migraine. Caused or worsened by PMR

[Predderman2020]

I have been getting phenomenal migraines over the last month. All day every day, worse in the morning. Also pain up into scalp on one side next to left eye. Doesn’t appear to be GCA … I had it examined by doctor and separately by an eye doctor. Could this be a another result of PMR inflammation showing up at a lower level (4mgs)? Thank you.

[123-go]

Hello, Predderman. What kind of examinations were you given?

[Predderman2020 in reply to 123-go]

Inflammation measurements via blood tests to see if those levels had shot up. The answer was No. In the sense that, (as we know if you are taking Pred, they are normally kept under control); separately a thorough exam of eye and back of eye showed no abnormality. I am now seeing a chiropractor who cracked and twisted me and thought I had occipital inflammation. Which makes sense. Couldn’t go today with car puncture. But I will ask him tomorrow how long till it should resolve. I am tied to a desk at the moment which is not great for neck. Also I had an infection in Sept which MIGHT have been Covid, which can take time to disappear, but is it possible that a residual effect of Covid is monstrous migraine, I wonder.

[PMRpro Ambassador in reply to Predderman2020]

If the chiropractor thinks "occipital inflammation" - THAT could be due to GCA, because that is a favoured region for GCA and the one that causes the risk to sight. It is very comforting to think "they couldn't see GCA" but it doesn't work like that - if the blood flow to the optic nerve isn't compromised, then the optic nerve won't show any effect where it joins the retina. And there is nothing else to see. The markers are also not really reliable.

Either way - have they not suggested trying a few days of higher dose pred to see if it helps? If it were me, I would want to at least try. If a week of high pred does nothing, you can drop back to the low dose so nothing really lost.

[Predderman2020 in reply to PMRpro]

thanks. I am on 4/5 now. How much do you think I should go to for 1 x week?

[Predderman2020 in reply to PMRpro]

My CRP is 2.5. And ESR 18. Albeit with 4-5 mgs of pred daily is that enough to rule out GCA? thanks!

[PMRpro Ambassador in reply to Predderman2020]

Not really - in that markers can be unreliable so symptoms always trump lab results. Have they ever been lower than that?

I'm really thinking in terms of trying a short course of high dose pred to see what happens - though pred is also used in migraine to relieve symptoms so it isn't foolproof. Have you seen a specialist neurologist or rheumatologist in Malta?

[Predderman2020 in reply to PMRpro]

Yes. A few years ago. I dumped him because he constantly pressured me to rapidly get off Pred in less than a month . How about the ultrasound? I have put up Pred to 10 mgs. Is that enough to see if it works to relieve? T

[PMRpro Ambassador in reply to Predderman2020]

Does anyone in Malta do the ultrasound? They need to have been trained to do it - which is why it isn't universally available. Can fully understand why you body-swerved that rheumy! Maybe he's away now?

[Predderman2020 in reply to PMRpro]

yes to Ultrasound, in fact. They are advanced, especially in preventative. Gozo Hospital is departmentally affiliated to Barts in London. I will ask to see if there is anyone there who can do an Ultrasound of the bloodflow to the optic nerve. Thanks. As far as increasing the dose, what level should I go to for the short, higher dose course you suggested. Thanks.

[PMRpro Ambassador in reply to Predderman2020]

Not u/s of the bloodflow to the optic nerve, that is deep in the brain and not accessible with u/s - it is the temporal artery, subclavian and brachial arteries that are of interest. Ultrasound is one thing - the temporal artery u/s is another. Ask them about the TABUL study

pubmed.ncbi.nlm.nih.gov/279...

[Predderman2020 in reply to PMRpro]

I understand now - reading the link I think there is no way that there will be someone widely capable enough to do that here. I will ask anyway.

[PMRpro Ambassador in reply to Predderman2020]

You would be surprised - many Maltese have worked in the UK and maybe there is someone who participated in the trial.

[123-go in reply to Predderman2020]

Thank you for the information. Personally, I feel you should have an ultrasound scan which gives a more conclusive diagnosis-I don’t know what is available in your part of the world. I really don’t want to alarm you but to me your symptoms do suggest there may be GCA involved in which case you would need high dose prednisolone, ie 60mg. Please, if you develop vision disturbances…blurring, double vision, blind spots.. ring 112 (I think that’s the no. in Malta for emergency services).

As for migraine being a long Covid symptom, see this:

thejournalofheadacheandpain...

I hope you get relief from your your horrendous pain soon.

[Predderman2020]

thanks! That sounds v sensible.

[Predderman2020 in reply to Predderman2020]

... also very comprehensive article - thank you

[Predderman2020 in reply to Predderman2020]

And I have requested an ultrasound via my (hitherto dogmatic) Rheumy. Thanks for prompting me. I will let you know what happens. By the way, I noticed that some patients with suspected GCA carry an emergency ‘kit’. This seems to me a great idea? I have a big stock of Pred which they sell over the counter here and my plan is to go for 60 mgs the instant my vision changes.