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Update on my Headache Specialist Visit

July 13th, 2008

If you’ve been wondering, I do think all the preparation I did paid off.  I met with my new headache specialist for over an hour on Tuesday, and I liked him.  He seems knowledgeable, up on current research, is respectful, takes his time, listens, answers questions.

He took a little over an hour with me. He is starting up the headache center for UMDMJ (University of Medicine & Dentistry of NJ) and RWJ (Robert Wood Johnson) University Hospital. The center has been open
less than a year. Right now he spends half his time with general neurology patients while they build the headache & Migraine practice. He plans to do headache medicine exclusively and wants to have an iv center here eventually. He said about 80% of his HA patients have chronic daily headache or transformed migraine. He is very concerned about preventing chronic pain in someone like me who hasn’t developed it yet.

Some very good news for me – when I talked about an emergency plan, he said to come to the ER at RWJ. They will contact him or the neurologist on call and will have my chart and a protocol for me. It’s about 15 minutes further to this ER as opposed to 20 to my nearest one, but I can cope with that. It’s a huge load off my mind to have an emergency plan.

We talked about preventives – he gave me the choice of starting them now or giving it a few months to see if my current success holds (2 mild migraines last month – see my post on Recent Success). I decided
to wait. He wants me to continue exercising every day, get 8 – 10 hours of sleep per night, and he wants me to add physical therapy for neck-strengthening exercises and get neck massages. If the headaches

increase again I can call him and he will start me on preventives. I will be seeing him again in mid-September.  I’m planning to do a lot of reading up on medication options before that time. Other issues – he wants me to get an ENG to test whether my vertigo is positional vertigo or Migraine related (MAV). He thinks from my description it is probably positional and they can correct that in the office. If it’s MAV
triptans could be a problem so I hope I don’t have it. My medication options are so limited already I sure don’t want them limited further!

He would also like me to do a challenge test with aspirin – I’ve talked to my primary physician about doing that in his office. (For those of you not familiar with my saga, I have a life-threatening allergy to ibuprofen, and that is in the same drug family as aspirin, naprosyn, all the other nsaids.) This is an allergy challenge test – to see if I react to the drug. The
staff would be standing by to save me if I have a reaction. The idea makes me very nervous. But if I am not allergic to aspirin it expands medication choices quite a lot. I need to think hard about whether I am willing to take that risk. He’d like to be able to give me naprosyn for when I can’t use a triptan – he also says because it’s longer acting
it’s less likely to cause rebound headaches than the triptans.

I left his office and developed a 2 day migraine – I think the drive and parking in the blazing hot sun did me in.  But I’m happy to have a good doctor on my team!  Since the appointment I have scheduled physical therapy, called to schedule an ENG, and ordered prescription sunglasses to deal with the summer sun.  I hope I’m on a roll!

– Megan

Hospital image ©2008 Robert Wood Johnson University Hospital, aspirin image courtesy of Ritcharnd Moskow.

Tags: allergy challenge test, headache center, headache specialist, migraine associated vertigo
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