Ask The Experts
My migraines are awful when the monsoon comes, what can I do to keep from having one every day? -Christina F.
Many migraine sufferers complain that their headaches are more severe and more frequent during the summer months and monsoon season. A study of 7,000 patients conducted by Harvard researcher Dr. Kenneth Mukamal, published in the journal Neurology in 2009, concluded that “higher ambient temperature and, to a lesser degree, lower barometric pressure led to a transient increase in risk of headache requiring emergency department evaluation.”
Unfortunately, there is not much that we can do to control the weather. Probably the best strategy is to stay well-hydrated and to avoid strenuous outdoor activities or exercise during times of the day when it’s excessively warm or humid. Many patients prepare for this difficult time of the year by scheduling appointments with their headache and pain specialists so that they have adequate preventive and abortive medications on hand.
It is probably also prudent to avoid known migraine triggers such as certain foods, changes in sleep habits, bright lights, loud noises, smells or fumes, medication overuse, and emotional stress.
Finally, there are many patients with chronic headaches who benefit from interventional pain management procedures and chiropractic care, in addition to their current medications. Often, these patients consult with their interventional pain specialists and chiropractors prior to the summer heat and humidity to determine whether they are candidates for new procedures or repeating their previous treatments.
I recently got diagnosed with scoliosis and have been on multiple medications taken twice daily. I use ice gels and heat, but am looking for long term pain relief. Any suggestions? -Jason V.
Scoliosis is an abnormal curvature of the spine. In scoliosis, the spine curves to one side or the other, usually best seen when looking at someone from front or back. Essentially the vertebra twist/rotate on each other rather than being in a straight line. Scoliosis is usually diagnosed during childhood and roughly 85% of the time it is “idiopathic” (this a term that we doctors use when we don’t know what actually causes something).
In adults who present with scoliosis, we approach the situation first by determining whether the patient is a candidate for surgical correction of the curvature, or whether we can manage their pain with more conservative treatments. Depending on the severity of the curvature, we may recommend a consultation with a spine surgeon to help us make this determination. If surgical correction is not advisable, the patient is a candidate for a wide variety of treatment options.
First, patients are given a comprehensive physical examination and imaging studies are typically ordered of the spine (x-rays, MRIs, CT scans). If basic life functions like breathing are affected, surgery may need to be considered.
Next, patients are advised to become active in low-impact muscle-strengthening endurance programs. The goal is to strengthen the muscles in order to better support the spinal column. Also, the pain specialist may prescribe medications which might include non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or naproxen) or muscle relaxants.
Fortunately, there are several interventional pain management procedures that can help control pain that is associated with adult scoliosis. At Arizona Pain Specialists we try to diagnose exactly where the pain is coming from (muscles, ligaments, discs, facet-joint nerves, etc.), as many sources of pain can exist with scoliosis. Then we target treatment towards those pain generators.
One of the most common sources of pain for scoliosis patients is the facet-joint. The facet joints are found in our spine and they give us the ability to bend forwards, backwards, and to rotate. In the lumbar spine, most of our flexion/extension movements occur at the L4/5 and L5/S1 joint levels. Facet-joint pain is often dull and achy, but at times can be sharp. Facet joint pain is often worsened with backwards bending and rotational movements. Patients can have difficulty with prolonged sitting and particularly with riding in a car. A targeted treatment towards this type of pain is to block the nerves (called “medial branches”) that supply these joints and stop transmission of the pain signals to the brain. If the pain comes quickly back, we can conduct radiofrequency ablation (RFA) of those nerves for a longer-lasting (6-15 months) period of pain relief. These RFA procedures are typically repeated every 6-15 months because the nerves do grow back over time.
Patients may also benefit from chiropractic care, physical therapy, acupuncture, TENS units and other modalities.
