Brief Answer:
No conflicting information. Can cause bleeding

Detailed Answer:
Fioricet has been reported to cause GI bleeding by both direct as well as indirect mechanisms. The incidence is considered to be rare to VERY rare.

Acetaminophen (an ingredient in Fioricet) itself can contribute to bleeding tendencies due to its lowering the circulating number of platelets which are important in the clotting mechanism which can effectively thin the blood.

The component of butalbital can cause a direct effect of the stomach lining as well as stimulating a vomiting reflex which can be violent in some people. The action of the vomiting can cause minor tears in both the stomach as well as lower esophagus causing some bleeding to appear.

I would see a headache specialist or a neurologist if your physician cannot suggest a better choice of medications for the headache. Fioricet is neither effective for the majority of people nor curative. There are better agents on the market to treat headaches which are secondary to concussions.

Good luck.

Please don't forget that your written feedback as well as a STAR RATING to this question are greatly appreciated if you've found the information of value. Also,
CLOSING THE QUERY on your end so that the network may process, archive, and properly credit this case for future reference garners my thanks as well.

Please do not hesitate to contact me directly in the future by looking me up on this network and sending questions to my specific attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:

http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474

This case required 28 minutes physician specific time for review, research, and final draft documentation for envoy.

---

Brief Answer:
Absolutely can be more problems in such patients

Detailed Answer:
Good morning once again (wee hours...don't know where you're at)....but yes, you're right- the risk of experiencing GI bleeds in the type of patients you've mentioned and by extension I suppose that means YOU TOO--- is higher when on something like Fioricet. I'm glad that your neurologist sees the wisdom anyways of taking you off that medication. I've been running the headache clinic at the VA for nearly 12 years and with some of the really severe TBI victims we have we still have never had to prescribe by first intention narcotics for their PCS. And it's entirely based upon true efficacy of the medication for the problem. People think I'm against these drugs because they are addictive, potentially abusable, have street value, yada, yada, yada. And that's NOT why I don't like them. They simply don't work..bottom line...there are better agents. And by the way, headache patients probably get hooked more often on aspirin and Tylenol than Vicodin and Oxycontin so the addiction card is a scam when it comes to why we shouldn't be using them....it's based on lack of efficacy and risk of causing Medication Overuse Headaches.

As far as Relpax is concerned....in my clinic I allow my patients to have up to 16-20 Relpax per month or any other triptan that is to their liking. 9 is really being stingy....they can allow a bit more than that...

Why not get on a stiff dose of Topamax? Does it whack you out on the job? That's understandable...what about other prophylactics?

Anyways, I don't want to spin too far off course because you already have a neurologist helping you so you don't need all these extra opinions. But you can offer to your neurologist (in case they are not headache specialists) that I would be happy to work in conjunction with them on this network with you if they wanted some input as to how to manage your headaches and keep you functional for your job.....it could take some time to get lined up but this is what I do for the vets who come to me all the time....and honey, lemme tell 'ya....we get the worst of the worst at our clinic!

Let your neurologist know that I am available on this network to contact if they so choose at :

http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474

Please don't forget that your written feedback as well as a STAR RATING to this question are greatly appreciated if you've found the information of value. And again,
CLOSING THE QUERY on your end so that the network may process, archive, and properly credit this case for future reference as well garners my thanks.

I'm running into a rash of folks who don't want to rate my answers over the past several days. And what that means is that the supply of peanuts that I get tossed by management is beginning to dwindle.....and once they're gone...my goodness the only thing I may have to munch on while writing answers to questions will be the small insects that light on my nose...if I'm fast enough! LOL! Please don't let that happen....keep the peanuts coming by writing a nice review if you think I deserve it...if not, I'll understand....NOT! HA!

This case required 20 minutes physician specific time for review, research, and final draft documentation for envoy.

P.S.- BTW, why do you have gastric bleeds? Don't tell me you're using so much aspirin or NSAID OTC medication that you perforated your stomach???

P.P.S.- If we can't raise your dose on the Topamax for whatever reason where are we with other good prophylactics...especially BOTOX??

---

Brief Answer:
Thanks again for your updates

Detailed Answer:
Topamax is considered by the XXXXXXX Academy of Neurology and the XXXXXXX Headache Society as being the most effective prophylactic medication we have for CHRONIC Migraine HEADACHES as supported by good clinical studies and evidence. Therefore, "Heck yeah baby! Turn it up" as somebody's song might say. Be on guard, however, for some side effects that could make you want to dial back such as tingling and numbness of the nose, the fingertips, the toes, and also as we go up in dose you may forget what 1+1=....HA! Not quite that bad...but you're talking about having a Master's....you might feel a little raw in the Quick Draw McGraw dept. of thinking if the dose gets up there.....all expected and known side effects. But the up side is marvelous relief from frequency and intensity of migraine headaches. And hopefully, as these were traumatic to begin with (I'm sorry you got nailed by a XXXXXXX ...how did that happen?) it is statistically likely that post concussive headaches will resolve with or without treatments inside of 3 years. Obviously, we don't people to have to suffer in the 21st century and so that's why I believe your regimen can be a little beefed up.

