the-counter or prescription more than two to three days a week can create moh. Yes, in my opinion it sounds like reducing triptan use may be sensible.

    Let me know how you are feeling,

    1. Hi LAnnSmith
      I have head pain daily and constantly attempt to distinguish moh. I found triptans gave me rebound migraine like echo pain. It takes me about three days to work through triptans headaches. Unfortunately I get too many severe migraines that not taking triptans is a choice I must make each time.
      After a bad bout, I also have a time when my head aches sort of like a bad bruise. Migraines can really beat me up so I give myself time to heal.
      To me it is about understanding each headache each day and weighing how to get through to tomorrow. Some moh and rebound headaches do not get worse so suffering through for a time can be my best strategy for the day.
      I have also tried Botox for about nine months and found it ineffective. I envy those who can get relief from this treatment.
      Migraine with aura was also touched upon. Years ago it usually meant visual aura. I think the definition has expanded to include many other affects. My common one is light sensitivity. Others include noise sensitivity, sort of a confused vertigo, deep growlly voice, and difficult thinking. Remembering names and sometimes words get challenging with the last aura symptom. I also get different warning symptoms like anxiety before a serious migraine comes on. Keeping a diary can be helpful in identifying your personal warning flags.
      Hope I have provided useful feedback

      1. Hi Nancy,
        Thank you for responding. I see that my letter wasn't clear about the aura part.
        I have no aura symptoms or sensation before the pain. The new neuro is saying that the visual sensations that I have during the pain phase is aura. The only time I have aura-like things happening is during the pain phase, well past any prodrome or aura phase.
        I'm just trying to figure out if that is now considered to be migraine with aura.


        1. Hi Brown T,
          Thank you so much for responding. I have read and re-read your letter, it is spot on to what I'm trying to figure out. Before your letter I had started to understand the 'bruised' headache might be the MOH, and wasn't medicating it. You verified that I'm doing the right thing with that. I'll continue analyzing headaches and scrutinizing them carefully instead of just grabbing a triptan. The wicked winds are terrible triggers this time of year so might need triptans there, but will pay attention to using ice and other things also.

          I've pretty much decided that her diagnosis of migraine with aura is incorrect, as I have absolutely no aura before the headache. I have all kinds of stuff happening during the pain phase, but nothing before it. Anyplace I've researched has clearly defined aura as before the pain, but she was telling me that she includes visual and sound disturbances "during the pain phase" as aura.

          So thanks for writing, everything you wrote was so helpful to me. Oh, and I do keep a diary, it's worth everything

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