Another interesting and very informative set of answers came from Timothy Hain this morning. Interesting how opinions differ over clenching of the jaw. And as we discussed earlier, different practices have their favourite medications. Really great that this project has been so well-received. Good news on his take for migraine in women –– that it does diminish with age and does typically get better after 55 (no doubt because of menopause). And there’s one common theme we’ve seen here: migraineurs are VERY sensitive to medication. We know this of course but nice to see that it has been confirmed and that starting at a sub-therapeutic dose is the right move.
Great news for women who are in their 50s, not so great for those of us ‘spiking’ in our mid-late 30s…
Sorry for that little blast of negativity - I shouldn’t complain as I’m doing pretty well
Thanks again Scott for getting such an informative response from another expert in the field. It is also interesting to note both the similarities and differences of opinion between Dr Hain and Dr Rauche.
Hi All,
Good news on his take for migraine in women –– that it does diminish with age and does typically get better after 55 (no doubt because of menopause).
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Thanks for getting this together Scott!! Great job.
But why oh why am I getting worse after menopause?
Maybe the Zoloft is treating my anxiety and Verapamil my MAV. Who knows … Either way my water is currently up to my shorts so I can function pretty well.
I’m wondering now if I could have tolerated Zoloft had I taken it at a different dosing? Five years ago they started me on a whole pill! When I went nuts the doc said to halve it and I was still nuts. If I had known what I know now, I would have started on about an 1/8th or 1/4. It may yet be another med to go back to if I feel the need one day.
It is possible for any of these medications… I started very low and very slow…12.5 mg’s for a month… I also take it with .50 of Klonopin. I am going to come off the Klonopin this summer… I think yes a lot of these meds if you can ride out the side effects you get better. Problem is we already feel like hell and then have to deal with side effects. Human nature onto to the next med… Based on what your research from 2 top doctors say. I guess I should be happy I am highly functional at 90% to 95%. My threshhold is pretty good. I work, go to ball games, drink a coffe in the am… so I have a normal life… Plus with twins on the way I am going to need to be functional this fall as I am going to be dizzy from that
Great news for women who are in their 50s, not so great for those of us ‘spiking’ in our mid-late 30s…
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Yeah, that’s what I thought too. Although, it would be nice if we would go into remission for 10-15 years. Maybe by the time it came back at menopause, they would have the treatment all figured out.
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But why oh why am I getting worse after menopause?
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Hopefully, your body is just adjusting to the change in hormone levels and once it is adjusted it will go away forever. )
Scott - I haven’t thanked you yet for doing this. It was a brilliant idea! I greatly appreciate your efforts to put this together, contact the physicians, and post their answers. YOU are such a valuable resource to all of us. THANK YOU!
Yeah, thanks so much for doing this Scott. It really is fascinating how even the top Docs in this field disagree on certain points. I have to disagree with Dr Hain about the effect clenching and the jaw has on migraine because of the improvements I have seen from tackling it but it’s still really interesting!
I find it interesting (and relieving) that Dr. Hain says that migraine is one of those things that tends to get BETTER with age or simply as time goes by. I read a study that suggests the same. This is not to say that Rauch is wrong, as I agree that once you have MAV you most likely always have it, but I believe in my heart of hearts that the intensity can be expected to get less as time goes by. It’s a nice thought right?
Thanks Marci! I never tire of this investigation … just a science/evidence geek I guess
Becky – I think, at the moment, there is no solid evidence for clenching to be a cause for migraine, however, as Rauch said, it is plausible. And you’re feeling a positive effect since addressing it. I did come across some info showing the trigeminal nerve being associated with the jaw area so certainly makes sense. I’m going to stick in a really good figure showing how the trigeminal nerve innervates the face. Definitely a lot going on around the jaw area … and notice the sinuses too.
This last figure which looks overly complicated shows the extent of input to the vestibular system. Nerves pop out from the neck directly into the vestibular nuclei where the brain processes everything. It’s no wonder a neck massage makes some feel so dizzy.
Do you ever get neck massages, or massages at all? Ever since I got dizzy I been super paranoid about massages. I got my first attack after being massaged for 1 hr and a half…
Does anyone else have the same problem???
Em - I can’t handle a neck massage very well … I almost always walk away feeling dizzy and it lasts for hours. I think the reason is because of those nerves in the neck that go directly to the vestibular nuclei in the brain. It’s a bummer. S :?
A few comments related to above: while clenching itself may or may not “cause” MAV, any kind of facial or cranial pain can trigger it. That is what happened with me. I developed severe TMJ problems and that triggered my MAV (since I already have migraine/balance issues in my past.) My neurologist told me this (and he is one of the docs Scott wrote to.) He also told me that MAV does get better over time - possibly because the body adjusts and possibly with meds, but it does tend to get better in some ways. Best, Bonnie
Did you by any chance see that article I found once that said that when the researchers painfully stimulated the trigeminal nerve in migraineurs, the folks would get dizzy? I remember being elated at finding that, bc my dizzies started the day after a root canal in which they numbed the trigeminal nerve area (and the doc used way too much of the shot medicine…lidocaine/epinephrine?). Anyway, I agree it is all connected.
No, don’t think I did. Let me know if you can dig up the ref for it. Yeah, so maybe it’s all about causing trigeminal nerve pain per se that triggers the migraines … pain then is the important mediator. And this is what Rauch mentioned too.
The exact same thing happened with me, I had root canal and a day or two after had the symptoms come on. I had a pain in my jaw where he had injected me and at the time I thought that he must have punctured or done something to that part of my mouth. No one has since commented on that possibility, they thought that tooth problems were just a confusing part of the bigger picture. (I was diagnosed with VN and now MAV) Violet have you recovered yet - how long are you down the line, I am nearly three years - more or less better, but not really as still on drugs and feeling the side effects. I am grateful not to have the severe symptoms though, as they are sooooo debilitating. I think it is a very puzzling illness/condition. I think there is a tooth link myself.
I did try to contact the researchers at the University a while back, and while the head of the dept responded to me, the specific researchers unfortunately did not.
Wow. I do not think it is a coincidence. I found out that a root canal can trigger the oral herpes virus that likely causes VN (especially if you have lots of epinephrine given, I believe), so that would clearly point to the possibility of VN and then MAV. However, I also think there’s a chance the root canal might just provoke a major vestibular migraine cycle…a relative of mine also first started to get major migraines (the “normal” kind) after dental work. There is also a dentist in NY who thinks migraines are caused by swelling around the teeth…my guess is that some migraines are triggered that way, but probably not all.
Since I started taking Prozac (6 months ago), my symptoms have very very slowly been ebbing away. The Prozac has especially helped with the extreme fatigue and the depersonalization. Tolerance to head movement is also slowly getting better. I just hope it continues and I think I may need to up the meds to get better results; also may need to add another med, like neurontin or something. I also had/have BPPV, so maneuvers have also helped me.
I am very sorry to hear that you have been dealing with this for so long. Do you have a doctor you like? That can make a big difference I think. I would love to hear more about your story.
Although, it would be nice if we would go into remission for 10-15 years. Maybe by the time it came back at menopause, they would have the treatment all figured out.