Steroids for migraines

Steroid medications can be very effective for migraine headaches that fail to respond to other medications. Steroids, such as prednisone, dexamethasone, methylprednisolone have many potential serious side effects if taken for a long time. We know about these long-term side effects from patients with asthma, arthritis, lupus and other conditions who have take steroids daily for months and even years. However, these medications are relatively safe if taken for only a few days. If a severe headache does not respond to Migralex, sumatriptan, (Imitrex), or other medications, I prescribe a two-day course of dexamethasone. The usual dose is 8 mg daily for two days. Other doctors prescribe a six-day course of methylprednisolone (Medrol Dosepak). However, if a headache completely resolves after two days, it seems unnecessary to continue this medication for the full six days. In the office, we also give intravenous dexamethasone which provides faster relief than tablets. Another indication for steroids is for cluster headaches. A ten-day course of prednisone (starting with 100 mg and reducing by 10 mg every day) can sometimes stop the entire cluster period. Unfortunately, for some cluster headache sufferers headaches return as soon as the dose of prednisone is lowered. If no other preventive medication, such as verapamil, lithium, topiramate (Topamax) or divalproex (Depakote) work, some patients with severe attacks are willing to accept the risk of long-term side effects of steroids. Some of these side effects are weight gain, diabetes, stomach ulcers, glaucoma, high blood pressure, and osteoporosis.

  1. Dr. Mauskop says: 03/03/20179:20 am

    Yes, 40% of strokes are accompanied by a headache and sometimes it is of migraine type. Steroids could help, but not necessarily the best first choice. Anti-inflammatory drugs, such as ibuprofen or naproxen or an injection of ketorolac can be tried first. In a hospital, an infusion of magnesium should be tried before any drug.

  2. Does Ischemic stroke cause migraine head ache ?could it be treated with steroid??? says: 03/03/20174:39 am
  3. Dr. Mauskop says: 01/07/20175:02 pm

    I will write a blog post on the topic of vestibular migraines in a few days.

  4. Joyce says: 01/03/20173:57 am

    Could you tell me about vestibular migraines and how they are treated?

  5. Dr. Mauskop says: 12/01/20161:40 pm

    I am sorry, but I cannot provide specific advice to any patient I have not seen, but would ask you doctor about higher doses of Internal (propranolol) – the average is about 160, but patients often need 240 mg or even more. Botox is the best prophylactic treatment from chronic migraines. The blood test to do is RBC magnesium level.

  6. Joyce says: 11/30/20162:11 am

    Addendum: My terrible ha moves around it doesn’t stay in one place. Also when the steriods wear off it comes right back terrible again and to the ER I go.They know me now. They do not give me narcotics and they do not work for the ha anyway. They tried that when I was hospitalized in May. They had to switch to IV steriods. I can’t take NSAID except toradol but not much of it they hurt my stomach and give me bad reflux. IV valium works but not po. The klonopin helps at bedtime. If I don’t take the klonopin at hs then I wake up with what I call a hangover ha totally different then what I have all the other time. The other ha I have feels like the same type ha when I had viral meningitis in 1989, exactly the same. So I have the morning hangover ha which switches to meningitis ha rest of the day when I get up until I go to bed. Little more history that I thought might help.

  7. Joyce says: 11/30/20161:59 am

    I saw my medical doctor and had some labs. TSH, T4, Lipid panel, CMP, and HgbA1C. HgbA1C was elevated at 6but I just had IV steriods 2 weeks before. Slightly elevated cholesterol and trig.I see my neurologist this Thursday. I’m up to 100 mg of Inderal(generic) and still taking klonopin 1mg at hs. I’m still having ha’s. See my 11/22/2016 note and I have several others on your page. I would like to know what i need to discuss with my neurologist for further testing. I’ve had terrible ha’s since end of May when I was hospitalized. I have no aura, no difference in sensitivity to light or sound with them. When I get them really bad even though I’m on Inderal my BP goes very high. They only respond to IV steriods, toradol, and IV valium at their worst. My neurologist thinks I have ?chronic migraine but I have never heard of anyone having a ha for soon to be 7 months. What other conditions should I ask to be looked for? I do have MS, but my 4 MRI’s Ihave had since May have shown no changes or active lesions. These ha’s are affecting my life to where I can’t do my ADL’s. I can’t exercise, and can’t bend over. I’ve gained a lot of weight from all the steriods. I need some answers and some relief but I need to make sure I have a correct diagnosis for what is going on. I would like your recommendations on labs, and what other conditions to check for. I’ve never had a problem with ha’s. I woke up one day with a severe ha and my BP 184/110 and I have never had high BP. When I get them I’m so sick I can’t get out of bed besides the terrible ha I feel really physical sick like I’m going to die. It’s a struggle to get up just to go to the bathroom much less the hospital. I’m very allergic to a lot of meds so my treatment options for chronic migraine if that is what it is limited. I feel like there is something else going on. Does CT or venogram show more than an MRI? I’m 54 in age. Thanks for your help wish I was closer and could come seee you. Looking forward to some recommendations to discuss. Thanks for your help.

  8. Dr. Mauskop says: 11/24/201611:16 pm

    Salty taste can be a symptom of migraine, but seeing your regular doctor and getting blood tests is a good idea.

