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Suggest Treatment For Chronic Migraine Causing Disturbed Sleep
Question: My husband and I have got sleep related problem. We both are not able to sleep properly. In my husband's case,even after going at the same time and waking up at the same time, sleep is not very relaxing, resulting irritating, sleepy mornings. In my case I have got chronic migraine problem, I can't sleep at night most of the times and then morning if I try to wake up early I will feel increase in headache manifolds. This increases my headache even more. Please suggest.
Brief Answer:
Your husband and you have different issues
Detailed Answer:
Hello XXXX Thanks for coming to HealthCareMagic. Let me see if i can address your issues separately from your husbands.
You have chronic migraines that are keeping you awake. How are these migraines being managed? Are you taking any triptan medications to prevent them? How do you manage your migraines when they start? Do you know what triggers them? If there is something in your bedroom that triggers them.. like the type of sheets you use or the air conditioning, then you might be able to prevent the headaches from occuring.
In your husbands case, you say that he is having poor quality sleep. Does he toss and turn while sleeping? Does he snore? Does he wake up often at night? Try and watch what he is doing at night and see whats going on.
In general, Sleep Hygiene is an important practice to put into effect to help your quality of sleep. Sleep hygiene is the practice of preparing yourself for sleep in a certain way. Let me outline the procedures.
The most important sleep hygiene measure is to maintain a regular wake and sleep pattern seven days a week.
Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness.
Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it's not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.
See if these things help and then get back to me.
Vin
Your husband and you have different issues
Detailed Answer:
Hello XXXX Thanks for coming to HealthCareMagic. Let me see if i can address your issues separately from your husbands.
You have chronic migraines that are keeping you awake. How are these migraines being managed? Are you taking any triptan medications to prevent them? How do you manage your migraines when they start? Do you know what triggers them? If there is something in your bedroom that triggers them.. like the type of sheets you use or the air conditioning, then you might be able to prevent the headaches from occuring.
In your husbands case, you say that he is having poor quality sleep. Does he toss and turn while sleeping? Does he snore? Does he wake up often at night? Try and watch what he is doing at night and see whats going on.
In general, Sleep Hygiene is an important practice to put into effect to help your quality of sleep. Sleep hygiene is the practice of preparing yourself for sleep in a certain way. Let me outline the procedures.
The most important sleep hygiene measure is to maintain a regular wake and sleep pattern seven days a week.
Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness.
Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it's not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.
See if these things help and then get back to me.
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor
Thanks for your advice!
Just to give more informattion on the questions, you have raised.
Doctor:How are these migraines being managed? Are you taking any triptan medications to prevent them? How do you manage your migraines when they start? Do you know what triggers them? If there is something in your bedroom that triggers them.. like the type of sheets you use or the air conditioning, then you might be able to prevent the headaches from occuring.
XXXX: I have taken many medications: but no luck. Right now I am not on any medication.I generally do not have "zero" headache day. I do not even remember when I had zero headache last time...its always like a base headache line (if we draw a curve with headache intensity on Y axis and days/time on X axis) and my headache would go up and down over and above that "base" headache line...Known triggers: Fried foods, hunger, lack of sleep, exersion, sometimes chocolates
complete history of my problem:
====================================================
Background: I used to face headaches since my childhood but for few hours only which would go if I took my meals early and went to sleep in a noise-free & light-free room and after tieing my head with a handkerchief. Vomiting once used to help in such conditions. Frequency of such headaches was once/twice a month.
History of Problem:
1) PCOD (Poly Cystic Ovary Disorder) problem since 2008:
a) Allopathic medicines from 2008 to 2010: Not much effect except getting regular periods
b) Ayurvedic medicines from 2010 to XXXXXXX 2013: regular periods till April 2012, but after that due to one of migraine pills (Es-Flunarizine) (recommended by one of the doctors) I have put on 6 kgs in a month's time with periods becoming irregular (I didn't get my periods for 4 months after this).
2) Headache:
a) Started from Feb 2012.
b) Tried ayurvedic medicines as I was taking the same for my PCOD problem, but it didn't work for headache.
c) Started taking allopathic medicines for headache as headache persisted for 20+ days a month
d) After referring to MRV scans all doctors concluded of it being a case of chronic migraine
e) Visited many hospitals and tried many medicines including Selebium-5 mg, Amitone-5mg,10mg, Es-Flunarizine, TOPAMAC-50mg-once, TOPAMAC-50mg-twice a day as base medicines with other painkillers like Naxdom-250mg,500mg,Headset,Acedor-P, Dart,iMol on SOS basis.
Betacap TR 40 1 tablet in morning, Pregabaline Sustained/extended release tab (SR/ER) 75 mg at night-tried for 2 months
Current MedicationsCurrent State:
1) PCOD:
a) Not on any medication
b) Reduced 10-11 kgs in past 1 year, hence periods are regular without any medication
b) Doing 45-60 mins physical exercise 3-4 days in a week.
c) Maintaining a low carb diet
2) Headache:
a) Started with Topamac-50mg (Topiramate tablet)+ Eliwel 25 mg (Amitriptyline Hydrochloride tablet)- 1/2 tablet each
b) This combination one neurologist has prescribed me and I have taken for past 4 days
c) It has not reduced my headache but I am feeling giddiness and very sleepy even after sleeping for 9 hours, I am not able to do any work because of sleep; moreover after every meal I am vomiting, yesterday also I vomited 3 times.
d) No painkillers work in case of headache
e) After vomiting also there is no relief in headache
f ) Increased headache during bedtime,disturbed sleep due to headache
g) Disturbing pain in lower back of head, neck, shoulder and upper back areas
h) In case of headache face muscles also start paining- cheek bones, jaws, temple area
Note: I am not on any medication right now.
1 point to note here, I have visited NIMHANS earlier,, when a junior doctor prescribed me Es-Flunarizine for 3 months and didn't recommend me to see any XXXXXXX doctor. Due to consumption of that medicine I had put on 6 kgs in a month's time and my PCOD problem worsened (as mentioned before also).
Known AllergiesWhen I take Topamac, after every meal I vomit.
===================================================
Doctor: In your husbands case, you say that he is having poor quality sleep. Does he toss and turn while sleeping? Does he snore? Does he wake up often at night? Try and watch what he is doing at night and see whats going on
XXXXX: Yes he tosses and turns while sleeping. He does snore many a times, although not all the time. He also stays up for a long time and gets some sleep mostly 2-3 am.
Just to add, he is preparing for his UPSC exams, for which he has taken subbatical. He has cleared his prelims and would be appearing for main in dec-2014. This is his 3rd attempt. Due to poor sleep, he is not able to concentrate and remember anything which he studies.
We both have quite light food which is prepared at home. We hardly go out for food as we do not have onion and garlic. In breakfast, we generally have fruit salad only. We take soaked almonds in morning with breakfast.
