Shoulders, Migraines, and Drugs (oh my)!

During the past few years, I have been working with my doctor and other specialists to treat my ongoing medical conditions better, particularly migraines and chronic shoulder pain, but also others.  Here I wanted to keep a record of what I/we have discovered, and I hope it may be of use to other people perhaps with similar perplexing symptoms; HOWEVER please remember that if you are experiencing any of these things for yourself – consult your doctor.

For the past 12-24 months, I was taking a prophylactic drug called Pizotifen to prevent the onset of migraine, and Migraleve (a combination of Paracetamol, Codeine and an anti-emetic drug) to relieve symptoms.  This combination had not successfully reduced the occurrence of migraine to any acceptable level.

Following further discussion with a new doctor at my GP surgery, and a referral to a pain clinic (see shoulder info below), the prophylactic has been changed to amitriptyline, and the reliever has been changed to sumitriptan (trade name: Imigran).  I am in the process of reducing the Pizotifen, with the intent to stop it completely.  I may also take Migraleve in addition to the sumitriptan during an attack, if the symptoms do not abate.

This new combination appears to be working much better than the previous, and I will continue to monitor this with my doctors.  We (my doctors and I) have also identified a potential link to my shoulder pain – see below.

Although I have still had a number of migraines in the past few weeks, both at home and at work, I have been able to treat them much more successfully; the severity has generally been less and the treatments have counteracted the symptoms faster.  In most cases I have been able to continue to function and deliver work both in the office and when working from home, even when suffering a migraine attack. Which is a great improvement!

For some very informative presentations regarding migraine, I’ve found this short series of video clips presented by an American MD Craig Blackwell:

1 – Experience; what you see and feel:

2 – Clinical; Aura, distinctions from other neurological conditions

3 – Mechanism; What’s going on in the brain

Chronic Shoulder Pain
Following the appointments and investigations that I have had in the past 5-6 years with my GP, the Orthopaedic surgeon, the neurology department, and most recently the Pain Clinic, we have made some conclusions which have begun to explain my chronic pain (which still does not have a full diagnosis, but the picture is becoming clearer).

Up until recently, the treatments for my shoulder consisted of Naproxen, an anti-inflammatory drug and analgesic for muscular pain (this replaced Diclofenac; which I was previously taking, but has been discontinued for long-term pain due to the increased risk of heart-attacks), and courses of physiotherapy. I was also prescribed Omeprazole, which is a stomach-protecting antacid type drug to alleviate side-effects of the Naproxen.

Following the various investigations by Orthopaedics, and Neurologists (also a nerve conduction study), I was referred to a Pain Clinic. Here the specialist doctor recognised that the pain I am feeling is neuropathic in nature, rather than skeleto-muscular, and has replaced the Naproxen with another drug called Gabapentin (trade name Neurontin), designed more specifically to treat neuropathic pain. I have been slowly building up the dose of this new drug to an effective dose.

For info, Gabapentin is NOT an opiate derivative, and does not therefore have the related risk of addiction, etc. I now very rarely take the Naproxen (unless I have period pain), and will shortly no longer require the Omeprazole for my stomach.

The specialist described how it is likely that my neurones either have an existing predisposition, or have been re-programmed over several years to activate and send pain signals, when they should be sending regular sensation signals to my brain. To help with both the pain itself, and to begin to re-train the neurones, I was issued with a battery-operated TENS machine to try (Transcutaneous Electrical Nerve Stimulation). This device I was advised to wear every day, all day if required, and run an electric current between the electrodes on my skin around the shoulder/neck/back area. This has helped greatly to manage particularly the referred pain that extended from my shoulder all the way down to my fingertips, and has helped to prevent much of these incorrect pain signals from going to my brain. I have found this to be a very helpful device, and have purchased my own TENS which I wear almost every day at work and at home.

Of course, now having used the TENS for a while, my skin has become irritated, so I’m having to reduce how much I use it..

Following on from this conclusion, that the pain in my shoulder was neuropathic, the specialist also linked some of the pain sensations in my arm to be extensions of my migraine symptoms. This phenomenon is also described in the migraine presentations, linked above, as the “sensory aura” – i.e. similar to the visual aura but instead of there being an electrical “storm” in the visual cortex of the brain, this occurs in either the sensory or motor cortices. (I have since confirmed this to be the case: I also occasionally experience inexplicable pain in my other “good” arm which lasts for several hours at a time, and as I already deal with a lot of pain on a daily basis, I hadn’t regarded this as a significant event. This happened a couple of weeks ago, after my pain clinic visits and as an experiment I took a sumitriptan migraine reliever pill. This pain then subsided during the following 30-60 minutes).
Therefore, the specialist also changed me from the Pizotifen (a gradual decrease before coming off completely) to the Amitriptyline as the prophylactic which not only is prescribed for migraine, but also for chronic pain conditions.
Overall, these changes to my medications will combine so that I am taking fewer total drugs in order to treat these multiple conditions.

Other notable conditions and events:
The long-term conditions above have contributed to a continual decrease in my general mood, over the past 10-20+ years. Only very recently had this fact come to the fore as I had hit a few particularly low points, and then spoken to my doctor. Idiosyncrasies in mood and behaviour tend to be quite common in the family history, and only a few months ago did I come to the conclusion that this is not the “norm”. I am now being treated for low-mood/depression, and have had a short course of CBT (cognitive behavioural therapy). This has helped to stabilise my mood, so that I am much more able to cope with day to day activities.

Also constant pain, and recurrent migraines, lower my mood further – by being under better control just helps to keep my whole life in better order.
Also I’m asthmatic… breathes deeply! *phew*!


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