  9. Joyce says: 11/22/201612:51 am

    I woke last Saturday with a terrible migraine and also a salty mouth. The salty mouth lasted 5 days. I went to to the ER Saturday night for treatment of the severe migraine. The migraine was gone when I left the ER but they could not figure out was was causing my salty mouth & lips. Everything I drank or ate tasted like salt. My salvia tasted like I had a tsp of salt in my mouth. Do you know what might have caused this or what I need testing for. I’m going to my regular doctor for blood testing. I’m on generic inderal 80 mg a day and klonopin 1mg for chronic migraine. A week before this I tried B2 and Bromalin, and I’ve been on magnesium gycinate 400 mg qd for couple of months. I had stopped the B2 & bromalin several days before this because it made me feel kind of yucky. I had the salt taste for one day the week before. It was the next day after eating some ham. Ham seems to make my body feel sick now. I had not had any ham 2 weeks before this happened on Saturday and have never had this before.Appreciate any thoughts or testing you might think I need. I was treated in ER with Solumedrol 125 mg IV, toradol 30 mg IV, Phenergan 25 mg IV, and when that didn’t totally work valium iv which finally took the migraine away. My severe chronic migraines will only respond to steriods. I also have MS. I don’t see my neurologist until Dec. 1, so I’m having to followup with my medical doctor. I have spoken with you before on this site. Thanks!

  10. Dr. Mauskop says: 11/04/20161:41 pm

    Yes, it sounds like cluster headaches. You can ask your neurologist for a prescription for a large tank of oxygen. It should be used with a mask and a high flow of 10-12 liters/min. Botox, even though not approved for cluster headaches, can help. It has helped some of my chronic cluster headache patients.

  11. Catherine says: 11/04/201612:29 pm

    Dr. Mauskop, thank you for getting back to me. Yes, the risks to steroids are serious but, I’m still in awe of how magically they worked for me. In the past couple of days I’ve been doing much online reading and am beginning to think that I suffer from cluster rather than migraine headaches; the runny nose, days, weeks at a time of stabbing pain behind the eye, waking in the night with the pain and then a sudden repose of anywhere from 6 days to 3 weeks and lastly, I was once given a high dose of Oxygen at the ER for a “headache” which was heavenly and effective. I’m also feeling frustrated in that I’ve been seeing the same neuro for the past 25 years who has never suggested anything other than migraine, never offered alternatives and frankly dismisses me when I speak of the bobble-head after Botox. I just ordered some Glia online (good to know Nature’s Way makes it also) and have begun taking magnesium, B2, D3 and Feverfew supplements. I guess what I’m saying is that perhaps there is finally hope to be able to live like other people, freer to enjoy all that is life. I do though also need to find the courage to reach beyond my current neuro to someone else. It seems to me a combination of therapies and tools is the best and most effective way to manage these headaches. Thank you again for your time/blog as it’s given me new hope which is a powerful thing.

  12. Dr. Mauskop says: 11/03/20169:10 pm

    Yes, it is worth trying Botox again, but without getting injections into the neck muscles. Instead, injections can be given on top of the head, where the pain is. Here is my recent post on Common avoidable problems with Botox injections. Many neurologists are not willing to deviate from the standard injection protocol, so it is best to call ahead.

    Instead of Imitrex, it may be worth asking your doctor about trying Maxalt, Zomig, or Amerge. All three are available in a generic form – rizatriptan, zolmitriptan, and naratriptan.

    As far as prednisone, it is a powerful anti-inflammatory medicine, which sometimes works very well for migraines, with long-term use it can cause many potentially serious side effects. Boswellia is an anti-inflammatory herb that can also be very effective with no side effects. Nature’s Way is a good and inexpensive brand of Boswellia I recommend.

  13. Catherine says: 11/03/20168:30 pm

    I am a 57 year old woman who has suffered from Migraines my entire adult life. I’ve tried Topamax but didn’t like that it made my cognitive skills dull, though it did seem to help somewhat. I had been on Elavil for years but didn’t care for the vivid dreams. I’m currently on Tizanidine but continue to get 15 or more headaches a month. I finally tried the Botox treatment which gave me moderate relief the first time but a terrible case of bobble-head and a horrible stiff neck. The second treat more stiff neck/bobble-head and moderate improvement and the same result with the third treatment; I stopped as the trade off for me wasn’t worth the moderate migraine relief. I’ve also noticed in the past 4 or 5 years the pain is changing. It used to be classically on one side of my head or the other and switch to the other side when it was moving out. I now have pain on top as if tension is involved and terrible neck and base of the skull pain. I never have pain on the left side of my head anymore, only on the right behind the eye. Also, it should be noted I usually wake with my headaches. Imitrex has always worked well with pain but recently began to upset my stomach thereby landing me in the hospital this past weekend with severe vomiting and migraine. They gave me an IV and different pain killers which worked but soon after getting home they wore off and I was back at square one. My neuro called in a script for Prednisone which I had never tried …it was like a miracle; all pain was gone from the neck, the base of the skull, behind the eye, all of it, gone! My questions are why can’t I take it as a prophylactic? Might oxygen therapy work for me? Should I try Botox again but maybe find a different practitioner who is better at choosing injection sites to avoid the bobble-head? I would love to enjoy the last couple of decades of my life without these debilitating headaches. I want to laugh, run, dance, go-out, entertain, hike, bike, travel and live life the way people without headache do. Respectfully submitted, Cate

  14. Dr. Mauskop says: 09/21/20169:45 pm

    I would ask her doctor about Botox injections, increasing the dose of nortriptyline to 75 mg and possibly higher if her blood test shows a low nortriptyline level. I would also ask the doctor to check her RBC-magnesium level, CoQ10, vitamin B12 and D levels. If any of these are low or even normal but at the bottom of normal range (RBC mag below 5, D below 35, B12 below 450), taking a supplement could help.