We do maintain sleep hygiene. I do exercise 4-5 days 45-60 mins/day in morning. If in the evening then I will take warm water bath before sleep. I use seperate clothes for sleeping. I don't use pillow instead of that I use bedsheet for supporting my neck. We do not use bed for reading, watching TV etc. and I change bedsheet in every 6 days.
I hope these information would help you in analysing more anout our problems.Just to add, I have asked a query for both migraine and sleep problem with healthcare magic before but no luck in getting any relief.
Eagerly waiting for your reply.
XXXX
Thanks for your advice!
Just to give more informattion on the questions, you have raised.
Doctor:How are these migraines being managed? Are you taking any triptan medications to prevent them? How do you manage your migraines when they start? Do you know what triggers them? If there is something in your bedroom that triggers them.. like the type of sheets you use or the air conditioning, then you might be able to prevent the headaches from occuring.
XXXX: I have taken many medications: but no luck. Right now I am not on any medication.I generally do not have "zero" headache day. I do not even remember when I had zero headache last time...its always like a base headache line (if we draw a curve with headache intensity on Y axis and days/time on X axis) and my headache would go up and down over and above that "base" headache line...Known triggers: Fried foods, hunger, lack of sleep, exersion, sometimes chocolates
complete history of my problem:
====================================================
Background: I used to face headaches since my childhood but for few hours only which would go if I took my meals early and went to sleep in a noise-free & light-free room and after tieing my head with a handkerchief. Vomiting once used to help in such conditions. Frequency of such headaches was once/twice a month.
History of Problem:
1) PCOD (Poly Cystic Ovary Disorder) problem since 2008:
a) Allopathic medicines from 2008 to 2010: Not much effect except getting regular periods
b) Ayurvedic medicines from 2010 to XXXXXXX 2013: regular periods till April 2012, but after that due to one of migraine pills (Es-Flunarizine) (recommended by one of the doctors) I have put on 6 kgs in a month's time with periods becoming irregular (I didn't get my periods for 4 months after this).
2) Headache:
a) Started from Feb 2012.
b) Tried ayurvedic medicines as I was taking the same for my PCOD problem, but it didn't work for headache.
c) Started taking allopathic medicines for headache as headache persisted for 20+ days a month
d) After referring to MRV scans all doctors concluded of it being a case of chronic migraine
e) Visited many hospitals and tried many medicines including Selebium-5 mg, Amitone-5mg,10mg, Es-Flunarizine, TOPAMAC-50mg-once, TOPAMAC-50mg-twice a day as base medicines with other painkillers like Naxdom-250mg,500mg,Headset,Acedor-P, Dart,iMol on SOS basis.
Betacap TR 40 1 tablet in morning, Pregabaline Sustained/extended release tab (SR/ER) 75 mg at night-tried for 2 months
Current MedicationsCurrent State:
1) PCOD:
a) Not on any medication
b) Reduced 10-11 kgs in past 1 year, hence periods are regular without any medication
b) Doing 45-60 mins physical exercise 3-4 days in a week.
c) Maintaining a low carb diet
2) Headache:
a) Started with Topamac-50mg (Topiramate tablet)+ Eliwel 25 mg (Amitriptyline Hydrochloride tablet)- 1/2 tablet each
b) This combination one neurologist has prescribed me and I have taken for past 4 days
c) It has not reduced my headache but I am feeling giddiness and very sleepy even after sleeping for 9 hours, I am not able to do any work because of sleep; moreover after every meal I am vomiting, yesterday also I vomited 3 times.
d) No painkillers work in case of headache
e) After vomiting also there is no relief in headache
f ) Increased headache during bedtime,disturbed sleep due to headache
g) Disturbing pain in lower back of head, neck, shoulder and upper back areas
h) In case of headache face muscles also start paining- cheek bones, jaws, temple area
Note: I am not on any medication right now.
1 point to note here, I have visited NIMHANS earlier,, when a junior doctor prescribed me Es-Flunarizine for 3 months and didn't recommend me to see any XXXXXXX doctor. Due to consumption of that medicine I had put on 6 kgs in a month's time and my PCOD problem worsened (as mentioned before also).
Known AllergiesWhen I take Topamac, after every meal I vomit.
===================================================
Doctor: In your husbands case, you say that he is having poor quality sleep. Does he toss and turn while sleeping? Does he snore? Does he wake up often at night? Try and watch what he is doing at night and see whats going on
XXXXX: Yes he tosses and turns while sleeping. He does snore many a times, although not all the time. He also stays up for a long time and gets some sleep mostly 2-3 am.
Just to add, he is preparing for his UPSC exams, for which he has taken subbatical. He has cleared his prelims and would be appearing for main in dec-2014. This is his 3rd attempt. Due to poor sleep, he is not able to concentrate and remember anything which he studies.
We both have quite light food which is prepared at home. We hardly go out for food as we do not have onion and garlic. In breakfast, we generally have fruit salad only. We take soaked almonds in morning with breakfast.
We do maintain sleep hygiene. I do exercise 4-5 days 45-60 mins/day in morning. If in the evening then I will take warm water bath before sleep. I use seperate clothes for sleeping. I don't use pillow instead of that I use bedsheet for supporting my neck. We do not use bed for reading, watching TV etc. and I change bedsheet in every 6 days.
I hope these information would help you in analysing more anout our problems.Just to add, I have asked a query for both migraine and sleep problem with healthcare magic before but no luck in getting any relief.
Eagerly waiting for your reply.
XXXX
Brief Answer:
Lets talk about your migraines first.
Detailed Answer:
Hi again Akansha. Thanks for giving me a detailed history. I'm grateful you did as it allows me to narrow down my thoughts and be more useful to you.
I'm going to try and address 2 issues in this message.
1) Advanced prophylaxis techniques (prevention) of YOUR Migraine issue. Where I think you can go from where you are and what I think needs to be done.
2) Ruling out Sleep Apnea in your husbands case and stress management techniques due to his rigorous exam schedule.
By far, I think your issues are more important from a medical stand point, so I'm going to try and discuss them first. Please note that I have NO TRAINING OR EXPERIENCE with regard to Ayurvedic Medications and I do not feel qualified to comment on their use. I do generally recommend that my patients NOT mix the usage of these two schools of medicine when dealing with the SAME disease process (ie: Using Ayurveda and Allopathy to treat a heart condition or in your case, Headaches)
So when it comes to the management of migraines, you definitely fall into the class of chronic migraine sufferers. Since you say that the attacks are a daily issue, then I'm going to rule out the idea of Menstrual Migraines as being your issue and ignore the therapies that are prescribed for that.
I see that you have been on :
1) Topiramate - "Topamax" - An Anticonvulsant commonly used in migraine prophylaxis
2) BetaMethasone - “BetaCap” - A steroid, also commonly used for migraines
3) Flunarizine - “Sibelium” - A calcium Channel blocker with the same uses
4) Selebium?? I’m not familiar with that drug, could you help me out? Do you mean Selenium or are you referring to the afore mentioned Sibelius (Flunarizine)
5) Amitone - A Calcium supplement,
6) Pregabalin - “Lyrica” / “Maxgallin” - another anticonvulsant that acts similar to Gapapentin and is being used more commonly in migraines with promising results.
