Migraine

Hi all -

I just had a great visit with my PCP - Dr. Scott Berk of Stockton Family Practice in Stockton, NJ. In case anybody is nearby and looking for someone good! I made the visit to ask a lot of questions and he took a lot of time and answered them. I've been seeing him for 6 years, but I generally only go when I'm sick and so this was a treat. We talked about my medication allergies & pain management, my migraines, my hormones, and my sinuses. He is a real example of a doctor who works as a partner with his patients.

MJ asked how it went, so I'm sharing here... probably a little long, just warning you. But this ties together so many things I've been dealing with, wondering about, bending your ears about...

He's going to write a letter to my insurance co (which limits me to 4 Imitrex per month) insisting that they fill my Imitrex prescription as written. Then I will follow up with the neuro next week to see if other triptans might be good for me.

He cleared up the sinus surgery thing for me - if it's about scraping out all the tissue, he doesn't think it's a good idea, often causes as much harm as good, but if it's just to remove nasal polyps (which I have) it's probably a good thing bec those interfere with drainage and can therefore make infections hang around and breed. We will CT scan my head and decide whether to go in & snip them.

He told me the choline salt of aspirin I take should work for muscle pain (and so for TTH) but I'm not taking enough! (Here I was, following the scrip... but never complained that they don't work!) so he's reviewing the dosage and I will have something I can take for TTH, and muscle strain, backache, etc. Oh, hooray! He also gave me the name of an amino acid that induces the body to produce endorphins - he says it's a natural substance, can't cause any rebound, just increases endorphin production which eases pain. So I got some of that.

Only chance of addressing the med allergies (finding out exactly which nsaids I am allergic to, and whether I still am) is if I go take the meds in the drs office and they stand by with life-saving equipment - or spending thousands to have a lab isolate out the individual ingredients of the meds and testing with each of them. I don't know that I want to take the risk, and I definitely dont' have the $$ to spend, just so long as I have something I can use to keep any little pain from morphing into migraine!

Not a lot new on the migraine front except I'm going to start magnesium as a preventive and he also recommends it under the tongue as an abortive - if I've maxed on triptans for the week. He loved my migraine/wellness diary, and agrees that meditation/relaxation should help calm my system down to keep the migraines under more control.

That's most of it - maybe the best part was how glad he was to see me when I'm not sick - he told me he feels so bad for me when I come in sick!

Anyway, onward & upward - just wanted to let you know. Now 9 days to the neuro appointment.

- Megs

Thanks for letting us know how it went, Megs! It sounds like you really do have a great PCP. Hold on to him - he's a keeper!

Hopefully his letter to your insurance will help you get past the 4 Imitrex limit. Have you tried any of the other triptans, or just Imitrex? I know some members here have had luck getting their insurance to cover multiple triptans. Then at least you'll have options. It sounds like you're looking into that, so good for you!

I have it on my list to ask my HA specialist about GelStat Migraine as a possible abortive option. It's an OTC gel containing ginger and feverfew that you apply under the tongue. I believe Teri uses it. I'm hoping it will be a good alternative to the triptans, since it's very easy for me to go into MOH - especially since I always take ibuprofen with Imitrex or Frova, so then I can't use any triptans or NSAIDs once I reach my limit. I'll be interested to hear if the magnesium under the tongue works for you. I may ask my specialist about that as well.

I'm seeing my PCP on Friday. I need a referral to a podiatrist for an ingrown toenail (uck - already had the surgery to fix one big toe and now the other one is a mess). I also plan to talk to her about some other issues.

It's amazing the difference it makes when we have good doctors on our healthcare team. BTW I'm somewhat familiar with your area of NJ - I grew up in Toms River/Manahawkin and my mom worked at Stockton for a bit. Small world, right?

Anyway, so glad to hear you had a good appointment. Hope your neuro appointment is also helpful and productive!

Megs-I'm so excited for you; it sounds like you had a very productive visit.

I can't wait to hear about your neuro visit!!

Hi Megs!

I'm glad your visit went so well! I'm not so fond of my PCP. He's great if you just want someone to call in an occasional antibiotic for you, but with more difficult health issues...not so much. He's always willing to give a referral, though. (He loved the idea of me seeing my new HA specialist...)

It sure is nice that he's going to appeal the Imitrex restriction for you. Did you have to really push for his help? Or did he offer?

How do you use the Magnesium under the tongue? Do you crush it first? Or just let a pill dissolve there? Or does magnesium come in some other form? I haven't heard of using it this way before!

OK, I must say that that sinus surgery does not sound like fun. If it were me, I'd have to be REALLY, REALLY certain that it was absolutely, 100% necessary before I'd even think about it!!! (But I tend to be squeamish about any surgical procedure involving any part of my head. ) I hope you'll find out that it's not needed!

I hope the neuro visit is just as fruitful!

jenny

I'm so glad you had a great visit. I love my internist, too. I've been seeing him for between 20 and 25 years. We were both relatively babies when I started seeing him!