  15. Sherri says: 09/20/20165:40 pm

    I have a daughter who is 17 with diagnosis of SLE. Has history of dizziness in the past when competitively swimming which caused headaches controlled with Nortipytlline 25mg for the past few years. Started with a headache last October when she had and SLE flare related to a virus. Around the same time was started on Imuran for her Lupus. (Also on Plaquenil and Prednisone 5mg daily). Headache continued for months on a daily basis. Nothing seems to help with these headaches. The headache finally stopped within 24-48 hours after starting Benlysta Infusions for treatment of her Lupus. The headache was gone for approximately 6 months until she had another flare of Lupus after being placed on Lamisil for a toenail fungus and also having strep throat. Now the headache has continued again. Nothing is helping with it, including Hydrocodone, Toradol. Have increased her Nortriptylline to 50mg daily with no improvement. Has had MRI/MRA of head that is normal. Headache is daily. Previously (before Benlysta infusions) tried Topamax and Depakote without relief. Is still on Imuran and Plaquenil. Due for Benlysta infusion that she gets every 4 weeks. Has had the headache daily for the past 1 1/2 months. Her rheumatologist doesn’t believe in Prednisone over 30mg unless severe flare which he did give her 60mg last October which maybe helped her head a little. Any recommendations or thoughts. I hope you can make sense of this.

  16. Dr. Mauskop says: 07/29/20167:16 am

    Amerge is a lot safer than steroids, so I would follow your neurologist’s advice.
    RBC magnesium is just a blood test and we often recommend taking magnesium even without a blood test. The test can be helpful if taking mavnesium doesn’t help and we suspect a persistent deficiency due to poor oral absorption.

  17. Joyce says: 07/29/201612:22 am

    After 2 months I still have a migraine. I’m on Inderal 30 mg bid. I could not tolerate it higher due to side effects. Still only thing that will relieve ha is steriods. I just got off a 12 prednisone po course and the ha is back. My neurologist wants to try amerge. Can you tell me about this drug and side effects. I’m scared to try due to my numerous medication allergies. Is there anything natural that helps? I did get the magnesium glycinate and I am taking 400 mg bid. I could not get them to do a RBC magnesium. If this is low I know you said I would need magnesium but exactly what is the RBC magnesium? I’m really desperate for some help we are going on 3 months of a migraine if that is what it is. I can’t take this pain much longer. Any suggestions would be helpful. The last 2 previous posts are mine. I wish I could come to NY to see you.

  18. Dr. Mauskop says: 07/11/20168:07 pm

    I am sorry, but that is a lot of questions which I cannot answer without getting a lot more information and without seeing you in person.

  19. Joyce says: 07/11/201612:20 pm

    You responded at 8:50 am to my question. I have couple of more questions. Could my ha’s be coming from my MS? Without steriods my I keep the constant severe ha and high BP so why are the steriods keeping it normal when on them because of inflammation? Do you think this is ? Chronic migraine or do I have some underlying blockage type problem or something else other than migraine? If so, I noted the ifo you listed but if we were looking at something vascular or blockage wise what might it be?I also have symptoms of Intracranial HTN and Thunderclap ha. Any other info is appreciated. Thanks for your time!

  20. Dr. Mauskop says: 07/11/20168:50 am

    Here are a few ideas to discuss with your doctor. First of all Inderal (propranolol), 10 mg twice a day is a very small dose and is not likely to help. Long-acting Inderal, 60 mg is my usual starting dose and many patients need 120, 160 or even a higher dose. You do not have hypertension to have a good effect on migraines. Elevated CRP clearly indicates inflammation, which may be contributing to headaches, so a visit to a rheumatologist could help. Underactive thyroid is another factor that often makes migraines worse, so taking Synthroid could help. Another important test to check is RBC magnesium and if it is at the bottom of normal range, get an infusion. Daily intake of oral magnesium glycinate, 400 mg could also help. There are many posts on magnesium on this blog – here is one and one more.