You are not a veteran by any chance are you? Where in the country are you located and is your neurologist a headache specialist? Perhaps, you'd be better served by a headache specialist in your area....BOTOX is an excellent example of a Grade A prophylactic considered to be standard of care here in the VA where I direct the clinics and our vets have the most STRESSFUL stuff going on that you can imagine and they do very well (in my humble opinion)......

I would be happening to look at your neuropsych report if you'd like to upload it to this system. I understand the frustration where the docs don't seem to be cross talking...at any rate, I will close at this point by thanking you very much for your support.

If you'd like to write to me ever directly with a question or continuation of this query please use the following link and it'll take you directly to a dialog box which you can type your question directly to me.....I think my smiling picture is next to the box! :) yeah, that one!

Here's the link: http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

All the best and again the offer remains open that I'd be happy to read your neuropsych report and also work in concert with your neurologist on the headaches if they feel I can be of benefit....but I know how egos can be and territory can be trespassed on so don't necessarily push it....I'd probably feel as jealous if someone else wanted to muscle in when I thought I could handle it.


Your gracious written feedback and a STAR RATING are greatly appreciated as well as CLOSING THE QUERY (for now).

This response required 21 minutes of physician specific time to review, research, and document in final draft form for envoy.

---

Brief Answer:
Many thanks for your kind words on the supplements

Detailed Answer:
And thanks for the uploaded data. It's nice to put a sleep (all be it sleeping?) and a BRUISE (wow-- an 8 year old did that?). Geezzz....What was a XXXXXXX doing in his reach if he's got those sorts of management issues? Sure you don't want to try being a social worker for nursing homes? Those clients generally can't pick up bricks anymore! HA....well, at any rate...I only make light of it cuz you're still miraculously working through all this. I read the report by Dr. Hyson. Now, he's not the neurologist, right? Or maybe he is...it's not clear from his report. By description (and by the looks of things) I agree that you are now suffering from post-concussive syndrome. I also believe you suffered from a mild TRAUMATIC HEAD INJURY to begin with even though there was no loss of consciousness. It's good that you're working and staying active. As I said in my other note the data would suggest that headaches are generally short lived in these sorts of cases and self limited....but while you have them they should be treated as aggressively as possible.

I think you would be best served by a headache specialist but also understand the catch 22 you're in with this being a WC case. We used to accept WC but the paperwork just got so unwieldy and reimbursements dropped so low that we had to make the tough decision not to accept patients anymore. However, I retained seeing State Disability cases which have been coming to the office now for nearly 15 years so I feel we're trying to stay somewhat within the system....just like you're doing with Child Protective Services.

If your neurologist would like to bounce ideas around as to medications that we typically use in our head trauma patients I'm open to discussion with him. I actually have one doctor who is communicating with me via this network all the way from Israel about a young girl with daily severe migraines. I tell you the same thing I told the doctor. You should consider filling out a log of your headache events. You can find good logs on the internet and even as free apps for smart phones. Doesn't sound like you'll have much luck getting your neurologist to look at them because they take time to sit down and digest and then, analyze. Much easier to just prescribe "9 pack of Relpax." LOL....well, the life of a busy neurologist I guess...some times I look at the other side of the fence those guys who have these assembly line practices. I just have never been able to bring myself to treat people like that....went against the grain of how I brought up and trained.

I also do appreciate your time to write a little feedback. You know that's the name of the game these days...if there were a FB page I'd probably be asking you to LIKE me or something obtuse like that....instead of gauging CLINICAL results medicine has been reduced to a popularity contest of sorts....ugghhh...ok..off the soapbox.

Remember, if you did want to treat these headaches more aggressively in terms of the Relpax I believe you should be able to go all the way up to 16 doses monthly but that's also assuming that you are being placed on a good stiff dose of something else as a prophylactic, Topamax, some TCA, or consideration of BOTOX.....but there again, WC rears its ugly head. Doubt they'll pay for BOTOX injections. You'll have to enroll in a self defense class where they warm up with "Ducking Exercises" in the future!

Lots of luck and I'm sure things will improve....just keep thinking positively.....and the fact that you're working is GREAT....keep it up.

I know people have been bashing the VA lately...but as one who has been working there for 13 years now I can tell you that I think my colleagues do a great job by and large.....are there those who don't do as awesome a job as one would like? Yeah, sure are....I know I don't do an AWESOME job 100% of the time...everybody has those days, those patients, but all in all I think the VA is a different place than it was decades ago when it earned all the crappy reputation and now with the scandals here and there.....but I'd be able to give you BOTOX! HAHA without any problems. And I'd be able to spend all the time I WANTED to spend without people looking at their clocks....things like that...

Of course, I'm appreciative of your favorable comments in a written note of feedback with the all the important START RATING! If there are no further comments or questions to ask also, CLOSING THE QUERY is appreciated but you can also get me to come out and play again if you knock on my door at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This case required 37 minutes physician specific time for review, research, and final draft documentation for envoy.

---