Along with these i see that you have taken many NSAID (Non Steroidal Anti-Inflammatory Drug) class drugs like IMOL and the like to deal with the headaches on an SOS basis.
If I have forgotten anything, please set me straight.
I see that you are currently on, or were on as of 4 days ago:
1) Topiramate, which you have been on before
2) Amitriptyline - “Eliwell” - an Antidepressant commonly used for migraine prevention.
Again, if I have missed anything, set me straight.
I see that you are educated well enough about your disease to know to look for your triggers and try and avoid them, that is excellent. I hope that you are keeping a headache diary. A small book that you can chart the time, severity, circumstances surrounding your headaches and treatments on a daily basis. These kinds of notations are invaluable. It seems like you have a good amount of information regarding your past treatments, so I am going to assume that you do keep a diary.
Now, I have some further questions for you regarding your past treatment:
Q1) Has Topiramate (Topamax) ever caused you nausea in the past?
Q2) Did the nausea start after taking the Eliwell or the Topamax?
Q3) Have you ever been prescribed a BetaBlocker medication like Propranolol or Atenolol for migraine prevention.
Q4) Have you every been given Botulinum Toxin injections in your neck or forehead for Migraine Prevention?
Q5) Have you ever been in Cognitive Behavioural Therapy Sessions with a trained Psychologist?
Q6) Have your Vitamin D and Calcium levels been checked in the recent past?
The reasoning I have for asking these questions is below:
Q1) The Alternative to Topiramate is another Anticonvulsant known as Sodium Valproate which acts in a different way and works very well on MANY Topiramate resistant migraine patients. I’ve used it on my patients and i’ve seen it work.
Q2) I really truly hope that the Eliwel is not causing you the issues, because I have seen that drug work on almost everyone I have ever recommended it too with great effect. In situations where insomnia (sleeplessness) is associated with the migraines, Eliwel has been my “go to” drug. There is an alternative in that case however. Piztofen is an older drug with a different action that has been used in this case. Its not considered better that Eliwel, but it is something to consider.
Q3)In patients with chronic migraines, especially those associated with anxiety symptoms, I have seen the Beta Blocker Propranolol work very well. If you have never been prescribed a Beta Blocker, it might be a good idea to explore this option with your neurologist.
Q4)Botulinium Toxin Type A is produced by bacteria and is used as a drug to paralyze certain key nerves in the head and neck that are known to be triggers for migraines. there is sound medical evidence to support getting “BoTox” injections in cases like yours where the patient has not responded to at least 3 previous drugs or is having trouble adhering to the medication regime (i hope you are not in this category). If you have never received BOTOX, it is worth exploring this option with your Neurologist.
Q5) CBT is a good adjunct therapy for people with chronic migraines, especially ones who have been depressed or anxious. In my old residency training hospital, we used to routinely send ALL chronic migraine sufferers for evaluation by a psychologist to see if CBT would help them. The thing to remember is that talking about a psychologist does not mean I or ANYONE else thinks you are crazy. Anyone who thinks that is immature. Psychologists in general and CBT in particular are used in a wide variety of patients who have no mental health issues AT ALL. So, I would encourage you to explore this option with your Neurologist at the earliest.
Q6) The cause of migraines can be boiled down (most of the time) to a problem with the blood flow in some parts of the Meninges (protective coverings of the brain) and the brain. It has been shown that Astrocytes ( a type of brain cell) help in regulating this blood flow and they use CALCIUM as a communicating agent. So if you are calcium deficient (either you don’t get enough in your diet, or you can’t absorb it due to Vitamin D deficiency), there is some evidence to support the idea that normalising Calcium levels through supplementation or Vitamin D therapy can help.
So, to sum up. i believe the unique things that may be considered in your case are:
1) The use of a beta blocker like propranolol
2) Switching out topamax for Valproate
3) BOTOX injections
4) CBT
5) Getting a Vitamin D level checked and your Serum Calcium level checked would be a good idea, if these levels are normal, then, well dead end on this front. But if they are abnormal, then correcting this may help control the migraines.
If Eliwel is causing you nausea, then you could possibly look to a drug like Piztofen as a poor substitute. Also, see if you can get a prescription for an Acid blocker like Omeprazole from your neurologist or your primary doctor, this nausea may be due to gastric irritation and that may help control it and allow you to use the Eliwel without issue.
The management of chronic migraines is complex and slow. Many patients need a combination of therapies and the winning combo that works for one person may have no effect on another. It can be disheartening and drive people crazy. Take heart. You are not alone in this. You need to keep plugging away. More research happens everyday and new therapies are always on the horizon.
I hope at least one of my suggestions helps you out here.
Now, to your husbands sleep issues. He sounds like he may be suffering from sleep apnea, the occasional snoring and disturbed sleep make him sound like a candidate. Sleep apnea can be caused by many things, including Obesity, Excess caffeine and sugar intake, smoking and the long term use of muscle relaxants. Its much more common in people with short necks.
The evaluation of this problem is easy enough. He needs to go for a sleep study. He will be wired up and monitored overnight at the sleep study centre and they will check into the different causes. If he has sleep apnea, a good ENT or Sleep specialist will be able to help him. If he doesn’t, then we have done no harm in ruling it out.
Now, He is studying for these exams. That is a stressful time. How is he coping with these stressors? Does he eat regularly, get regular exercise, etc? Does he meditate or do Yoga? You mentioned he has faced this exam before, do you think his previous experiences with the exam may have caused him clinical depression?
Stress and depression can lead to severe sleep issues. So think along these lines and get back to me. If you think it is something that needs to be looked into, I will guide you on what needs to be done next.
I hope your husbands exams go well for him, but remember, these are just exams, they do not make or break a human being.
I look forward to your thoughts.
Vinay
Lets talk about your migraines first.
Detailed Answer:
Hi again Akansha. Thanks for giving me a detailed history. I'm grateful you did as it allows me to narrow down my thoughts and be more useful to you.
I'm going to try and address 2 issues in this message.
1) Advanced prophylaxis techniques (prevention) of YOUR Migraine issue. Where I think you can go from where you are and what I think needs to be done.
2) Ruling out Sleep Apnea in your husbands case and stress management techniques due to his rigorous exam schedule.
By far, I think your issues are more important from a medical stand point, so I'm going to try and discuss them first. Please note that I have NO TRAINING OR EXPERIENCE with regard to Ayurvedic Medications and I do not feel qualified to comment on their use. I do generally recommend that my patients NOT mix the usage of these two schools of medicine when dealing with the SAME disease process (ie: Using Ayurveda and Allopathy to treat a heart condition or in your case, Headaches)
So when it comes to the management of migraines, you definitely fall into the class of chronic migraine sufferers. Since you say that the attacks are a daily issue, then I'm going to rule out the idea of Menstrual Migraines as being your issue and ignore the therapies that are prescribed for that.