  21. Joyce says: 07/10/201611:28 pm

    7 weeks ago I started with a severe ha out of no where. By day 2 it was worse and I felt very ill. Ended up going to the hospital by ambulance. BP 184/110. I was admitted to the hospital. MRI with & w/o and MRA done of the head. I also have MS since 2009. In the hospital was given Medrol Dose pak, klonpin, IV Reglan (gave me tremors in Lt. arm) stopped. Had a shot of Dilaudud and Zofran which took it from a 20 to 8 on pain scale in ER before being admitted..Headache mostly went away except dull ha. As soon as I finished ther steriods ha’s came back. Unable to see neurologist. Saw my Medical Dr. gave me another Medrol Dose pak and ha’s better until day 4 of tapering down and get terrible ha’s and high BP again. Went to walk in clinic at my MD office and was given DepoMedrol 80 mg IM shot and ha’s get better until shot starts wearing off. End up in ER with terrible ha and BP 164/107 given Toradol, Benadryl, Phenergan IV. Made ha worse. Gave me Valium 5 mg IV took ha away in 10-15 minutes except for dull one. Next days ha’s back. Saw neurologist finally. She started me on Inderal 10 mg BID. Still having ha’s with BP high of 100 to 110 on bottom. Last week ended back in ER BP 186/118, terrible ha, Left sided facial numbness and chest pain between shoulder blades and running down from neck. Had another MRI of the Head w/o contrast to R/O CVA. Was given Toradol 30mg, Valium 5mg, and Solumedrol 125 mg all IV. BP stayed up whole time didn’t work right away. When I left ER they gave me another Valium 5mg IV which took ha down to dull finally but BP was better 134/89 when Ileft. Solumedrol has been working but now it’s wearing off. the ha’s are starting back with increased tendency every day and BP tonight was 150/106. My neurologist thinks I have ? Chronic Migraine, but I think something else is wrong. The only thing the ha’s are responding to are the steriods. I’m very allergic to most of the meds for ha’s so there is not much choices. I don’t have high blood pressure. I only have high blood pressure when I get the ha’s. What other disorder could be causing this? I was also having some right flank pain and my Medical MD order CT of Pelvis?ABD w/o contrast(I’m allergic) and it showed inflammation or mass at my cecum. My neurologist did bloodwork my c-reactive protein is high at24.7, TSH 5.250 high, Cortisol 17.7 & I was on steroids. I really need some answers and try to figure out what’s going on. I’m a nurse, so of course I’m trying to find answers on my own. Thanks for any input on what is causing this. MRI’s and MRA did not show anything new. I’m going on 8 weeks with ha and high blood pressure with ha.Thank you!

  22. Dr. Mauskop says: 06/08/20169:30 pm

    You are clearly suffering from cluster headaches and not migraines, notwithstanding
    How many neurologists have told you that you have migraines. They do sometimes respond to a short course of steroids if you start with a high dose (60-100 mg) and taper over 10 days. Other treatments that work to stop an individual attack are 100% oxygen through a mask at a high flow (10 liters/min) and Imitrex injections. If 50 mg tablets of Imitrex help, 100 mg is usually more effective. To abort the cluster, besides steroids, an occipital nerve block can help. Verapamil is a good daily preventive medication for cluster headaches. You can read more about clusters on our website.

  23. Boris says: 06/06/20165:22 pm

    I have been suffering with what dozen docs say migraine headaches. they come and they go but it always the same they start out with one a month lasting 10-20 min then slowly they increase to one per week lasting as long as 40 min within two months from start day they will be come a daily attacks that will last from 30-40 min and then they will really kick in to over drive having 3 to 4 attacks per day with a min of 40 min each after each attack I’m totally spend with no energy left in me. If I do not take medication they will become as bad as 14-16 hour headache every day the rest of the time I just be passed out a sleep. I take Imitrex 50 mg when attack happens for preventive I take Inderal 20mg and to relax the muscles I take some 350mg 3 times a day. I go to massage and a chiropractor 2-3 times per week. this has worked in the past to get rid of my attacks but don’t seem to be doing much other then numbing the pain on the right side of my head.
    Once the attacks stop they stay away for years at the time. I been suffering like this from the age of 10 and now I’m 50 and still cant get them to stay away for good. My question is with a steroid thing help in my case?
    Thank you for your time.

  24. Dr. Mauskop says: 05/14/20165:18 pm

    I would ask your doctor for sumatriptan or another triptan, which you can combine with an NSAID, such as naproxen. Rebound from caffeine and caffeine containing drugs is real, but triptan a and NSAIDs rarely cause rebound. This post on daily use of triptan a is the most commented on with over 150 comments.

  25. Samantha says: 05/14/20163:00 pm

    I am currently dealing with rebound migraine headaches that have been ongoing for 2 weeks. My doctor has cut me off of all my meds and put me on a round of prednisone. She gave me a muscle relaxer and said I can continue with gabapentin as needed and benadryl to help sleep. I am still suffering through the day with horrible pain. What can I do to help alleviate some of the discomfort while I wait for the steroids to kick in?

  26. Dr. Mauskop says: 03/21/20168:02 pm

    Yes, Botox can be very effective for the prevention of migraines. It doesn’t help everyone, but in my experience, 70% obtain relief. Although Botox does completely prevent all migraines in some patients, the majority of people find that the frequency and/or the severity of their attacks dramatically improves, even if the headaches are not completely gone. You should also keep in mind that the first treatment may provide only 20-30% of relief, but the next one could provide 50% and the one after, 80% relief. There is a small percentage of lucky patients for whom the first treatment stops all of their attacks.

