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BostonHeadacheDoc

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  1. Like
    BostonHeadacheDoc got a reaction from jon019 in New here but not new to the evil!   
    Hi bobcat, 
    Well that sounds rotten. Certainly not CH as the headache is all day, also CH is strictly one sided- sounds like yours is not? Not CH in which case verapamil is not going to help at all at all. Indomethacin is non specific, certainly a good anti-inflammatory, beware known to be very irritating to the stomach. Best avoid using the term cluster-migraine as it causes mass confusion and it is mostly used by folks who know not what the attacks are. 
    Your story at the gym (at least you were lifting a dumbbell) and sudden headache- that is often one of 2 things, a thunderclap headache- which can be a syndrome known as reversible cerebral vasoconstriction syndrome (RCVS) but that only lasts- days to weeks; or could have torn a muscle, ligament or other neck hardware resulting in a cervicogenic headache (caused by neck problem). I totally understand why they thought of low pressure headache- can present with quick onset headache focused at the back of the head (can be thunderclap). Low pressure/low CSF volume headache is generally positional - you get much better quickly lying down, with head down, only for the pain to come back quickly when upright.
    Out of control high blood pressure can also present like this- as you have high blood pressure you had better be measuring your blood pressure at home (with a home BP kit) to make sure it is not very high). Botox is not going to help you.
    I was recruited to the Graham Headache Clinic at Brigham and Women's Faulkner Hospital April 15th. Fell free to PM me if you have any Qs or bmcg@bu.edu 
  2. Like
    BostonHeadacheDoc got a reaction from jon019 in New here but not new to the evil!   
    Hi bobcat, 
    Well that sounds rotten. Certainly not CH as the headache is all day, also CH is strictly one sided- sounds like yours is not? Not CH in which case verapamil is not going to help at all at all. Indomethacin is non specific, certainly a good anti-inflammatory, beware known to be very irritating to the stomach. Best avoid using the term cluster-migraine as it causes mass confusion and it is mostly used by folks who know not what the attacks are. 
    Your story at the gym (at least you were lifting a dumbbell) and sudden headache- that is often one of 2 things, a thunderclap headache- which can be a syndrome known as reversible cerebral vasoconstriction syndrome (RCVS) but that only lasts- days to weeks; or could have torn a muscle, ligament or other neck hardware resulting in a cervicogenic headache (caused by neck problem). I totally understand why they thought of low pressure headache- can present with quick onset headache focused at the back of the head (can be thunderclap). Low pressure/low CSF volume headache is generally positional - you get much better quickly lying down, with head down, only for the pain to come back quickly when upright.
    Out of control high blood pressure can also present like this- as you have high blood pressure you had better be measuring your blood pressure at home (with a home BP kit) to make sure it is not very high). Botox is not going to help you.
    I was recruited to the Graham Headache Clinic at Brigham and Women's Faulkner Hospital April 15th. Fell free to PM me if you have any Qs or bmcg@bu.edu 
  3. Like
    BostonHeadacheDoc got a reaction from jon019 in New here but not new to the evil!   
    Hi bobcat, 
    Well that sounds rotten. Certainly not CH as the headache is all day, also CH is strictly one sided- sounds like yours is not? Not CH in which case verapamil is not going to help at all at all. Indomethacin is non specific, certainly a good anti-inflammatory, beware known to be very irritating to the stomach. Best avoid using the term cluster-migraine as it causes mass confusion and it is mostly used by folks who know not what the attacks are. 
    Your story at the gym (at least you were lifting a dumbbell) and sudden headache- that is often one of 2 things, a thunderclap headache- which can be a syndrome known as reversible cerebral vasoconstriction syndrome (RCVS) but that only lasts- days to weeks; or could have torn a muscle, ligament or other neck hardware resulting in a cervicogenic headache (caused by neck problem). I totally understand why they thought of low pressure headache- can present with quick onset headache focused at the back of the head (can be thunderclap). Low pressure/low CSF volume headache is generally positional - you get much better quickly lying down, with head down, only for the pain to come back quickly when upright.
    Out of control high blood pressure can also present like this- as you have high blood pressure you had better be measuring your blood pressure at home (with a home BP kit) to make sure it is not very high). Botox is not going to help you.
    I was recruited to the Graham Headache Clinic at Brigham and Women's Faulkner Hospital April 15th. Fell free to PM me if you have any Qs or bmcg@bu.edu 
  4. Like
    BostonHeadacheDoc got a reaction from jon019 in New here but not new to the evil!   
    Hi bobcat, 
    Well that sounds rotten. Certainly not CH as the headache is all day, also CH is strictly one sided- sounds like yours is not? Not CH in which case verapamil is not going to help at all at all. Indomethacin is non specific, certainly a good anti-inflammatory, beware known to be very irritating to the stomach. Best avoid using the term cluster-migraine as it causes mass confusion and it is mostly used by folks who know not what the attacks are. 
