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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Visit to the Neurologist
        
(Message started by: michael on May 3^rd, 2007, 1:26pm)

Title: Visit to the Neurologist
Post by michael on May 3^rd, 2007, 1:26pm

I've recently been to to see a neurologist on an appointment set up by my doctor. As is usually the case this cycle was just coming to an end at the time so there wasn't much we could try. However, he has advised my doctor what to do at the next attack (probably early next year).

1. Imigran injection when needed (more than 2 a day if required)
2. Oxygen at 10-15 lpm
3. Prednisolone - 60mg/day for 10 days
40mg/day for 5 days
20mg/day for 5 days
4. Verapamil - 80mg 3 times a day increasing by 80mg (assume he means 3 times a day) each week with an ECG every increase of 240mg up to a max of 960mg if tolerated.

I obviously can't try this yet and I certainly will when I need to - just curious what you guys think.

Title: Re: Visit to the Neurologist
Post by Bob_Johnson on May 3^rd, 2007, 1:52pm

A sound, conventional approach which says the doc knows his headaches.

Title: Re: Visit to the Neurologist
Post by Guiseppi on May 3^rd, 2007, 1:55pm

WOW! I'm very impressed with his regimen! I'm not one of the more knowledgeable people on the board, some of the research types will be along shortly. But from the pred taper to the high flow rate oxygen to the high dose verapamil I'd think your neuro spends some time reading this board! The only thing I can think of to add is to make sure the oxygen mask is a non rebreather, but I'll bet he already thought of that too. Congrats on finding a learned neuro!!

Guiseppi

Title: Re: Visit to the Neurologist
Post by LeLimey on May 3^rd, 2007, 3:49pm

on 05/03/07 at 13:26:08, michael wrote:

1. Imigran injection when needed (more than 2 a day if required)

This is the only point I feel the need to comment on Michael.

Please be aware that the makers of Imigran state quite clearly on their leaflets that two doses per day is the maximum they recommend.

If you take any more than that it will be at your own risk as the leaflets in the box state it quite clearly.

Imigran, as with all triptans, is a vaso constrictor. It works by constricting blood vessels and thus reducing pain but it doesn't just constrict them in your head, it constricts them around your entire body.

Please be aware this could place a lot of strain on your heart, I'm not saying it WILL - just be aware of the dangers.

I'm sorry to sound like a doom and gloom merchant but I feel honour bound to point out the con's as well as the pro's of potentially using more than the stated dose.

Hope it helps - and I hope you never do get another cycle!

Helen

Title: Re: Visit to the Neurologist
Post by michael on May 3^rd, 2007, 5:39pm

Hi Helen
Thanks for your concern

One of the reasons I insisted on seeing a neurologist is that I had become totally dependant on injections as a abortive. When you know something will abort within 10 minutes and its in your pocket, it's difficult not to use it.
I'd never had more than one attack a day before so it seemed the perfect solution. However, since using it I now get several hits a day, and its become a vicious circle. I became convinced that the injections were causing rebounds and so was my doctor. I stated this several times to the neurologist but he was adament that this wasn't the case, and that I shouldn't feel restricted to two a day, and this is in his letter to my doc. Ths last cycle I've had has probably been my worst and I've no intention of overdosing on injections again.
The neurologist I saw was Dr Evangelou, who you know so well.

By the way, sorry I havent phoned yet. I've had a lousy cough this week and I can't manage more than half a dozen words at a time right now.

Mike

Title: Re: Visit to the Neurologist
Post by BB on May 3^rd, 2007, 10:06pm

on 05/03/07 at 13:26:08, michael wrote:

4. Verapamil - 80mg 3 times a day increasing by 80mg (assume he means 3 times a day) each week with an ECG every increase of 240mg up to a max of 960mg if tolerated.
.

He meant increasing by ONE tablet of 80 mg per day at a time for a whole week before increasing again by another 80 mg.

Ie First off take 80 mg 3 times per day, if not working well yet increase to 80 mg two tablets in the morning but still only one tablet afternoon and night.

The next week if you still need to increase it then take 2 mornings and afternoon but still one only in the evening.

By the time you increase to 80 mg two tablets 3 times a day then you need a ECG to check your heart.

Hope this helps.

Annette

Title: Re: Visit to the Neurologist
Post by birdman on May 4^th, 2007, 8:20am

Glad there are some good neuro's out there. As Guiseppi said, get a good mask, recommend the clustermasx, just got it and it is awesome.