  27. margo says: 03/21/20166:25 pm

    Thank you for your information and time Dr. Mauskop. My trigger for migraine attacks is the flourescent lighting at my work (who also pays my insurance and dr bill) so I cant avoid it. Somehow I have to deal with it. The ONLY time I get migraines is around those lights. In order to help deal with it, I take triptans and starting the 10 day steroid treatment, but Botox was mentioned here and by my neuro. Does botox take the pain completely away? Can it stop the migraine cycle altogether? I know the flourescent lights are not bad of themselves and there could be an underlying problem. So far the MRI/MRA showed everything normal as did all my blood tests.

  28. Dr. Mauskop says: 01/30/20164:08 pm

    The doctor who prescribed dexamethasone should be available by phone or another doctor should be covering for her. Otherwise, I would look for a doctor who is available to answer urgent questions like yours. I cannot give specific advice to patients I haven’t seen, but the general rule is, if something makes the headache worse, stop it.

  29. Angelica says: 01/30/20163:57 pm

    Hello, I am writing because both my Mom and I struggle with severe Migraines, but my Mom’s migraines are definitely worse. She has spent the last 2 weeks with migraines every day so she scheduled an appointment with her neurologist who prescribed a 6 day doseage treatment of steroids (4mg each). We are desperate because we have never heard of treating migraines this way and after starting the dose as prescribed the first day her headache got worse. The pain got so bad that we took her to the emergency room not knowing if we can give her any kind of pain medicine while on the steroids or if she should stop them all together. The Doctors in the emergency room could not advise whether to stop the treatment or not and prescribed her Vicodin. Her Neurologist is unreachable and only sees patients at her clinic every 3 months! We’re looking for a second opinion or someone to give us a definite answer whether she should continue with the steroids or not but it is Saturday and there are no clinics open. Please help.

  30. Dr. Mauskop says: 01/17/201610:23 am

    You need to ask your doctor. But in general, steroids are used for a prolonged episodic migraine which does not respond to migraine medications, such as sumatriptan, and not for chronic migraines. An exception could be a chronic migraine with a sudden worsening of pain.

  31. Darlene says: 01/17/20162:16 am

    Decided not to take dexamethasone after reading other reviews on this and other steroid horror stories. Seems to be futile.

  32. Darlene says: 01/17/20161:46 am

    Question was not answered. Chronic migraines. Just finished memedrol dose pack lastnight. Headache beginning tonight. Can I take a 4mg dexamethasone tablet previously prescribed? Also on 175mg topiramate, 150mg lamotrigene (depression) 1x and 2mg klonopin 1x daily.

  33. Dr. Mauskop says: 01/13/20169:09 am

    You are most likely suffering from cluster headaches, even if you don’t have all of the symptoms. I would ask your neurologist about trying verapamil instead of Topamax to prevent these headaches. To stop individual attacks, Imitrex injections and oxygen can be very effective. Botox can be also effective. Magnesium supplementation can be effective for both migraines and cluster headaches.

  34. QuitaC2011 says: 01/13/20161:50 am

    Hi Dr. Mauskop,
    I recently read your blog and found it very insightful. I am 22 year old recent college graduate. I am kind of searching for answers to figure out what’s causing my headaches and what the best possible treatment could be. I started having migraine like headaches when I was a kid. I would get the throbbing head pain, sensitivity to movement, sensitivity to smells. I rarely had nausea though. Only when my headache were extremely severe did I have nausea, along with light headness, and feeling overall really unwell. My headaches begin to change though around my pre-teen years. I started getting this horrible pain behind my right eye. The pain would be so bad at times I would cry. I would pace and even rock back in forward. I would try everything to make it go away. This headache would go away and reoccur the next day, and do the same thing for day for about two weeks. Then eventually I would have months where I felt fine and only a headache every now and then. Then just when I thought they were gone they would reoccur. As of right now I still get these same headaches, and they are not as severe, they no longer make me cry. They get pretty bad most days and I have to completely stop what I am doing to lay down for a while because the pain hurts so bad, and my right eye is so sensitive to light. It only effect my right eye.I have been placed on topomax to help with the flare ups, but even at 100mg, I am getting a flare up about 5 months out of a year. And my last flare up hasn’t gotten better. I have done research on on cluster headaches and I don’t meet the full criteria. Though there are time my headaches do reoccur multiple times a day. I have also done research on other headache disorders. It doesn’t really meet the criteria of a migraine but my neurologist thinks that what it is. The thing is my headaches usually last around 15mins- 6hrs. During my current headache cycle they have been lasting around 2hrs usually with meds or with rest. Most times they last longer with rest and reoccur if I only take rest. Also they occur in all hours of the day. They occur during the morning and the night..and even have been waking me up at night. I have considered the possibilty of tension headaches..but it only effect the one side of my head..mainly my eye and radiates to my frontal region. Also I don’t I have one constant headache every day, every day I end up with a new headache sometime during that day, whether it be morning, night, school, home etc. I read this blog to inform myself on what to expect from upcoming appointments and try to know as much as possible about what medications I could be interacting with. My question for you is do you have any advice or possible insight of what could be going on with me. I am currently on headache 22? So I am a bit desperate for answers


  35. Dr. Mauskop says: 12/15/201512:07 am

    Chiari malformation is often accompanied by headaches and it is usually easy to diagnose on a routine MRI scan of the brain. If the Chiari malformation is very mild (it is measured in millimeters) it does not cause headaches, however, some neurosurgeons still offer surgery in the false hope that it will relieve headaches.

