How can I manage migraines without affecting my treatment?

Question

Hello doctor,

I have been experiencing more frequent and intense migraine attacks lately, and I am wondering if they could be related to my multiple myeloma or the treatment I am receiving for it. The headaches are typically one-sided, throbbing, and often accompanied by nausea and sensitivity to light.

Although I have had migraines for years, these feel different, sharper, more persistent, and harder to manage. I am currently undergoing chemotherapy and also taking medication for bone pain, and I am concerned that these treatments might be making the migraines worse. Could abnormalities in my blood counts or calcium levels be contributing?

I also occasionally feel dizzy or lightheaded, and I am unsure whether that’s due to the cancer itself, a side effect of the treatment, or part of the migraine. Would it be advisable to get brain imaging to rule out any complications?

I am particularly worried about the possibility of central nervous system (CNS) involvement or whether this could be a side effect of the steroids. I have been trying to manage the headaches with my usual migraine medication, but it does not seem to be as effective anymore.

What can I do to better control the migraines without interfering with my multiple myeloma treatment?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concerns.

I understand your concern. Multiple myeloma and migraines are distinct conditions. Migraines are a type of headache, while multiple myeloma is a cancer of the bone marrow. Even in earlier or less active stages, such as smoldering multiple myeloma, neurological symptoms like migraines are not directly caused by the disease itself, but certain associated factors can contribute to headaches.

Yes, chemotherapy and certain pain medications, especially those used to manage bone pain, can potentially worsen migraine headaches. Chemotherapy itself can trigger headaches, and some medications used for bone pain, if taken excessively, can lead to "rebound headaches" or exacerbate existing migraines.

Blood counts and calcium levels, particularly high calcium levels (hypercalcemia) and hyperviscosity due to abnormal proteins, can also contribute to headaches, including migraine-like headaches, in individuals with multiple myeloma.

Multiple myeloma can cause elevated calcium levels in the blood (hypercalcemia) due to bone breakdown and increased calcium release into the bloodstream.

Hypercalcemia can lead to symptoms like confusion, dizziness, and headaches. Myeloma cells produce excess abnormal proteins (paraproteins), which can thicken the blood, leading to hyperviscosity. This can cause blood flow to slow, affecting the brain and leading to symptoms like headaches, dizziness, and impaired vision.

Multiple myeloma can also affect other blood cell counts, such as causing anemia (low red blood cell count), which leads to fatigue and weakness and can potentially contribute to headaches. Yes, you may also feel dizzy from the disease itself and the ongoing treatment, so multiple factors are at play here.

I do not think you need any imaging at the moment, but you should consider adjusting your migraine medication dose by consulting with your neurologist, especially in the context of your multiple myeloma treatment. I believe that would be a wiser step and could help improve your migraine symptoms.

I hope this helps.

Thank you.