I see that you have been on :
1) Topiramate - "Topamax" - An Anticonvulsant commonly used in migraine prophylaxis
2) BetaMethasone - “BetaCap” - A steroid, also commonly used for migraines
3) Flunarizine - “Sibelium” - A calcium Channel blocker with the same uses
4) Selebium?? I’m not familiar with that drug, could you help me out? Do you mean Selenium or are you referring to the afore mentioned Sibelius (Flunarizine)
5) Amitone - A Calcium supplement,
6) Pregabalin - “Lyrica” / “Maxgallin” - another anticonvulsant that acts similar to Gapapentin and is being used more commonly in migraines with promising results.
Along with these i see that you have taken many NSAID (Non Steroidal Anti-Inflammatory Drug) class drugs like IMOL and the like to deal with the headaches on an SOS basis.
If I have forgotten anything, please set me straight.
I see that you are currently on, or were on as of 4 days ago:
1) Topiramate, which you have been on before
2) Amitriptyline - “Eliwell” - an Antidepressant commonly used for migraine prevention.
Again, if I have missed anything, set me straight.
I see that you are educated well enough about your disease to know to look for your triggers and try and avoid them, that is excellent. I hope that you are keeping a headache diary. A small book that you can chart the time, severity, circumstances surrounding your headaches and treatments on a daily basis. These kinds of notations are invaluable. It seems like you have a good amount of information regarding your past treatments, so I am going to assume that you do keep a diary.
Now, I have some further questions for you regarding your past treatment:
Q1) Has Topiramate (Topamax) ever caused you nausea in the past?
Q2) Did the nausea start after taking the Eliwell or the Topamax?
Q3) Have you ever been prescribed a BetaBlocker medication like Propranolol or Atenolol for migraine prevention.
Q4) Have you every been given Botulinum Toxin injections in your neck or forehead for Migraine Prevention?
Q5) Have you ever been in Cognitive Behavioural Therapy Sessions with a trained Psychologist?
Q6) Have your Vitamin D and Calcium levels been checked in the recent past?
The reasoning I have for asking these questions is below:
Q1) The Alternative to Topiramate is another Anticonvulsant known as Sodium Valproate which acts in a different way and works very well on MANY Topiramate resistant migraine patients. I’ve used it on my patients and i’ve seen it work.
Q2) I really truly hope that the Eliwel is not causing you the issues, because I have seen that drug work on almost everyone I have ever recommended it too with great effect. In situations where insomnia (sleeplessness) is associated with the migraines, Eliwel has been my “go to” drug. There is an alternative in that case however. Piztofen is an older drug with a different action that has been used in this case. Its not considered better that Eliwel, but it is something to consider.
Q3)In patients with chronic migraines, especially those associated with anxiety symptoms, I have seen the Beta Blocker Propranolol work very well. If you have never been prescribed a Beta Blocker, it might be a good idea to explore this option with your neurologist.
Q4)Botulinium Toxin Type A is produced by bacteria and is used as a drug to paralyze certain key nerves in the head and neck that are known to be triggers for migraines. there is sound medical evidence to support getting “BoTox” injections in cases like yours where the patient has not responded to at least 3 previous drugs or is having trouble adhering to the medication regime (i hope you are not in this category). If you have never received BOTOX, it is worth exploring this option with your Neurologist.
Q5) CBT is a good adjunct therapy for people with chronic migraines, especially ones who have been depressed or anxious. In my old residency training hospital, we used to routinely send ALL chronic migraine sufferers for evaluation by a psychologist to see if CBT would help them. The thing to remember is that talking about a psychologist does not mean I or ANYONE else thinks you are crazy. Anyone who thinks that is immature. Psychologists in general and CBT in particular are used in a wide variety of patients who have no mental health issues AT ALL. So, I would encourage you to explore this option with your Neurologist at the earliest.
Q6) The cause of migraines can be boiled down (most of the time) to a problem with the blood flow in some parts of the Meninges (protective coverings of the brain) and the brain. It has been shown that Astrocytes ( a type of brain cell) help in regulating this blood flow and they use CALCIUM as a communicating agent. So if you are calcium deficient (either you don’t get enough in your diet, or you can’t absorb it due to Vitamin D deficiency), there is some evidence to support the idea that normalising Calcium levels through supplementation or Vitamin D therapy can help.
So, to sum up. i believe the unique things that may be considered in your case are:
1) The use of a beta blocker like propranolol
2) Switching out topamax for Valproate
3) BOTOX injections
4) CBT
5) Getting a Vitamin D level checked and your Serum Calcium level checked would be a good idea, if these levels are normal, then, well dead end on this front. But if they are abnormal, then correcting this may help control the migraines.
If Eliwel is causing you nausea, then you could possibly look to a drug like Piztofen as a poor substitute. Also, see if you can get a prescription for an Acid blocker like Omeprazole from your neurologist or your primary doctor, this nausea may be due to gastric irritation and that may help control it and allow you to use the Eliwel without issue.
The management of chronic migraines is complex and slow. Many patients need a combination of therapies and the winning combo that works for one person may have no effect on another. It can be disheartening and drive people crazy. Take heart. You are not alone in this. You need to keep plugging away. More research happens everyday and new therapies are always on the horizon.
I hope at least one of my suggestions helps you out here.
Now, to your husbands sleep issues. He sounds like he may be suffering from sleep apnea, the occasional snoring and disturbed sleep make him sound like a candidate. Sleep apnea can be caused by many things, including Obesity, Excess caffeine and sugar intake, smoking and the long term use of muscle relaxants. Its much more common in people with short necks.
The evaluation of this problem is easy enough. He needs to go for a sleep study. He will be wired up and monitored overnight at the sleep study centre and they will check into the different causes. If he has sleep apnea, a good ENT or Sleep specialist will be able to help him. If he doesn’t, then we have done no harm in ruling it out.
Now, He is studying for these exams. That is a stressful time. How is he coping with these stressors? Does he eat regularly, get regular exercise, etc? Does he meditate or do Yoga? You mentioned he has faced this exam before, do you think his previous experiences with the exam may have caused him clinical depression?
Stress and depression can lead to severe sleep issues. So think along these lines and get back to me. If you think it is something that needs to be looked into, I will guide you on what needs to be done next.
I hope your husbands exams go well for him, but remember, these are just exams, they do not make or break a human being.
I look forward to your thoughts.
Vinay
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor
Thanks a lot for all your efforts and thoughts on our problems! You have been very patient in reading and writing so much! I really appreciate!
Just to answer/clarify few things:
1) Selebium: I wanted to write Sibilium only. So please ignore the typo.
2) Current medications: Currently I am not on any medications. I have stopped having my last medicines i.e.:
a) Topiramate, which you have been on before b) Amitriptyline - “Eliwell” - an Antidepressant commonly used for migraine prevention.
I do not even have any pain killers as nothing works in relieving the pain.
3) I have never been on mix of two kind of medicines like Ayurvedic+Homeo, or Ayurvedic+ Ellopathic etc.