  36. Devin Bostick says: 12/12/20157:12 pm

    I understand that temporal arteritis is not a possibility based on my workup. How about Chiari malformation? I am looking into this closely with the Chiari Institute in Long Island. Why would a migraine last for 9 months without subsiding, only getting worse, without nausea or sensitivity to light or sound, not triggered by anything in particular (I don’t take medications, drink alcohol, tea, or coffee, or smoke and have healthy diet), and worse while lying down and with Valsalve manuevers?

  37. Dr. Mauskop says: 12/08/201510:18 pm

    Temporal arteritis at the age of 23 with normal blood tests is not a possibility, but chronic migraine is. Autoimmune diseases are diagnosed by blood tests and if all of the tests are normal, it is also extremely unlikely. Botox is the only FDA-approved treatment for chronic migraines, but needs to be repeated at least twice to see if it helps. Herbal products such as Boswellia and meditation are also worth trying.

  38. Devin Bostick says: 12/07/201511:43 pm


    I am a 23 year old male. For the past 9 months I have had an odd sensation of pressure and pain over an artery on my head near my temple above my right ear. The pain is worse is the morning and lasts all day. It can be sharp if I touch or palpate the exact artery. The pain has gotten worse since March this year. I have had MRI of brain and cervical spine, CTA of head and neck, rigorous blood work (ESR, CRP, autoimmune antibodies (ACA, ANCA, RF, etc), lyme disease, CBC, vitamins), ultrasound of artery, lumbar puncture, and biopsy of inflamed artery near painful artery -> all tests were normal. I have been to a headache clinic, neurology department at Mount Sinai hospital in NYC for 5 days, and to numerous neurologists, ENTs, primary care doctors, and one rheumatologist.

    My exact symptoms are detailed below:
    1. Dull ache on affected side of head near temple and around ear. Dull ache worsens when bending over or tilting head or leaning body to affected side.
    2. Dull ache develops into constriction-like sharp pain when temporal artery is touched or pressed on (I can feel the pulsation under my skin and after feeling this I have pain; there is no pain anywhere else on my head except for local pain directly over this temporal artery elicited by soft touch and movement). This sharp pain lingers after touching artery and worsens when tilting head to affected side.
    3. Scalp tenderness
    4. Head pain worsens when lying down.
    5. Pressure in forehead and in upper front and back teeth
    6. Pressure behind nose near top and bottom of septum that worsens when bending over.
    7. Pain in head when talking, chewing too hard, opening mouth to wide, and singing.
    8. Throbbing head when lying down, heart beat moves whole body and head, very annoying.
    9. Swishing noise with heartbeat in ear when lying down (pulsatile tinnitus?)
    10. Pain in temple is relieved when pressing on artery in front of ear and stopping blood flow to superficial temporal artery above ear and in temple region.
    11. Hurts to wear glasses
    12. Fatigue in arms and legs
    13. Stiffness and extra tiredness in morning
    14. Tongue pain
    15. 20 lb weight loss over 3 months

    I have taken migraine medications (triptans, Depakote, botox, analgesic injections) with no relief. I have taken trigeminal neuralgia medications (oxycarbezepine, amitryptiline) without any relief. The pain is continuous and only subsides with high dose prednisone (60 mg/day), which has been prescribed to me twice in the past month for 7 day tapers by my primary care doctor out of desperation. Doctors are hesitant to prescribe me steroids because of the serious side effects from them, but I cannot live without them because the pain is too severe when I don’t take them.

    Could this be some kind of strange migraine? Could this be temporal arteritis (since the artery itself is in pain) even though I am so young (23) and all my tests have been negative? I am at wits-end with the pain and no doctor seems to have any ideas what could be causing this mysterious pain and body symptoms for so long without ceasing. I am worried if I have an underlying inflammatory/autoimmune condition that is causing this undiagnosed, unsuccessfully treated, and debilitating artery pain.


  39. Dr. Mauskop says: 08/10/20157:04 pm

    It’s always best to ask your doctor, but if prednisone works, you will not need Imitrex. Although 10 mg seems like too low of a dose to break a stubborn migraine.

  40. Patti says: 08/10/20156:54 pm

    I have been diagnosed with chronic migraines, my neuro and I have tried all the preventatives (botox, beta blockers, topamax etc.) I have been taking imitrex daily as I have had a very stressful period in my life. My neuro prescribed prednisone (10 mg) to use to cut the cycle. I was wondering if I am suppose to STOP taking the imitrex cold turkey while I am taking the prednisone or do I taper off while taking the prednisone.

  41. Dr. Mauskop says: 07/10/201510:00 am

    You may want to ask your doctor about trying tizanidine, starting with 4 mg nightly and gradually escalating the dose. Other, less frequently used drugs for chronic migraines include Namenda and Nardil. Magnesium Boswellia, CoQ10 are some of the non-drug treatments to consider.

