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    Old 05-13-2008, 06:20 PM   #1
    studyin
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    Howie - migraine treatment

    Hi Howie,

    I previously wrote on another thread about a great recording I paid for and downloaded on migraine treatment by James U. Adelman, MD (recorded in Jan 08). He is at the Headache Wellness Centre in Greensboro, North Carolina. This guy is on fire in terms of understanding treatment.

    Anyhow, I'm not trying to second guess anything your doc is doing for you but keep in mind what this guy had to say about treating migraine it's all he does 24/7. These were some of the things he mentioned which also reflects what Hain has to say:

    Calcium channel blockers: good for cluster headaches, not good for migraine; use doses higher than those for treatment of hypertension; may be effective if aura prominent feature; in studies, verapamil and amlodipine took up to 3 months to achieve effect.

    Other antidepressants: SSRIs and bupropion not effective in migraine; venlafaxine (Effexor) effective; in study, patients with anxiety benefitted from duloxetine; monoamine oxidase inhibitors effective, but have numerous side effects. Surprisingly, Cipramil (citalopram) did work for me although perhaps the SSRIs are more effective for vestibular migraine.

    Beta-blockers: all effective; propranolol most commonly used, but speaker prefers atenolol (inexpensive; can be given once daily, typically at night; fewer side effects). In studies, 45% to 60% of patients reported 50% reduction in headaches.

    Hope you're feeling well. I've come off Cipramil completely now ... been free of it for 2 weeks but have some break-through dizziness. Pretty much no anxiety though which St John's Wort is working on very well. But it appears Cipramil worked on the dizziness in a separate way. Sort of proves that the anxiety component is a separate matter. If I cannot stabilse this thing, my next effort will likely be atenolol followed by Effexor (low-dose).

    Best ... Scott

     
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    Old 05-13-2008, 06:41 PM   #2
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    Re: Howie - migraine treatment

    Scott:

    Interesting but I guess everyone is different. I am been better lately starting to make some headway. I would say 90% like 5 to 6 days a week sometimes 95%. I added a 2nd accupuncture treatment and i have been using biofeedback or meditation every day. I still have my days where I am off but overall the symptoms are waxing and waning. No more dizziness, no more visual problems...Just mild head pressure and mild nausea from time to time. I run 3 miles a day 6 days a week

    Study is interesting but i was 100% for 12 to 18 months. I had the relapse when I came off the Zoloft. So it is hard to say. At this stage I would only try a completely diiferent pattern of drugs if I had a total relapse. I assume Zoloft worked for me as Axiety was a major trigger..

    My doctor is not really seeing new patients anymore. He is a researcher. He was on TV talking about Vestibular Migraines in NYC and runs support groups.. He is probably aware as he said all Migraine specialist are one bring fraternity where they always meet and speak. He was at Michigan Headache institute this week

    I'll keep you posted...Good luck drug free but be patient as I was Drug free for 8 months until I was triggered back by a seasonal change off the drugs

    Howie

     
    Old 05-13-2008, 06:57 PM   #3
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    Re: Howie - migraine treatment

    Hey Howie:

    >>> I run 3 miles a day 6 days a week.

    That's amazing. You guys put me to shame! Once I feel a little more stable which should occur in the next few days I'm going to start consistently doing some aerobic exercise to raise the threshold and be healthier of course.

    Glad your dizziness has died. Mine is bearable right now but this is clearly unacceptable for the long run. Time will tell.

    Cheers ... Scott

     
    Old 05-14-2008, 05:33 AM   #4
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    Re: Howie - migraine treatment

    Scott:

    Slow and steady on the running.....Besides your dizziness shin splints can occur....

    I would love to take something else I know would get me to 100% with no side effects. But since I am pretty stable and functional at85% to 90%, to change anything may do more bad than good. You never know how I will react

    I am able to function and do everything at a high level just uncomfortable at times. I guess I am managing the MAV as well as can be just like one would diabetes. I try to use the alternative tools like accupuncture and biofeedback to get me thru rough days

    One day at a time...Maybe my doctor will add something

     
    Old 05-14-2008, 06:08 AM   #5
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    Re: Howie - migraine treatment

    That's what I was thinking - that maybe a new angle will get you to 100%. But totally understand you not wanting to mess around with it too much ... the thought of it all coming unstuck is not a good one at all.

