Dr. Robbins Says….

Weather changes are one of the top triggers for headache;  about 40% of people with migraine feel that weather is a factor in their headaches.  It is usually when a front is coming in, the pressure drops, and people state that they can ‘feel it‘ with their head.  Many do state ‘I can predict the weather with my head‘.  Since the headaches are often in the front, this may lead to a misdiagnosis of ‘sinus headache‘.  95% of patients, in 2 recent studies, who were diagnosed as ’sinus headache’ are actually suffering from migraine.  More on this later…..

The question always arises as to who truly needs an MRI.  With routine headaches, and no neurological symptoms or signs, the usual dictum is that scans are not absolutely necessary.  However, I would never fault any physician who does a scan on all headache patients.  With newer onset headaches, new onset daily headache, neuro symptoms or signs, the ‘worst headache of my life‘,  or a major change in pattern, MRI is often recommended.  Whether you should have one (or a repeat) is a highly individualized decision between you and your doctor (I hope that you do have a doctor!).

…what do they show??…MRI scans are excellent at detecting tumors, multiple sclerosis, and similar pathology.  They do NOT make the diagnosis of migraine, but rather they rule out significant pathology.

The cost of Botox, unfortunately, just went up.. from about $390 per 100unit vial to approx $417 a vial.

The cost of Botox does limit it’s use;  the average patient now recieves 50 to 100 units per treatment.  In the earlier days, we used lower doses.  I do think Botox has a role to play in migraine, CDH, and clusters, but the role is still being worked out.