My BCBS limits my Imitrex, too, to one package a month. 9 tablets, 6 nasal sprays, or 2 injections. But they cover one package of all three. So I get 17 doses a month. Not 3 a week if I have to take 2 doses, but at least 3 a week if I only have to take one.

They'll also cover multiple triptans. Before I started seeing my new specialist, who put me on only Imitrex, I had prescriptions for Imitrex NS (which is great!), Relpax, and Frova. Of course, I had to wait 24 hours before I could switch, but Blue Cross paid for all of them.

Maybe we could get the drug companies to put more doses in each package!

Gretchen in Mississippi

I admit, I'm interested in the mag. under the tongue too?

Please let us know how that works. Always looking to learn something new. Thanks!

Thanks guys - I will definitely update you when I've tried it. The magnesium is in powder form in a capsule - so he said to open the capsule and dump it under my tongue. So we'll see...

Great idea, Gretchen, to get the med in several forms - I wonder if Oxford would cover that? I only thought of getting several different triptans or switching - I'll be talking to the neuro about it all next week.

I wish they allowed me a package of 9 - I'm supposed to get 4 but the pharmacy won't split the package, so I end up paying out of pocket for the other 5 - and with a $50 (!!!) co-pay I end up paying about $115 for the package of Imitrex! It's killing the bank balance! And my PCP told me he'd give me samples, then we talked about so many things I forgot to ask for them at the desk... But I go back in Monday for a blood draw so I'll ask for some then.

- megs

Megs,

This is great!! You have a wonderful PCP. Let us know how the magnesuim in the powder works. That's something I am going to bring up to my PCP. Regarding the sinus polyps; my DH has them too. I know how they are just rotten and interfere with drainage. I have heard that it is a not that invasive of a surgery. But, I have heard they can come back. My DH is thinking of having his removed. Have you decided to have the surgery?

Also, what amino acid induces the body to produce endorphin production to ease pain. That is very interesting.

All in all, you sound like you have one smart cookie for a PCP

Let us know how thing go

Hi Dar -

I have not decided to do the surgery - I won't decide that fast, I am pretty surgery-phobic! Dr. Berk wants me to consult with an ENT, so he'll be sending me a recommendation for one. He also told me he wants me to research the connection between seasonal allergies, aspirin allergy, and nasal polyps, all of which I have, and which are co-morbid, apparently. I guess since I showed him all my research, wellness diaries, etc he has confidence in my research abilities but I have no idea where to start with this one. I emailed him to ask for some help... maybe I'll be the big nasal polyps expert soon!

The amino acid is D-Phenylalanine. I got some sold under the name "Endorphigen," manufactured by Lidtke Technologies Corp. It says "for the dietary management of PMS." Hmmm - I don't get much PMS any more, but I guess lots of endorphins would help you feel better when PMS-ing, huh?

I'm not hoping for any pain to try these thing out on, but I can't help but wonder how they'll work!

- Megs

Hi, Megs,

Sounds like a great appointment! I'm happy for you.

Regarding the magnesium as an abortive, you may want to take a look at this Ask the Clinician, Sublingual magnesium as a Migraine abortive?.

quote:

Originally posted by nutmegan:

Not a lot new on the migraine front except I'm going to start magnesium as a preventive and he also recommends it under the tongue as an abortive - if I've maxed on triptans for the week. He loved my migraine/wellness diary, and agrees that meditation/relaxation should help calm my system down to keep the migraines under more control.
- Megs

Megs,

You make me laugh, talk about surgery-phobic, my DH has been thinking about it for a year now LOL. Thanks for the info on the amino acid. I am going to talk to my PCP about it. I'm all about feeling better when PMSing Thanks again

Dar

Thanks for the info Teri - Hmm - Dr. Krusz says magnesium tablets won't work because they won't absorb sub-lingually - but this is powdered magnesium taurate which my doc says is "maximally bio-available" - we'll see. I'll ask the neuro about it when I see him next week.

- megs

Megs,

Please note the other point he made which was oral mag does not work acutely, only as a preventive. Not to be disrespectful of your doctors, but Dr. Krusz also has a PhD in neuropharmacology and a DEA investigational license. He has done extensive research on the use of mag for Migraine. If he says it won't work acutely taken orally, the I trust what he says.

quote:

Originally posted by nutmegan:
Thanks for the info Teri - Hmm - Dr. Krusz says magnesium tablets won't work because they won't absorb sub-lingually - but this is powdered magnesium taurate which my doc says is "maximally bio-available" - we'll see. I'll ask the neuro about it when I see him next week.

- megs

Teri of course no disrespect taken, at all! My doctor is not a migraine expert! I just wondered whether Dr. Krusz was addressing this particular form - maybe I should just ask him! I certainly meant no disrespect to Dr. Krusz, either!

- Megs

Hi Megs,

I asked him to clarify and that is where the Ask the Clinician post came from:

Sublingual magnesium as a Migraine abortive?

We know you didn't mean any disrespect to Dr. Krusz! I was excited he answered so quickly!