  42. jackie says: 07/09/20159:55 pm

    I have been on all classes of preventative for migraines. Beta blockers, calcium blockers, anti-convulsives, herbal, amitriptaline, nothing works. I have had 2 rounds of botox and that doesn’t seem to do anything. I am getting relief with sumatriptan when I get the headaches. Now on steroid for 3 days since i have had a headache for 4 days in row and dr. doesn’t want me to take more sumatriptin. Any thoughts on what I can try for preventative now? Getting 3rd round of botox in 2 weeks. Thanks.

  43. Dr. Mauskop says: 11/19/20147:51 pm

    Getting off Excedrin and all caffeine can make a dramatic difference and if headaches persist, Botox is the most effective and the safest preventive treatment for chronic migraines.

  44. I have had headaches daily since I am 12, I am no 50. I take sumatriptans that have changed my life because they do give relief. However lately I have had seven day migraines particularly stemming I right eye down to right neck. Got toradol, decadron,rega says: 11/13/20145:01 am

    I have always used excedrin, today I had a nerve blocker. I am on the current regime of topamax, avorstatin, venlafaxine, nifedipine for raynauds, synthroid for hypothyroid, sumatriptans that of course changed my life. However I had a doozy headache lately. My right eye and down my right side of face and neck. That is where the nerve blocker comes in and an infusion of toradol, decadron, and reglan. That infusion Did nothing. Any suggestions to curb these daily headaches?

  45. lisa says: 10/02/20149:35 pm

    I saw Dr finally, well after urgent care because the pain was unbearable that day. Shot of toradol didn’t help. The headaches do respond to Tylenol migraine, takes pain to a dull roar.

  46. lisa says: 10/02/20149:31 pm

    I dont have the typical migraine symptoms so do not believe that’s what my headaches are. Usually 3 days of unable to function pain and it’s gone. This time after 21st days, I say dr. Given prednisone for 5 days 50mg. Does this sound right?

  47. Erin says: 09/17/20144:13 pm

    I have been on Tramadol for about 6 years now for migraines. I was having migraines that left me unable to function – I have to work and I have kids so this is not possible. My neurologist at the time and I tried everything…Imitrex, Maxlat, various combinations of medications and I have changed my entire diet. I take the steroids (predinsone) maybe twice a year for rebound headaches as the tramadol has helped so much. I take 100mg every day as I have been directed for 6 years. It seems like many doctors are reluctant to let me continue with this regime. Is this really that bad? I’m made to feel like a drug addict for wanting to take something that as helped for so long.

  48. Dr. Mauskop says: 08/18/20147:18 pm

    I cannot give any specific advice to anyone, but would suggest one more test – “RBC magnesium”, which is different from regular “serum magnesium”. As far as treatment, the best option is Botox injections, which is now FDA-approved for chronic migraines and therefore is covered by most insurance companies. For my patients, I also often combine a drug like Maxalt (but for some, Imitrex, Zomig, Relpax, or Amerge work better) with Migralex (my aspirin+magnesium combination, available at CVS for tension, menstrual, sinus and other types of headaches).

  49. Melissa Barrow says: 08/18/20145:10 pm

    I am a 25 y/o female experiencing migraines for 7 months now. Every test possible has been done on me already and have came back normal: CT, MRI, MRA, LP, CBC, Vit D, Nuc AB, Thyroid, T &S, HCG, Cortisol AM, Vit B12 + Folate… I mean EVERYTHING! I was on Imitrex but it made the migraines worse. In and out the ER almost 4 times a week, 2 of Dilaudid doesn’t touch the pain. I am currently on 200mg Topomax with Maxalt, Zofran, and Xanax for break through pain and my doc just start me on 5 day steroid pack. Absolutly NOTHING is helping! Any ideas? Ive seen 2 specialty Neurologists, nobody has answers.

  50. Dr. Mauskop says: 08/07/20145:04 pm

    There are not a lot of good studies on steroids for migraines. We think they work because migraine is proven to involve inflammation and steroids are the most powerful anti-inflammatory drugs.

  51. Jake Bouchard says: 08/07/20144:49 pm

    Dr. Mauskop,


    I am a pharmacy student at Western New England University and also suffer from migraines. I am currently on a prednisone taper. I cannot locate evidence in the literature to support that steroids are a successful treatment for migraines, but have read many testimonials and you seem to have had much success with your prescribed regimens. How did you conclude to prescribe steroids initially to your patients and how would the drug have such a quick effect to snap the cycle? The results seem extremely beneficial! I hope you have the time to respond to my questions and that you are having a wonderful summer.

    I truly appreciate your time and expertise,

    Jake Bouchard
    Western New England University
    Doctor of Pharmacy Candidate Class of 2017

  52. I have used courses of 4 mg dexamethasone 2x day to successfully break migraine cycles. The insomnia and jitteriness are awful. This last time, I took only on e a day for three days and still cannot sleep. How long does if take to leave my body? I fear th says: 07/30/20143:10 am
  53. The Varying Levels of Migraine says: 04/23/20147:38 am

    I and couldn’t find anything about using a Steroid to kill a migraine. Then, I finally found this article. And another one here about Steroid Injections for cluster

  54. Dr. Mauskop says: 03/25/20146:14 pm

    Temporal arteritis is extremely unlikely. It could be either migraine or new daily persistent headache. I cannot give any specific advice on medications without seeing the person and getting the details of family history, medical history, other symptoms, test results, etc.

