My mother has had a chronic, intractable migraine for about 11 or 12 years. All day, every day. Some days it’s worse than others, but it’s never any better than, say, a 6 on the pain scale.
We haven’t been able to figure out a cure, or even a cause.
She just got back some MRI results, which we hadn’t done for a few years. At a glance it looks like they’re still baffled, but there are enough things written other than “unremarkable” that I thought I’d give it to the Dope and ask for an English translation. (I have her permission, of course.)
EXAM: MRI BRAIN WO CONT
CLINICAL INDICATION/HISTORY: Headache; Chronic HA (>= 3 months) with
refractory/debilitating pain; No known/automatically detected potential
contraindications to MRI
TECHNIQUE: Multisequence multiplanar MR imaging acquired through the brain.
COMPARISON: No prior
FINDINGS:
Parenchyma: There are a few scattered small caliber foci of chronic T2 and FLAIR
hyperintensity most apparent in the frontal lobes. Diffusion imaging is normal.
No acute infarction. No acute hemorrhage. No mass lesion.
CSF spaces: Ventricles and cisterns remain midline in position
IAC regions: Unremarkable
Parasellar region: Unremarkable
Vasculature: Appropriate flow voids within the major skull base vasculature.
Cervicomedullary junction: Patent
Orbits: Unremarkable
Paranasal sinuses: Clear
IMPRESSION
No acute intracranial hemorrhage or territorial infarct. No mass effect.
-No identified source for reported headaches
I’m not a doctor of any kind, but I do read a lot of MRI reports. So, while we wait for an expert to chime in, I’ll give you my impression.
She went in because of a history of chronic headaches.
They did an MRI without contrast
They saw some minor “foci” that would not be unusual.
Diffusion imaging examines white matter changes at the microscopic level. (usually related to traumatic brain injury, but not always) Normal according to the radiologist.
CSF spaces relates to the appearance of the voids around the brain (and within) Cerebral Spinal Fluid. Trauma, age, or something like a subdural hemetoma could alter the appearance, or shift the midline of the brain (not a good thing). Here, normal.
So, basically a normal brain scan. I assume that allows them to rule out some causes for her headaches, but doesn’t point to what’s actually going on with her.
Not a doctor, but I review such records and complaints of migraines often.
As you know there is no clear lab test/exam finding to diagnose migraines, nor to assess severity of migraines. This MRI essentially ruled out other possible causes for her headaches.
I’ve had migraines my whole life. I had one idiot doctor who told me “you can’t keep on having these headaches!”
(Gee, thanks, doc, I feel so much better since I obviously will stop having them right now!")
I’ve had scans and x-rays galore.
I remember the glorious day the first triptan drug became available! Wonderful stuff!
But I keep on having the damned headaches!
The Daughter gets migraines. She’s tried everything, she even takes an anti-seizure drug.
I’ve seen commercials for two drugs that prevent migraines. I’m sure it will probably take another generation before insurance companies will pay for those. I hope it doesn’t take that long.
Because COTU#2 has been getting full-blown migraines now.
She’s nine years old.
I hope the lady who had the MRI can qualify for the migraine-prevention drugs. She desperately needs to get her life back.
I remember when Imitrex first hit the market. IIRC, it was something like one or two hundred dollars per dose…and worth every penny.
To this day, I still keep a giant pile of sumatriptan (as well as some others) on hand. Both pills and vials, for when I’d rather give myself a shot and have the headache be gone in a minute or two. I nearly always have some nearby (at home, at work, in my car etc).
When my family doctor first let me know Sumatriptan was available as an injection, she said it came in a two pack, and averaged about $30 a shot.
At that time, I had to pay. My insurance didn’t pick up Imitrex until it came in tablet form, at that time 25mg a tablet.
By the time my two kids were in high school, all four of us had prescriptions for Imitrex. I’d get the prescriptions filled at the beginning of the month. Then I’d come home, break apart the card holding the pills, and throw them all into a bowl in the kitchen. I felt like I was leaving “snacks” out for everyone!
I have never been able to accumulate a stockpile such as yours. Mr VOW and I use them up!
I might use 30 of them one month and one or two the next. Since insurance limits me to something like 9 a month, I always refill them whether I need it or not.
Plus, keep in mind, each script it’s separate. So the insurance has a limit for the pills and a limit for the vials (or statdose), but you can still max out both of them each month. Throw in some Rizatriptan (Max Alt) and you get another handful of them. In fact, I’d be willing to bet if you had your doc write a script for the regular 100mg pills AND the 50mg pills, you could get them both filled each month and double how many you have on hand.
If the insurance blocks that, use GoodRx to fill one or the other.
