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Suggest Treatment For Severe Headache
Question: Dr. XXXXXXX Saghafi, I am still having headaches. I went to a new neurologist that has a high reputation for her work with headaches. She agreed with you that this is not indicative of the original diagnosis of trigeminal neuralgia. We are incrementally reducing the Carbamezepine to zero at the end of two weeks. Starting Elivil slowly with hopes that its side effect tendency to reduce headaches will work. I did a headache log the first week but have not this week. I have had no days without headaches but last week horrible Monday followed by two excellent days followed by horrible Thursday, moderate Friday, worse Saturday, mild Sunday, moderate to poor Days each day this week. Afternoons remain better but not good.
Thanks for asking. XXXXXXX XXXXXXX
Thanks for asking. XXXXXXX XXXXXXX
Brief Answer:
Treatment of headaches is a process
Detailed Answer:
Thank you for your return question. It's good that you have a doctor who has a reputation with headaches. As a headache specialist I can tell you that the successful treatment of any type of headache requires a diagnosis then, treatment strategy/intervention. The headache diary I have my patients keep is detailed with respect to a variety of symptoms and parameters having to do with the headache because that is how we can diagnose them and determine how trends are going to tell us whether or not interventions are working.
Just because a person continues to HAVE headache pain and discomfort doesn't necessarily mean that the headaches are not IMPROVING. It really depends on the parameters and how they are responding. This requires analysis. This is why I nearly always recommend trained headache specialists who utilize diaries and logs.
I will make this one specific recommendation about what you've told me and that is the NORTRIPTYLINE is generally a better tolerated choice to amitriptyline with respect to side effects. Titration of the drug is best done in very small increments and usually at bedtime in order to help ameliorate symptoms that may occur after taken.
Usually Tricyclic antidepressants such as amitriptyline and nortriptyline take up to 5 weeks to get up to ceiling dose and that's assuming no other causes, triggers, or circumstances such as other medications that could cause headaches as side effects (i.e. trazodone).
Treating of headaches is a process.
If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 30 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Treatment of headaches is a process
Detailed Answer:
Thank you for your return question. It's good that you have a doctor who has a reputation with headaches. As a headache specialist I can tell you that the successful treatment of any type of headache requires a diagnosis then, treatment strategy/intervention. The headache diary I have my patients keep is detailed with respect to a variety of symptoms and parameters having to do with the headache because that is how we can diagnose them and determine how trends are going to tell us whether or not interventions are working.
Just because a person continues to HAVE headache pain and discomfort doesn't necessarily mean that the headaches are not IMPROVING. It really depends on the parameters and how they are responding. This requires analysis. This is why I nearly always recommend trained headache specialists who utilize diaries and logs.
I will make this one specific recommendation about what you've told me and that is the NORTRIPTYLINE is generally a better tolerated choice to amitriptyline with respect to side effects. Titration of the drug is best done in very small increments and usually at bedtime in order to help ameliorate symptoms that may occur after taken.
Usually Tricyclic antidepressants such as amitriptyline and nortriptyline take up to 5 weeks to get up to ceiling dose and that's assuming no other causes, triggers, or circumstances such as other medications that could cause headaches as side effects (i.e. trazodone).
Treating of headaches is a process.
If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 30 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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