4) Answers to your questions:
Q1) Has Topiramate (Topamax) ever caused you nausea in the past?
XXXX: Yes, almost after every food I used to vomit. I took upto 50mg twice in a day on doctor's prescription.
Q2) Did the nausea start after taking the Eliwell or the Topamax?
XXXXX: Nausea started after Topamac but due to Eliwell, I will get over sleep and if I control and wake up for going to office, I will have severe headache due to excessive sleepiness.
Q3) Have you ever been prescribed a BetaBlocker medication like Propranolol or Atenolol for migraine prevention.
XXXX: I am not sure about the medicines composition but I have mentioned names of all the medicines so if its not part of the list of medicines then I have not taken I believe. I am sorry for the vague answer but I do not remember the composition.
Q4) Have you every been given Botulinum Toxin injections in your neck or forehead for Migraine Prevention?
XXXX: I have never taken any injections for migraine. But I have read and reasearch about it. But it seems to be very expensive treatment which lasts only for 3 months. Please correct me if I am wrong.
Q5) Have you ever been in Cognitive Behavioural Therapy Sessions with a trained Psychologist?
XXXX: I never have been to any Psychologist so as to CBT. Could you brief me about this and would it be helpful in my case? Is it for sleep problem or for migraine?
Q6) Have your Vitamin D and Calcium levels been checked in the recent past?
XXXX: I have got checked my hormones level but not Vitamin D and Calcium levels. But I would need prescription for this, right?
5) I used to maintain migraine diaries, but as its a daily affair, I am not maintaining it for quite a long time. As I mentioned earlier also, there would always be a base headache line if you plot headache intensity on Y axis and date of X axis, and then headche varies over and above that base headche line. I could sense (sometimes) why it has got increased when reasons are very evident like hunger, lights, horns or fried food. Hence I am not maintaining daily diary.
6) Now answers to your questions in my husband's case:
How is he coping with these stressors?
XXXX: He does not do anything special. He just distracts himself by watching some comedy programs/movies
Does he eat regularly, get regular exercise, etc?
XXXX: Yes, he eats regularly and he does some floor exercises before taking bath but not more than 10 mins.
Does he meditate or do Yoga?
XXXX: Yes, he meditates once after morning XXXXXXX and then after evening XXXXXXX
You mentioned he has faced this exam before, do you think his previous experiences with the exam may have caused him clinical depression?
XXXX: Actually he is a very jolly kind of person and accepts things faster including failures. He talks to people as well like maids in house etc. So I do not think that he can have depression kind of things in his case. Probably if you could give me some checkpoints then probably I can answer to them.
Just to add my husband has got IBS problem due to which he wastes his 3-4 hours of time in bathroom that becomes stressful for him.
Waiting for your reply. Thanks!
Thanks & Regards,
XXXX
Thanks a lot for all your efforts and thoughts on our problems! You have been very patient in reading and writing so much! I really appreciate!
Just to answer/clarify few things:
1) Selebium: I wanted to write Sibilium only. So please ignore the typo.
2) Current medications: Currently I am not on any medications. I have stopped having my last medicines i.e.:
a) Topiramate, which you have been on before b) Amitriptyline - “Eliwell” - an Antidepressant commonly used for migraine prevention.
I do not even have any pain killers as nothing works in relieving the pain.
3) I have never been on mix of two kind of medicines like Ayurvedic+Homeo, or Ayurvedic+ Ellopathic etc.
4) Answers to your questions:
Q1) Has Topiramate (Topamax) ever caused you nausea in the past?
XXXX: Yes, almost after every food I used to vomit. I took upto 50mg twice in a day on doctor's prescription.
Q2) Did the nausea start after taking the Eliwell or the Topamax?
XXXXX: Nausea started after Topamac but due to Eliwell, I will get over sleep and if I control and wake up for going to office, I will have severe headache due to excessive sleepiness.
Q3) Have you ever been prescribed a BetaBlocker medication like Propranolol or Atenolol for migraine prevention.
XXXX: I am not sure about the medicines composition but I have mentioned names of all the medicines so if its not part of the list of medicines then I have not taken I believe. I am sorry for the vague answer but I do not remember the composition.
Q4) Have you every been given Botulinum Toxin injections in your neck or forehead for Migraine Prevention?
XXXX: I have never taken any injections for migraine. But I have read and reasearch about it. But it seems to be very expensive treatment which lasts only for 3 months. Please correct me if I am wrong.
Q5) Have you ever been in Cognitive Behavioural Therapy Sessions with a trained Psychologist?
XXXX: I never have been to any Psychologist so as to CBT. Could you brief me about this and would it be helpful in my case? Is it for sleep problem or for migraine?
Q6) Have your Vitamin D and Calcium levels been checked in the recent past?
XXXX: I have got checked my hormones level but not Vitamin D and Calcium levels. But I would need prescription for this, right?
5) I used to maintain migraine diaries, but as its a daily affair, I am not maintaining it for quite a long time. As I mentioned earlier also, there would always be a base headache line if you plot headache intensity on Y axis and date of X axis, and then headche varies over and above that base headche line. I could sense (sometimes) why it has got increased when reasons are very evident like hunger, lights, horns or fried food. Hence I am not maintaining daily diary.
6) Now answers to your questions in my husband's case:
How is he coping with these stressors?
XXXX: He does not do anything special. He just distracts himself by watching some comedy programs/movies
Does he eat regularly, get regular exercise, etc?
XXXX: Yes, he eats regularly and he does some floor exercises before taking bath but not more than 10 mins.
Does he meditate or do Yoga?
XXXX: Yes, he meditates once after morning XXXXXXX and then after evening XXXXXXX
You mentioned he has faced this exam before, do you think his previous experiences with the exam may have caused him clinical depression?
XXXX: Actually he is a very jolly kind of person and accepts things faster including failures. He talks to people as well like maids in house etc. So I do not think that he can have depression kind of things in his case. Probably if you could give me some checkpoints then probably I can answer to them.
Just to add my husband has got IBS problem due to which he wastes his 3-4 hours of time in bathroom that becomes stressful for him.
Waiting for your reply. Thanks!
Thanks & Regards,
XXXX
Brief Answer:
Furthuring our conversation
Detailed Answer:
Hi Akansha, Thanks for your vote of confidence and thanks for following up.
I have about 5 discussion points in your regard and 2 in your husbands. So lets begin with you.
I) So we know that that TOPAMAC is a drug that doesn’t sit with you very well. We have alternatives. SODIUM VALPROATE is a good alternative I have used in the past. So I would suggest you ask your doctor to start that and stop the prescription for the TOPAMAC.
I am loath to even consider you stopping the AMITRIPTYLINE until we have transitioned you off off the TOPAMAC. The reason is as I said before, it’s a drug almost tailor made for your situation of chronic migraine and insomnia. We cannot be 100 percent sure the AMI is the one causing the nausea as the TOPAMAC may be the only cause. So would ask you to to talk to your neurologist about trying it again while you are on the VALPROATE. To try and lessen the nausea I would say starting a small dose of OMEPRAZOLE in the morning would help with the irritation. If that didn’t work you could add a dose of ZOFRAN (Ondonsetron, an anti-nausea Medication). Discuss these options with your Primary doctor or your Neurologist.