    Scott

     
    Old 05-14-2008, 06:17 AM   #6
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    Re: Howie - migraine treatment

    Vestibular Migraines are just not black and white as far as treatments. While their is research going on it is a lot of guess work.

    everyone is different which makes it harder for the doctors and researchers..... as far as medications....A lot of theory but no clear cut answers...They are trying though....

    Thats why if you can get some relief maybe your brain will start to manage and compensate on its own by treating all the triggers on your own and relaxing your body when it needs it.

     
    Old 05-14-2008, 06:33 AM   #7
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    Re: Howie - migraine treatment

    Scott:

    Another thought is part of the problem I have and I assume some of us have is we are perfectionist and anything but 100% will not do....I am starting to realize that I am a lot better that 4 years ago and even 7 months when the relapse occurred and instead of chasing 100% all time just embrace it.. Live my life as is for now and less pressure might relax the nervous system and mind...
    Let the doctors do all the work and research. Otherwise I will end up spending my entire life trying to figure things out. If I just report how I feel and trust the doctor and let him do his job maybe they will find the right combination. I mean they have gotten me to this point. Things can be worst and were...

    I am at a point where I want to be 100% but in the meantime I want this to be in shadows of my life instead of controlling my life.

     
    Old 05-14-2008, 06:34 AM   #8
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    Re: Howie - migraine treatment

    >>> Vestibular Migraines are just not black and white as far as treatments.

    Totally agree, however I'd like to think that playing the statistics on this will create a greater chance of complete success. For me personally, I'm aiming to shoot for the treatments that Hain, Rauch and Adelman seem to agree on which work best in the largest groups of patients that they see with the fewest side-effects. Of course any one of us might be an outlier where the usual successful treatments don't do the job or come with intolerable side-effects.

    According to these guys Cipramil and Zoloft should be pretty hopeless for migraine and yet they worked for both of us maybe because we've had such strong anxiety components to this. Unfortunately for me Cipramil is not doable any longer. Hate the stuff. If I have to go the SSRI route again, Effexor will be the one given it's high success rate (no doubt because it is an SNRI).

    S

     
    Old 05-14-2008, 06:37 AM   #9
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    Re: Howie - migraine treatment

    Scott:

    Another thought is part of the problem I have and I assume some of us have is we are perfectionist and anything but 100% will not do....I am starting to realize that I am a lot better that 4 years ago and even 7 months when the relapse occurred and instead of chasing 100% all time just embrace it.. Live my life as is for now and less pressure might relax the nervous system and mind...
    Let the doctors do all the work and research. Otherwise I will end up spending my entire life trying to figure things out. If I just report how I feel and trust the doctor and let him do his job maybe they will find the right combination. I mean they have gotten me to this point. Things can be worst and were...

    I am at a point where I want to be 100% but in the meantime I want this to be in shadows of my life instead of controlling my life

     
    Old 05-14-2008, 08:11 AM   #10
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    Re: Howie - migraine treatment

    Quote:
    Originally Posted by Howie2 View Post
    Let the doctors do all the work and research.
    Sorry to butt in guys - but I just wanted to give a quick comment on this. While I agree that over-obsessing about our condition and spending countless hours on the internet trying to figure out treatments can be maddening, I also believe that knowledge is power. I remember meeting with Robert Baloh from UCLA, and he mentioned that there is so little research being done on vestibular migraines, or migraines in general. I can attest to this, even if coming at if from personal experience with my brother. My brother suffers terribly from migraines and has all of his life. His doctors recommended brain surgery (which made things way worse). The doctors thought the brain surgery would be best for him. So he went from one or two migraines a week, to one or two migraines a DAY, plus seizures, depression, anxiety, disability, etc.

    The doctors do not always know best. Just read all of the stories on this site about how many countless doctors we have all been too - all of them with different diagnosis' and medication approaches. Even quite often, misdiagnosis'.

    Especially in the realm of neurology, I think it is very wise to do lots of research.

