### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, I have suffered chronic Migraine for ovre 30 years but for the last 6 months I have had more migraines than ever, a persistent daily headache, and toothache , I have even had the tooth extracted but am still suffering severe pain. I have had all the scans going. I have vascular malformations in upper thorax , mri s have shown bony lesions in skull and spine with further treatments and investigations pending. I have even had a mouthguard made by the dentist but after a few days of wearing this at night it has blistered my gums which adds to the pain. Don t know where to turn to.

### output:

Hello, Thanks for posting this question in ChatDoctorLet me tell you the causes of headache are many and one has to find out the exact cause. Headache can be due to migraine, cluster headache, brain tumor, infection, vascular malformations and so on.  I have noted all your problems need to be re-evaluated in a hospital/teaching medical university with Multidisciplinary facility where neurologist/headache specialist / dentist/ interventional radiologist will jointly evaluate you. Their clinical evaluation will determine if you need a brain MRI scan (I am not sure if you have done to rule out any vascular malformation in the brain too). Some people may harbor vascular malformations in multiple sites of the brain. If it turns out to be migraine (which is a diagnosis of exclusion), you will benefit with the following approach1. Acute attack: simple analgesics. Sumatriptan nasal spray. Avoid the precipitating factor. Avoid stress, coffee and lack of sleep. Do regular exercises and good sleep hygiene2. During the chronic phase: You may take one of these medicines: Amitriptyline, propranolol, topiramate, valproate etc. The changes which are seen in the skull and spike are due to the presence of long standing vascular malformation. Hope this helps