II) Propanolol is a Betablocker medication and from what I have gathered from your history, you have never been put on it. I STRONGLY suggest you discuss the idea of starting a small dose of the medication at night before you go to bed. The drug is very commonly used and you should have been considered a candidate for it awhile ago. The only reason I can think of is that maybe someone considered it, but decided not to put you on it due to some heart condition or the like. As long as your heart is healthy and your heart rate is in the normal range, this is a safe drug to use.
III) I’m glad you’ve researched BOTOX before, so lets jump right to it. Yes it’s expensive. I’ve seen the effects last around 3- 10 months with 6 months being the average with the patient being on both medications and the BOTOX administration. But you’re right, it could last only 3 months. But if it works, it would be 3 months with minimal headaches. Whats that worth to you?
IV) I recommended CBT in this case for the migraines. The sessions normally last about 30 minutes to an hour and the Psychotherapist tries to break down your perception of the headache and allow you to recategorize the pain mentally. I’m not really an expert on the methods itself. All I know is that I’ve seen it work. You would probably find psychotherapists at NIMHANS who are skilled at using CBT for Migraine issues. That would be MY first place to look.
V) You don’t need to get a prescription to check Vitamin D levels, Serum Calcium and the like. You can just walk into the lab of your choice and ask. When you do it. Ask for the following tests.
Vitamin D Level,
Serum Calcium
Parthyroid Hormone Assay (Also known as Parathormone or PTH)
Also, if you have recent blood work from other hormonal assays and the like, I would ask that you to upload them to me so I can get a better picture of your general health.
Now, to your Husband
I) Your husbands history of IBS makes me suspect the idea of Sleep Apnea even more strongly. The two have a history of being related. Not always, but the statistics show a slight correlation. I would suggest even more strongly that he get a “Sleep Study” done.
II) Now that I know he has IBS, I want to know everything about it. How is it being managed? What medications is he taking for it? Have any of them been checked for causing insomnia? Is he on a special IBS diet? Is he seeing a Gastroenterologist about it? What are his weight and height currently?
So there you go. I hope I haven’t left anything out. Let me know what you are thinking.
Vinay
Furthuring our conversation
Detailed Answer:
Hi Akansha, Thanks for your vote of confidence and thanks for following up.
I have about 5 discussion points in your regard and 2 in your husbands. So lets begin with you.
I) So we know that that TOPAMAC is a drug that doesn’t sit with you very well. We have alternatives. SODIUM VALPROATE is a good alternative I have used in the past. So I would suggest you ask your doctor to start that and stop the prescription for the TOPAMAC.
I am loath to even consider you stopping the AMITRIPTYLINE until we have transitioned you off off the TOPAMAC. The reason is as I said before, it’s a drug almost tailor made for your situation of chronic migraine and insomnia. We cannot be 100 percent sure the AMI is the one causing the nausea as the TOPAMAC may be the only cause. So would ask you to to talk to your neurologist about trying it again while you are on the VALPROATE. To try and lessen the nausea I would say starting a small dose of OMEPRAZOLE in the morning would help with the irritation. If that didn’t work you could add a dose of ZOFRAN (Ondonsetron, an anti-nausea Medication). Discuss these options with your Primary doctor or your Neurologist.
II) Propanolol is a Betablocker medication and from what I have gathered from your history, you have never been put on it. I STRONGLY suggest you discuss the idea of starting a small dose of the medication at night before you go to bed. The drug is very commonly used and you should have been considered a candidate for it awhile ago. The only reason I can think of is that maybe someone considered it, but decided not to put you on it due to some heart condition or the like. As long as your heart is healthy and your heart rate is in the normal range, this is a safe drug to use.
III) I’m glad you’ve researched BOTOX before, so lets jump right to it. Yes it’s expensive. I’ve seen the effects last around 3- 10 months with 6 months being the average with the patient being on both medications and the BOTOX administration. But you’re right, it could last only 3 months. But if it works, it would be 3 months with minimal headaches. Whats that worth to you?
IV) I recommended CBT in this case for the migraines. The sessions normally last about 30 minutes to an hour and the Psychotherapist tries to break down your perception of the headache and allow you to recategorize the pain mentally. I’m not really an expert on the methods itself. All I know is that I’ve seen it work. You would probably find psychotherapists at NIMHANS who are skilled at using CBT for Migraine issues. That would be MY first place to look.
V) You don’t need to get a prescription to check Vitamin D levels, Serum Calcium and the like. You can just walk into the lab of your choice and ask. When you do it. Ask for the following tests.
Vitamin D Level,
Serum Calcium
Parthyroid Hormone Assay (Also known as Parathormone or PTH)
Also, if you have recent blood work from other hormonal assays and the like, I would ask that you to upload them to me so I can get a better picture of your general health.
Now, to your Husband
I) Your husbands history of IBS makes me suspect the idea of Sleep Apnea even more strongly. The two have a history of being related. Not always, but the statistics show a slight correlation. I would suggest even more strongly that he get a “Sleep Study” done.
II) Now that I know he has IBS, I want to know everything about it. How is it being managed? What medications is he taking for it? Have any of them been checked for causing insomnia? Is he on a special IBS diet? Is he seeing a Gastroenterologist about it? What are his weight and height currently?
So there you go. I hope I haven’t left anything out. Let me know what you are thinking.
Vinay
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor
Thanks a lot for your reply. Here are my answers/comments for your questions:
1) Botox injections: Could you please tell me whats the approximate cost of this treatment? And are there any sideeffects for this?
2) I will get the asked tests done and will update you on the results.
3) I have got my hormonal profile tests done in Oct-2012 when my Gynaecologist told me to do that for PCOD treatment. If I get to have the tests again, I will update you on the same.
For my husband's case:
1) He has Tripahala 1st thing in the morning and then after sometime he goes to freshen up.
2) He's not on any medication, as he tried the treatment with Dr. Kini (Gastroentrologist in Manipal Hospital, bangalore), but it didn't work. He tried Ayurvedic and Homeo treatments also but no luck
3) We avoid gaseous food and spices in food. And he takes fruits salad in breakfast. No other special diet he is on.
4) Currently he's not on any medication as we didn't want to try anything new & take risks in his case as his exams are in mid Dec-2014.
5) His current height is 5'6" and weight is 65-66 kgs.
I hope I have answered all your questions. I have a question, where is your current location, if in XXXXXXX in which hospital you are appointed. Could I come for migraine treatment to you? Could that be workable. If yes, could you please share your contact details and address where we can visit you.
Waiting for your reply.
Thanks & Regards,
XXXX
Thanks a lot for your reply. Here are my answers/comments for your questions:
1) Botox injections: Could you please tell me whats the approximate cost of this treatment? And are there any sideeffects for this?
