Key to conquering painful migraines is to diagnose and treat them early

She wasn’t.

“I was kind of running around clueless,” said the 17-year-old. “I started not remembering any of the plays I had. I started trying to shoot in the other team’s basket.” Rushed to the hospital by the third quarter, she was diagnosed with a concussion. Recovery from that wasn’t easy. But what the concussion ultimately triggered — and getting the problem properly diagnosed and treated — was far more difficult.

Years of debilitating headaches followed, often keeping her in bed for weeks. Myriad doctors couldn’t diagnose or treat the problem. Then she found Dr. James Charles, a neurologist and headache specialist at Holy Name Medical Center in Teaneck. His diagnosis and treatment of what were ultimately determined to be migraines, she says, was life-changing. After being sidelined not only from basketball but from life as a teenager, Margaret is ready to get back in the game.

“It’s been so long since I felt like this,” said Margaret, who will begin her senior year at the Academy of the Holy Angels in Demarest this fall and already plans to join both a summer basketball league to practice up and this year’s high school team when the full season starts.

She must be feeling better to say that. Because it wasn’t long ago when she wouldn’t leave her room, no less the house. Recovering from the concussion, alone, was a long road.

“My first neurologist was telling me that a concussion is different for everyone and that I needed to adjust to what I thought my limits were. For a whole month, I was just sleeping in a dark room, trying to avoid light. I don’t even remember much of it because I had short-term memory loss, at that point. When I finally returned to school, I couldn’t remember my locker combination. I couldn’t remember my teachers’ names. I tried to go back to my old study habits but I couldn’t memorize anything, or retain information the same way I did. I had to sort of re-invent myself as a student and find new ways to adapt to this new reality,” she said.

One helpful tool: Little daily reminder notes. “Pretty much everything I thought of, I had to then write down on a sticky note or else I wouldn’t remember it. I had a million sticky notes on my computer, most of the time,” she said, with a laugh.

What wasn’t so much a laughing matter, however, were the migraines that began about nine months after the concussion. “I didn’t know they were ‘migraines,’ at that point. They were just these huge, debilitating headaches that just made me stay in my room. I didn’t want to leave my room. I didn’t want to have contact with other people. My mom started getting really concerned. We started going to doctors. A neurologist, an optic neurologist, an endocrinologist, a physical therapist, an ophthalmologist.”

Some had the theory the headaches were connected to the concussion. Others didn’t. Nobody offered any kind of effective treatment.

By the time she was referred to Dr. Charles at the Headache Treatment Program at Holy Name, Margaret thought she had exhausted her options. Suddenly, he started asking all the right questions.

“He went back to my childhood and asked if I had serious stomach pains as a child. I immediately said ‘yes!’ I had HORRIBLE stomach pains as a child. I even had to go to the hospital once. He said those were migraine headaches in my stomach.”

Charles, board-certified in neurology and clinical neurophysiology, said as weird as it sounds, it’s a tell-tale precursor to people who experience migraines of the head later in life. They get stomach migraines as kids. “She grew out of it as she got older. But then came her injury. Yes it was a concussion but it was also a trigger that set off the migraines.”

A clinical associate professor of neurology at Rutgers School of Biomedical and Health Sciences, Charles said other childhood symptoms of people who later in life suffer migraines include severe vomiting for no apparent reason and paroxysmal vertigo — the sudden sensation that you are spinning.

The doctor noted that an early diagnosis can lead to a much more successful outcome because the headaches themselves can cause irreversible damage over time. “The pain networks of the brain start to become degenerated and altered. You get iron deposition in parts of the brain, and you get white matter changes. This implies that the migraines are damaging the upper parts of the brain. It’s a vicious cycle and you must break it aggressively or you will have headaches every day of your life. So when you are a young person like this, there is a window of opportunity to help them.”

Charles immediately sent Margaret to Holy Name, where she underwent two rounds of “infusion therapy,” certain targeted intravenous drugs specifically designed to fight migraines, according to the doctor. Each round took about six hours to administer. “It basically resets the brain modulating system, to make the patient well again.”

Holy Name is the only facility in New Jersey offering this type of treatment to headache patients of all ages, according to Charles.

“From there, we put her on appropriate preventative medication, to keep the brain quiet.”

While he would not be more specific about what the infusion therapy medications are, he did say what they aren’t. “One thing that should never be done is to take barbiturates or opiates because it can actually make the problem worse,” he said.

Some doctors do administer those types of drugs, not realizing they can do more harm than good, he said. “In other cases, it’s just misdiagnosed as something other than a migraine — ‘you need new glasses, a sinus infection, a molar, a neck problem,’ ” he said.

It’s been two months since the infusion therapy essentially rebooted Margaret’s brain, to end what was a nine-day non-stop migraine. “I woke up the next day, and said to myself: ‘This is how you’re SUPPOSED to feel.’ I felt amazing. I hadn’t felt like that in months. Probably even in years. It was miraculous.”

Now she takes 25 milligrams of topiramate twice daily as a migraine preventive.

“She’s not a complainer. She’s always had a high tolerance for pain. So as a mother, seeing her suffer with no medical answers for such a long time was extremely frustrating and difficult. It was stressful,” said Liz Murray, Margaret’s mom.

Charles knew just what to zero in on. “Finally we had a doctor asking us intelligent questions,” Liz said — like the one about stomachaches as a child. Others included whether anyone in the family ever experienced migraines, and whether Margaret ever got a concussion before this most recent one.

“It was like an epiphany. Yes. Her nose was broken in the seventh grade playing basketball. There could have very well have been another concussion then. And my mother suffered from terrible headaches. She didn’t call them migraines though she called them sinus headaches. We never equated them to migraines at the time but they were probably migraines.”

Margaret says that despite everything she has been through, she isn’t even remotely gun shy about the possibility of another injury when she returns to the basketball court.

“I am mostly eager to get back,” she said. “I don’t want to play it scared anymore. I just want to put it all out there, and leave it on the court.”

Email: petrick@northjersey.com