Lyrica and Trigger point therapy, a method for success!!

So, it’s been a while since I last felt I had any news worth sharing with the world. For the past few months life has been like being in a boat full of holes, continually fighting just to stay afloat. However, and from me this statement may be shocking but, my GP seems to have finally found a medication that helps!

Starting from where I left off I have continued with my trigger point therapy, slowly increasing the time between treatments. Although this has by no means cured my headaches I do strongly believe that it has helped to reduce the frequency and intensity of the headache, and made a real difference to the neck and shoulder pain that use to drive me mad daily. My doctors do not seem to accept this but after over two years of continuous pain, I believe that on the subject of this treatment I am more qualified to judge it.

Anyway, after spending four days in hospital having an inpatient dihydroergotimine infusion I returned home. I did not see any real improvement from this treatment and actually had a really bad week of headaches the week proceeding. This lead me to my GP`s office to try and get some migraine meds to try and relieve my pain. We spoke for a while about the headaches and about how having a long term illness can lead to depression and anxiety issues. Although I do not feel that either of these were the cause for my headaches (as life was brilliant before I got this headache problem) I do except that over the course of the past couple of years I have become very anxious about my headaches. At the end of this consultation I was given a medication called Pregabilin (Lyrica). It`s a similar medication to Gabapentine which I tried a year or so ago but had to stop due to side effects. This medication is used to treat nerve pain and Migraines but is also used for General Anxiety Disorder, so two birds with one stone!

Since taking the Pregabilin I have noticed a difference in both the intensity of the headache and shoulder pain as well as the lack/decrease of worry when the headaches do get bad. It has also seemed to help with my sleep patterns as I know achieve an average of seven hours uninterrupted sleep, minus the odd toilet stop! Nearly a fifty percent increase in my sleeping time! I am at present taking 50mgs, 3 times a day. This is a low dose and over the next couple weeks I will be stepping it up to 100mgs, 3 times a day. I try not to get too excited in case this is not as helpful as it seems but at present it is great to be having days were I can face the day, complete tasks, achieve goals and targets I set myself.

Fingers crossed and will post soon.

Trigger points and teeth clenching!

Well at last some progress (although only a bit). Over the last couple months i have been having trigger point needling on my neck and shoulder. This involves my doc finding sensitive trigger points (that can refer pain to different areas of the body) and then repeatedly sticking them with a needle. Sounds fun hey!! Well it seems to help, and help alot more than the combinations of meds i have been eating every day. Although this has not cured my headaches, looking back at the last month especially, it has been really good with on average one bad headache day a week and even some days were my daily headache has either been extremely low grade (0-4) or not there at all.

I complement the trigger point needling with a 15 minute upper back and shoulder massage provided by my girlfriend and then 15 minutes of neck stretching and all this between two showers to keep the muscles warm and make the stretching easier. Then after this daily routine i apply a heat patch (8 hour long lasting) until i go to bed. And finally when i sleep i use a device called the NTI-tss. This device stops teeth clenching, which if you are in pain is a common senerio, and thus reduces the tension and strain you apply to your neck and head muscles while you sleep. This device is FDA approved and can be found at certain dentists.

About my headache

Well, were to start. I am a 23 year old male from Plymouth in the United Kingdom. I have a BSc (Honours) degree in Computer Systems and Networks from the University of Plymouth. On the 2nd September 2005 my life changed, although hopefully not forever! After a morning at work I returned home to enjoy my afternoon off.

During the morning I had spent a long period looking up and also took a jolt whilst holding a rope. I had also had a very sore throat for a few days before. When I got home I may have got overly annoyed that the football game I had been looking forward to all week was not on TV. In a minute of madness I punched into the sofa cushion to release my frustration. It was now about 2pm and I was still feeling normal. I jumped in the shower and then sat down with my girlfriend to watch TV and chill. OHHH how wrong I was.

At about 2.30pm I started to get an itchy left ear and a very sharp pain at the top of my left temple. At the start this pain was just in a small area of my temple, but was unlike anything I had felt before. Within an hour this pain had spread to cover the whole of my left temple area with the worst of the pain being smack on my left temple. Now normally by my own admission I am a bit of a night hawk and often, as my old man says, am burning the candle at both ends but on this day I was in bed by 7pm. I took two pain tablets and thought that it would be gone in the morning. Again how wrong I was! At this stage I want to mention that for the last 6 months to a year I had been having morning diarrhea and loose stools although was not causing me any physical problems as once I was empty I was fine for the rest of the day.