2) I will get the asked tests done and will update you on the results.
3) I have got my hormonal profile tests done in Oct-2012 when my Gynaecologist told me to do that for PCOD treatment. If I get to have the tests again, I will update you on the same.
For my husband's case:
1) He has Tripahala 1st thing in the morning and then after sometime he goes to freshen up.
2) He's not on any medication, as he tried the treatment with Dr. Kini (Gastroentrologist in Manipal Hospital, bangalore), but it didn't work. He tried Ayurvedic and Homeo treatments also but no luck
3) We avoid gaseous food and spices in food. And he takes fruits salad in breakfast. No other special diet he is on.
4) Currently he's not on any medication as we didn't want to try anything new & take risks in his case as his exams are in mid Dec-2014.
5) His current height is 5'6" and weight is 65-66 kgs.
I hope I have answered all your questions. I have a question, where is your current location, if in XXXXXXX in which hospital you are appointed. Could I come for migraine treatment to you? Could that be workable. If yes, could you please share your contact details and address where we can visit you.
Waiting for your reply.
Thanks & Regards,
XXXX
Brief Answer:
I will wait for the reports
Detailed Answer:
Hi,
Thanks for the information.
I will wait for the test reports. We, shall discuss on the same once I receive the reports.
For your husband :
I believe he is in the right path, managing the IBS with diet alone. let him continue the same, he might have more chances of getting better.
Please do get a sleep study as I advised. this provides much information on why the problem is and how to treat it.
Response to your question: I am sorry, I work online here. As per company protocols I must not disclose my practicing location or details. Kindly, bear with me.
I will wait for the reports
Detailed Answer:
Hi,
Thanks for the information.
I will wait for the test reports. We, shall discuss on the same once I receive the reports.
For your husband :
I believe he is in the right path, managing the IBS with diet alone. let him continue the same, he might have more chances of getting better.
Please do get a sleep study as I advised. this provides much information on why the problem is and how to treat it.
Response to your question: I am sorry, I work online here. As per company protocols I must not disclose my practicing location or details. Kindly, bear with me.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor
Thanks a lot for your reply.
I will update you my test reports once I am done with the tests.
We will try to get his sleep study once he's done with his exams. Do you recommend anything which he can do on immediate basis without going to any doctor?
Waiting for your response.
XXXX
Thanks a lot for your reply.
I will update you my test reports once I am done with the tests.
We will try to get his sleep study once he's done with his exams. Do you recommend anything which he can do on immediate basis without going to any doctor?
Waiting for your response.
XXXX
Brief Answer:
Loperamide for IBS, for you, Imol Plus.
Detailed Answer:
Hi there Akansha, Sorry for the Brevity of my last answer. I found out a bit about the pricing of BoTox for you. I've seen prices ranging from 3000 per injection to 5k per injection. once course of injections would be at least 3 injections. So the cost could be somewhere between 9k and 15k. These prices were told to me by a dermatologist, but he has done injection for migraines as well.
Now, to immediate management.
For your husband. There is an over the counter medication known as Loperamide (one brand name is Eldoper). It is an OTC drug and it has been used in the management of IBS. The normal way to use it is to take one 2mg tab, 3 times a day. Doesn't matter if it's on an empty stomach or not. It should give him some relief from being in the bathroom for hours at a time. I'm certainly no expert when it comes to IBS management, I have seen this help though. if he experiences painful bloating with the loperamide, then he should stop taking it.
The other thing he can do when he has time after his exams is to talk to his GI doc about starting Amitryptiline. It has a good effect for IBS patients. Do get the sleep study done as well.
For you, the Only OTC that I would recommend you try when the headaches get very bad is IMOL Plus. The Plus part is the addition of Caffeine which can be very helpful in some cases of severe migraines. That drug is an SOS drug though. Shouldn't take it on a regular basis and its a bad idea to take it before bed as the caffeine will mess with your sleep patterns (such as they are).
So that's what we can try for now without needing to go to a doctor. I hope this helps. Stay in touch and we can follow your progress together.
Vin
Loperamide for IBS, for you, Imol Plus.
Detailed Answer:
Hi there Akansha, Sorry for the Brevity of my last answer. I found out a bit about the pricing of BoTox for you. I've seen prices ranging from 3000 per injection to 5k per injection. once course of injections would be at least 3 injections. So the cost could be somewhere between 9k and 15k. These prices were told to me by a dermatologist, but he has done injection for migraines as well.
Now, to immediate management.
For your husband. There is an over the counter medication known as Loperamide (one brand name is Eldoper). It is an OTC drug and it has been used in the management of IBS. The normal way to use it is to take one 2mg tab, 3 times a day. Doesn't matter if it's on an empty stomach or not. It should give him some relief from being in the bathroom for hours at a time. I'm certainly no expert when it comes to IBS management, I have seen this help though. if he experiences painful bloating with the loperamide, then he should stop taking it.
The other thing he can do when he has time after his exams is to talk to his GI doc about starting Amitryptiline. It has a good effect for IBS patients. Do get the sleep study done as well.
For you, the Only OTC that I would recommend you try when the headaches get very bad is IMOL Plus. The Plus part is the addition of Caffeine which can be very helpful in some cases of severe migraines. That drug is an SOS drug though. Shouldn't take it on a regular basis and its a bad idea to take it before bed as the caffeine will mess with your sleep patterns (such as they are).
So that's what we can try for now without needing to go to a doctor. I hope this helps. Stay in touch and we can follow your progress together.
Vin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor
Thanks for your advices, I really appreciate this.
Just to update you that I was taking IMOL PLUS only in case of severe pain, but it has no effect on me, not even a bit. Then one of my fiends, told me that 1g paracetamol helps in her migraine. I tried that too because of that I had 1 day free of headache but from 2nd time onwards, the condition was same as IMOL PLUS. No effects! Thats the reason I do not take any tablets, some doctor told me to try HEADSET tablet, but looking at the warnings I tried only half but again no effect but I never tried the full tablet as it affects cardio system as per the warning on the tablet. Please suggest.
Also whatever medicines you are suggesting Betablocker etc. for my migraine, would it have any side effects as I informed earlier I have got PCOD and I have lost around 9-10 kgs due to which now I have got periods regular. So if I put on due to these medicines it would be a difficult situation for me. As I have written in history that due to Flunarizine I had put on 7 kgs just in a month's time and then I didn't get my periods for 4 months! Please advice.
For my husband, if we try Loperamide (one brand name is Eldoper), would it disturb his current schedule because as I informed before he has his exams in less than a month time. and we really can't afford to disturb the current situation even a bit. Please suggest.
Also, as it would take time to get tests done and getting the report and upload it here for your advice but the discussion would automatically be closed in 3 days in healthcare magic and eveytime I ask a query there would be a different doctor for the suggesion then how can we keep the discussion with you only. I mean its difficult to provide the same information and history of the problem in so much details everytime. Please advice.