  55. Aris Sharp says: 03/25/20145:57 pm

    Not sure if you are still responding but if you are,
    I’m a 25 year old male in relatively good shape but for the past month straight I’ve had a right temple headache, that is constant, does not come or go, just stays. Pretty localized to that right temple. Cat scan was normal. Doctor I saw over the weekend prescribed me a Medrol pack. But my primary prescribed me Triptans. Which should I take? Do you think I’m having migraines? I’ve never had them before.. Could it be a rare case of Temporal arteritis since I’m so young?

  56. Dr. Mauskop says: 12/20/20135:22 pm

    After two days without Fioricet seizures or any other serious problems are unlikely. However, rebound headaches are also unlikely if you took Fioricet for only a few days each month, unless you were also consuming caffeine in other forms. While in the hospital, intravenous infusion of magnesium could provide quick relief. Otherwise, taking magnesium by mouth daily may prevent future menstrual headaches.

  57. dee west says: 12/20/20135:10 pm

    I recently spent 4 days in the hospital. I was experiencing migraine headaches, Mri/Mra was normal. I’ve taken fioricet for 6-7 years, more so around my cycle time; i take 2 every 4hrs for 3-5 days, then a few other times during the month. I’ve never experienced such severe pain. The neuro who made rounds while i was in the hospital..indicaited i was experiencing REBOUND headaches and to STOP the fioricet. I have read a lot of frightening posts online about going COLD turkey off of this medicine; SEIZURES. I’ve express my concern with the neuro, he replied: STAY OFF OF THE INTERNET, different people experience different things. He’s prescribe MEDROL PAK 21’S and ELAVIL 10MG. Would you advice going COLD turkey off of the feriocets? My last dose were wednesday, i took 2.

  58. Stan lumley says: 01/17/20139:54 am

    Dr. Mauskop: This is my presenting medical problem I have had daily cluster head aches since mid to late September 2012. I wake up every morning anywhere from 2-4 am with a severe pain in my left eye radiating to the left side of the neck, into the left shoulder base of skull and neck. I will also run a temp from 97-100 degrees with chills and severe sweats. I was given various antibiotics including oxycyline thinking it might be caused by deer ticks. Now they have done numerous blood test and can find nothing wrong. Yes I had the eyes checked perfectly normal. The Mayo Clinic had diagnosed me with cluster head aches befor but they wer nothing like what I have now. The doctor prescribed Toprimate 25mg 1 tablet at night which helped me sleep better. Sumatriptan 50 mg a max of 2 x a day which did nothing to ease the pain. After 9 days the doctor put me on Methylpredonisolone dose 4mg tablets 6 the first day reducing down to 1 4 mg tablet. The methylprednisolone reduced the paing a little the first day. Day 2 up at 4 am with cluster head ache. Should I have been given a stronger dosage of Methylprednisolone and can it be taken with the Toprimate. Any suggestions to help with the cluster head aches would be greatly appreciated. Thank you for your consideration and cooperation.

  59. Dr. Mauskop says: 12/09/201210:57 pm

    You may want to ask your doctor about getting Botox injections to break your cycle of rebound headaches. An intravenous infusion of magnesium can sometimes also break a persistent migraine.

  60. Joy says: 12/09/20129:33 pm

    I have had migraines for years and medrol packs have always broken the cycle of rebound headaches. However recently I had an experience where Imitrex injections only worked temporarily do the doctor gave me the medrol pack. It took three days to work. Where it normally works the first day. When the sux days of the pack was over the headaches returned so he gave me another pack. Immediately after I finished that last pill the headaches have returned with such severity I had to take an Imitrex injection just to sleep last night. I honestly do not understand. I have never faced headaches retuning like this. Can you make some suggestions? I am on zonagran as a daily preventative.

  61. Dr. Mauskop says: 11/07/20125:48 pm

    Unfortunately, steroid medications have many potential side effects, which can be very serious. Taking prednisone, methylprednisolone (Medrol), or dexamethasone (Decadron) for up to two weeks for a prolonged or refractory migraine or for cluster headaches is considered relatively safe. However, some people develop side effects even after one day. If a small dose of prednisone (5 – 10 mg) is very effective, you need to discuss with your doctor investigating possible underlying causes of your headaches, such as temporal arteritis (if you are over 55) or another inflammatory condition.

  62. Anne says: 11/01/20129:11 pm

    The medrol dose pack will take my headaches away for the entire time I am on it. To break a bad cycle of headache, have you ever had a patient go on a low dose of prednisone for a month? I would like to try this to see if it could help. The problem is, i think I would just go back into my chronic mode of headaches as soon as I finished.

  63. Dr. Mauskop says: 08/22/20124:45 pm

    I usually recommend taking steroids for migraines on not more than 2-3 days a month and sometimes combine it with a triptan or Migralex (aspirin with magnesium) or an NSAID.

  64. Ana says: 08/22/20128:19 am

    How often can you utilize this treatment? More than once per month? It did abort a 25 day migraine. Also do you ever use Dexamethasone 4mg as part of abortive tx with a triptan and NSAIDS? Thank you.

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