Woke up the next day, 3rd September 2005, still with the headache and worse it was still at the intensity that it had been the day before. The pain was still on the left temple and remained there for a good three months or so. During this time I felt that there were two distinct problems. The extremely bad pain that started it all seemed to start to ease on occasion, although I was still not headache free. I seemed to develop a daily continuous moderate headache that was present 24/7 although its intensity would vary throughout the day. This headache could be on both sides of my head and at the same time too. The main difference was that this headache rarely reduced me to tears unlike the bad ones that do. Between September and January I tried a whole host of meds and alternative treatments including pain meds (which had very little affect), a range of migraine abortive drugs (nearly all the triptans), indomethacine (NSAID) and sodium valproate. I also used amitriptyline although probably not for long enough to see any benefit. None of these worked. The first small breakthrough came when my neurologist prescribed me a seven day course of prednisolone (which is a corticosteroid). This seemed to reduce the intensity and frequency of the really bad headache and made a small reduction to the daily headache. Also with the headache I have a lot of left sided neck pain as well as pain and discomfort in left shoulder and heaviness in left arm. I was also told I have IBS (irritable bowel syndrome) and that is to blame for my daily loose stools/diarrhea.

The year of 2006 was a long one with not a lot of progress being made. My GP`s (Local doctors) all told me my neurologist was the man who had to set the treatments and so began a very long game of pass the patient. However some good did come from the year, I had an MRI of head and neck, both had no significant findings (whatever that actually means .... I`m 23 there should be no findings and I should be healthy!). Also during this year I had several blood tests done and everything is OK there too apart from a raised number of eosinophil (which now in 2007 is at its highest yet, over three times the normal range) although my doctors don’t seem bothered in the slightest! At the end of 2006 I had a kidney stone, my first and hopefully last. I spent over a week in hospital and still the headaches remained as I went into the New Year, praying for a lucky 2007.

The New Year brought with it a referral from my doctor to a pain clinic in a bid to help me get the pain under control. Over the course of a couple of months I had three nerve block injections into the main nerves in the back of my head. This actually did help for a short while although at no stage did the headache go, the blocks seemed to ease the pain in the back of my head and top of my neck. After three treatments I was not able to have anymore for a while as they contain steroid. I was then passed again but this time to a physiotherapist who gave me a host of exercises and stretches to do. These seemed to help a bit with the neck and shoulder pain but did not have any significant long lasting effect on my headache. Next was a different approach. My physiotherapist contacted a colleague of his who was performing trails for a PHD in dry needling of trigger points. On my first examination with this lady, she identified several trigger points in the left side of my trapezius muscle. Treatment of these points gave me some neck and shoulder pain free days and seemed to give me more good days than bad with my headaches! Promising, I hear you saying. It was until last week she told me that because I was not headache free then there was little point carrying on. But what about the relief I’ve been getting? So it hasn’t cured the problem but as I’m sure other suffers will agree, it’s nice to have a treatment that helps at all rather than NOTHING. I hope to convince my physiotherapist who has done some acupuncture to have a go at this treatment and use me as his learning platform! Fingers crossed. And that just about brings us up to the present day. On Friday 20th July 2007 I have a lumber puncture and on the 24th July 2007 I am have a dihydroergotamine (DHE) infusion over four days. Both are pretty scary and to say I’m nervous is an understatement!

The headaches themselves remained daily (usual on sides of head, occasionally on back of head) with a decrease in the sever flare ups but still no clear pain free periods. Most days I have a constant mild to moderate ache in my head which varies in intensity throughout the day with flare ups of really bad pain once or twice a week that still makes me good for nothing. The Bad headaches tend to be on one side although they sometimes spread to whole head and hurts more if I move my head. The pain is sharp and my head almost feels like it’s swollen. I hate these ones! My daily headache feels like a tension headache and I often feel tension or weird sensations in the Left side of my head, neck and shoulder. I can have a good day with my headache but be in a lot of pain in my shoulder (makes a change from the head but still hurts!) The shoulder and neck pain seem to have no reason for being there and no amount of chiropractic or osteopathic care has helped and I now suffer from this on at least four out of seven days a week. Some days I have no pain in shoulder or neck and other days it bothers me as much as the headache. I often feel tightness in the top of my back on awakening as well as in top of shoulder and side of neck. The diagnosis from my neurologist is transformed migraine although he is not 100% positive. Hopefully by the end of this month I should have some answers!! I hope!!

I`ve probably forgotten and missed out bits and pieces but this gives you a rough idea of my situation. Any questions, help or advice would be gratefully received and hope this helps others who are unsure of their condition. All I want is no more headache!!

James Blackmore