Also do you suggest any good neurologist and gastroentrologist in XXXXXXX we live near Bellandur Central. Just for your information I have seen neurologists in Manipal, St. Johns, Nimhans and Fortis.
Thanks & Regards,
XXXX
Thanks for your advices, I really appreciate this.
Just to update you that I was taking IMOL PLUS only in case of severe pain, but it has no effect on me, not even a bit. Then one of my fiends, told me that 1g paracetamol helps in her migraine. I tried that too because of that I had 1 day free of headache but from 2nd time onwards, the condition was same as IMOL PLUS. No effects! Thats the reason I do not take any tablets, some doctor told me to try HEADSET tablet, but looking at the warnings I tried only half but again no effect but I never tried the full tablet as it affects cardio system as per the warning on the tablet. Please suggest.
Also whatever medicines you are suggesting Betablocker etc. for my migraine, would it have any side effects as I informed earlier I have got PCOD and I have lost around 9-10 kgs due to which now I have got periods regular. So if I put on due to these medicines it would be a difficult situation for me. As I have written in history that due to Flunarizine I had put on 7 kgs just in a month's time and then I didn't get my periods for 4 months! Please advice.
For my husband, if we try Loperamide (one brand name is Eldoper), would it disturb his current schedule because as I informed before he has his exams in less than a month time. and we really can't afford to disturb the current situation even a bit. Please suggest.
Also, as it would take time to get tests done and getting the report and upload it here for your advice but the discussion would automatically be closed in 3 days in healthcare magic and eveytime I ask a query there would be a different doctor for the suggesion then how can we keep the discussion with you only. I mean its difficult to provide the same information and history of the problem in so much details everytime. Please advice.
Also do you suggest any good neurologist and gastroentrologist in XXXXXXX we live near Bellandur Central. Just for your information I have seen neurologists in Manipal, St. Johns, Nimhans and Fortis.
Thanks & Regards,
XXXX
Brief Answer:
Brufen or Naproxen instead of IMOL, propanolol has few if any side effects.
Detailed Answer:
Hi Akansha, How about Brufen or Naproxen? Have they worked for you?
Propanolol has no major weight gain issues or other side effects. The main issues is that once you start it, it has to be taken regularly?
I do not believe the Loperamide should change your husbands schedule very much. But there is no way to be sure other than to attempt it for a day or two.
As for a good Neurologist or Gastroenterologist. I do not believe you should really keep changing doctors. Trya nd stick to any one that you have already gone to. Otherwise you will have troubles with a new doc getting to know your entire histories. Does that make sense?
I look forward to your thoughts,
Vinay
Brufen or Naproxen instead of IMOL, propanolol has few if any side effects.
Detailed Answer:
Hi Akansha, How about Brufen or Naproxen? Have they worked for you?
Propanolol has no major weight gain issues or other side effects. The main issues is that once you start it, it has to be taken regularly?
I do not believe the Loperamide should change your husbands schedule very much. But there is no way to be sure other than to attempt it for a day or two.
As for a good Neurologist or Gastroenterologist. I do not believe you should really keep changing doctors. Trya nd stick to any one that you have already gone to. Otherwise you will have troubles with a new doc getting to know your entire histories. Does that make sense?
I look forward to your thoughts,
Vinay
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor
Thanks for your reply.
As I have written before too, that I have tried these pain killers: Acedor-P (Acecelofenac & Paracetamol tablet), Naxdom-500 (Domperidone & Naproxen Sodium USp tablet), IMOL-Plus, Dart tablet and Paracetamol-1g. But no effects. Please suggest.
Also, do you suggest that my husband should start with Loperamide now as its not even a month left for his mains exam.
Also I had asked a question in my previous post that it would take time to get tests done and getting the report and upload it here for your advice but the discussion would automatically be closed in 3 days in healthcare magic and eveytime I ask a query there would be a different doctor for the suggesion then how can we keep the discussion with you only. I mean its difficult to provide the same information and history of the problem in so much details everytime. Please advice.
This is just to update you that we are currently not going to any neurologist and gastroentrologist. Hence I wanted to know if you could suggest some good doctor in both the fields it would be good because I will not be able to start taking propanolol/Beta blocker with any prescription I believe. Please suggest.
Thanks & Regards,
XXXX
Thanks for your reply.
As I have written before too, that I have tried these pain killers: Acedor-P (Acecelofenac & Paracetamol tablet), Naxdom-500 (Domperidone & Naproxen Sodium USp tablet), IMOL-Plus, Dart tablet and Paracetamol-1g. But no effects. Please suggest.
Also, do you suggest that my husband should start with Loperamide now as its not even a month left for his mains exam.
Also I had asked a question in my previous post that it would take time to get tests done and getting the report and upload it here for your advice but the discussion would automatically be closed in 3 days in healthcare magic and eveytime I ask a query there would be a different doctor for the suggesion then how can we keep the discussion with you only. I mean its difficult to provide the same information and history of the problem in so much details everytime. Please advice.
This is just to update you that we are currently not going to any neurologist and gastroentrologist. Hence I wanted to know if you could suggest some good doctor in both the fields it would be good because I will not be able to start taking propanolol/Beta blocker with any prescription I believe. Please suggest.
Thanks & Regards,
XXXX
Brief Answer:
Triptans can be used for headaches as well. After that, i am at a loss.
Detailed Answer:
Welcome back,
So, I am at a loss as to what would work for you on an SOS basis. Triptan class medications would be the last thing i can recommend. Sumitriptan etc are meds that can be used. They come in the form of a nasal spray.
I would reccomend your husband start the loperamide at his convenience. If he starts them tomorrow, then does not like the effect, he can stop and the drug will be out of his system in 12 hours or so.
Don't worry about trying to get back to me. Just mention my name in your next question and we will make it happen. No worries.
As far as Neurologists go, my favorite is XXXXXXX Singhal at Fortis Hospital on Bannerghatta Road.
My favorite GI doc is from Fortis as well (I have worked with both of them as I used to run the NeuroCritical Care Unit at Fortis), Dr. XXXXXXX KS.
Talk to XXXXXXX about your situation, he is a good guy.
Vin
Triptans can be used for headaches as well. After that, i am at a loss.
Detailed Answer:
Welcome back,
So, I am at a loss as to what would work for you on an SOS basis. Triptan class medications would be the last thing i can recommend. Sumitriptan etc are meds that can be used. They come in the form of a nasal spray.
I would reccomend your husband start the loperamide at his convenience. If he starts them tomorrow, then does not like the effect, he can stop and the drug will be out of his system in 12 hours or so.
Don't worry about trying to get back to me. Just mention my name in your next question and we will make it happen. No worries.
As far as Neurologists go, my favorite is XXXXXXX Singhal at Fortis Hospital on Bannerghatta Road.
My favorite GI doc is from Fortis as well (I have worked with both of them as I used to run the NeuroCritical Care Unit at Fortis), Dr. XXXXXXX KS.
Talk to XXXXXXX about your situation, he is a good guy.
Vin
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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