     
    Old 05-14-2008, 08:31 AM   #11
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    Re: Howie - migraine treatment

    Missy:

    I am not saying give up of course not, otherwise I would not be hear on this site still giving whatever advice and information my doctor gives me on his research... What I am saying in my case I have gotten to a point where I am 85% to 90% most days even 95% some days... So I am not sure like your brother I want to change the apple card. As compared to 4 years ago I can do everything I always did just uncomfortable some times. So since my doctor has gotten me to this point so far I have to trust his instinct. Changing things can make things worst not always better. As you see from most of the research there are percentages that work out and those that do not on certain drug trials. If my doctor wants to add one those medications or increase something , I am all for it... But everything in moderation . If I start questioning my doctor who has helped me because of studies that are out, I am at square one which is not a good thing.... Like I said I think most good Migraine Doctors and researchers are on top of these type of studies.


    I dont want miss my family grow in front of me as well.
    Even though I am on top of my condition, as I go to a support group 1 time a month my doctor runs, I go for Biofeedback, accupuncture , excercise, eat right and take the medication prescribed. I also want to enjoy parts of my life I missed the last 4 years. Everything in moderation.

    If I have a choice between playing WII with my son or doing research , compared to 2 years ago my answer would be play WII with my son, once he goes to bed if I am not tired then i research. When you let this control your life you become blind to everything around you.. I know this sucks but it does get better, it has with me, and we all need a ton of prayer and patience. As this makes us stronger it also puts things into perspective more.

    Last edited by Howie2; 05-14-2008 at 08:44 AM.

     
    Old 05-14-2008, 09:08 AM   #12
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    Re: Howie - migraine treatment

    Missy, I think you are absolutely right!

    These docs do have years of medical school training and I know they have extensive knowledge about their specialities, but in the end they read much of the same stuff we read (if only more medical journals would be accessible to the public!). In addition, we are far more motivated than most docs to get to the root of the problem, because we are suffering. Thankfully, there are exceptions to this, but case in point: the best vestibular rehab therapist down South suffered herself from vestibular loss, hence her diligence in treating it and educating other medical practitioners. At any rate, I'm a strong believer in keeping your wits about you at the docs and when dealing with an illness. One reason is that the pharmaceutical industry is very powerful and drugs are often prescribed that are harmful and/or useless, or that might not be right for you. That said, I know we're lucky to have our prescription meds! I'm loving them right now as I try to kick my sinus infection.

    Violet

     
    Old 05-14-2008, 09:19 AM   #13
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    Re: Howie - migraine treatment

    Quote:
    Originally Posted by Howie2 View Post
    If I have a choice between playing WII with my son or doing research , compared to 2 years ago my answer would be play WII with my son
    Couldn't agree with you more, Howie! One can certainly get TOO obsessed with internet research for sure. Like you said, all in moderation!

    In my experience, similar to what Violet said, WE are our own best advocates when it comes to wanting ourselves to feel better. The physicians who treat us do not have to live with what we do. They do not have to feel "85%" well. I understand what you are saying though - believe me. And I am thoroughly impressed that you are able to go jogging almost everyday - WOW! That is more than I can say for myself!

    Without sounding entitled, I think we all deserve to feel 100%. Yes, 100%. We are young and healthy (for the most part), and just happen to have overactive brain chemistry and neurological systems. But there are TONS of medications out there to help us. I think we should always strive to get to 100%, and be the best people who we are intended to be!

    Last edited by missy7777; 05-14-2008 at 09:19 AM.

     
    Old 05-14-2008, 09:24 AM   #14
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    Re: Howie - migraine treatment

    I agree but right now I need to trust my doctor...He said after Memorial Day if I am not more consitent at 95% he will increase my Verapamil or add another medication. Last time he added Verapamil I went to 100% within 3 months from 85%....

    BTW my doctor and every doctor on his staff is a Migraine Sufferer just not Vestibular. So he does feel for his patients. He allows his patients to email him anytime with questions and he responds almost immediatly. Plus he started the support group once a month where he has guest like accupouncturist, biofeedback etc.....

     
    Old 05-14-2008, 09:43 AM   #15
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    Re: Howie - migraine treatment

    Quote:
    Originally Posted by Howie2 View Post
    He allows his patients to email him anytime with questions and he responds almost immediatly.
    WOW - again, very impressed!! It sounds like you have a great physician Howie! Good luck on the Verapamil - I hope you (and the rest of us for that matter) reach 100% soon!!

     
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