Full Question:
I have had a constant headache for the past 3 years without much relief from medications. My neurologist believes that my headache started out as status migrainousus and then became a transformed migraine. I have tried pretty much every class of medication to both prevent and abort the headache without any success.
I have had several neurological exams, a CT scan and MRI (both without contrast), lumbar puncture, and various blood work (TSH, Magnesium, ESR, Prolactin) - everything has come back normal to date. Lately I have been wondering if my headaches might be due to a hormonal problem. Prior to my headache starting I was on OCP for several years and about 4 or 5 years ago I began spotting towards the end of my cycle every month despite trying various different pills. When I stopped taking the pill, my periods were often several months apart which my GP diagnosed as dysfunctional or anovulatory uterine bleeding. I tried two 3 month courses of OCP's and still have not been able to establish a regular menstrual cycle (periods are 35-45 days apart usually). As well, over a year ago I was taking amitriptyline for my headaches when I began to notice my left breast was expressing a small amount of milky discharge. The discharge continued even after the medication was stopped and my doctor ordered a prolactin level, which came back with normal results. Is it possible that my headaches could be due to a pituitary problem or would it have been ruled out by the tests I have already had?
Answer:
Hello;
Your circumstances may point to an endocrine underpinning accompanying the headaches. I'm not sure how often Migraines start out as Migrainosus and "convert" to transformed Migraine. Most daily headache has a component of simple analgesic overuse attached to it.
Having tried "pretty much every class" of preventive and abortive medications doesn't mean that others in those classes won't work for you. It's not unheard of for someone to try three calcium channel blockers for prevention (for example), the find that a fourth one works well. Nor is it unusual for a patient to try several of the seven triptans before finding one that does work.
Consultation with an endocrinologist AND a headache specialist might be quite the thing to do in this situation. You'll find a link to our directory of recommended specialists below.
Good luck,
John Claude Krusz and Teri Robert
If you need to find a headache and Migraine specialist, please see our listing of patient recommended specialists.
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About Ask the Clinician:
Dr. Krusz is a recognized expert in the fields of headache and Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and Migraines. You can read more about Dr. Krusz or more about Teri Robert.