    Your story at the gym (at least you were lifting a dumbbell) and sudden headache- that is often one of 2 things, a thunderclap headache- which can be a syndrome known as reversible cerebral vasoconstriction syndrome (RCVS) but that only lasts- days to weeks; or could have torn a muscle, ligament or other neck hardware resulting in a cervicogenic headache (caused by neck problem). I totally understand why they thought of low pressure headache- can present with quick onset headache focused at the back of the head (can be thunderclap). Low pressure/low CSF volume headache is generally positional - you get much better quickly lying down, with head down, only for the pain to come back quickly when upright.
    Out of control high blood pressure can also present like this- as you have high blood pressure you had better be measuring your blood pressure at home (with a home BP kit) to make sure it is not very high). Botox is not going to help you.
    I was recruited to the Graham Headache Clinic at Brigham and Women's Faulkner Hospital April 15th. Fell free to PM me if you have any Qs or bmcg@bu.edu 
  5. Like
    BostonHeadacheDoc got a reaction from jon019 in New here but not new to the evil!   
    Hi bobcat, 
    Well that sounds rotten. Certainly not CH as the headache is all day, also CH is strictly one sided- sounds like yours is not? Not CH in which case verapamil is not going to help at all at all. Indomethacin is non specific, certainly a good anti-inflammatory, beware known to be very irritating to the stomach. Best avoid using the term cluster-migraine as it causes mass confusion and it is mostly used by folks who know not what the attacks are. 
    Your story at the gym (at least you were lifting a dumbbell) and sudden headache- that is often one of 2 things, a thunderclap headache- which can be a syndrome known as reversible cerebral vasoconstriction syndrome (RCVS) but that only lasts- days to weeks; or could have torn a muscle, ligament or other neck hardware resulting in a cervicogenic headache (caused by neck problem). I totally understand why they thought of low pressure headache- can present with quick onset headache focused at the back of the head (can be thunderclap). Low pressure/low CSF volume headache is generally positional - you get much better quickly lying down, with head down, only for the pain to come back quickly when upright.
    Out of control high blood pressure can also present like this- as you have high blood pressure you had better be measuring your blood pressure at home (with a home BP kit) to make sure it is not very high). Botox is not going to help you.
    I was recruited to the Graham Headache Clinic at Brigham and Women's Faulkner Hospital April 15th. Fell free to PM me if you have any Qs or bmcg@bu.edu 
  6. Like
    BostonHeadacheDoc got a reaction from Dallas Denny in Searching for CH doctor in Massachusetts   
    I sent a PM to Concerned mom and offering all help I can, happy to see this young man soon. 
  7. Like
    BostonHeadacheDoc got a reaction from ThatHurtsMyHead in coming off high dose Topiramate advice needed   
    Hi Dan,
    Well you have the correct goal. Generally with cluster headache if you are not sure that a treatment is working- then it is NOT working. You are on a high dose of topiramate- did it ever work? How did you get up so high? If it is not helpful at 200mg a day then will not be at 600mg a day. Lucky for you tapering is easier with CH than with migraine. Suggest come down by 25mg-50mg a week. Not an exact science and you can cut the pills. Ideally with physician involvement we write scripts for 25mg tabs which makes tapering to zero easier. As you go lower you can take it all at night. Medically it is safe to taper quickly (over 2-3 weeks) but you have feel shitty. Me thinks your mind and memory will improve when you are off. Get off that stuff!!
    Peace 
  8. Like
    BostonHeadacheDoc got a reaction from ThatHurtsMyHead in What would you do   
    Matakarap,
    FOCUS. LISTEN-
    O2- at least 15liters/min via face mask, do it to abort.
    sumatriptan injections any dose- nasal spray not good in comparison- zolmitriptan is better if you really want to use nasal spray!
    STEROIDS.  Calm down these are anti- inflammatory steroids and often stop the CH, albeit temporarily in many people. Take in the morning. 
    VERAPAMIL
    Yes a minority of clusterheads actually have benefit so you deserve it to yourself to try the instant release form (80mg 3 times daily going to 2X80mg 3 times a day
     
    Peace,
    BostonHeadacheDoc!
     
  9. Like
    BostonHeadacheDoc got a reaction from Ricardo in Gammacore for Chronic Cluster Headaches   
    Dear Kristofer,
    Sorry to hear of your trouble. Some advice- if it is at all possible you should attend the Clusterbusters Annual meeting Sept in Denver. You will find out there are people who have had chronic CH for longer and all sorts of advice from many who have found success from an even worse position (like Bob Wold!). Seriously you need to be there. You need to talk to other chronic CH folks,- how many have you met?
    Opioids have no role in cluster headache. Before you construct a rebuttal to that, just think, how bad you are, on opioids and ask yourself, are they working??? Your body has been hijacked (by opioids) currently, but that can be dealt with. BTW The FDA does not have a maximum opioid dose, but may suggest a maximum for certain products like Actiq
    With the data we have, Gammacore has been shown NOT to work in chronic cluster headache, in 2 well conducted clinical trials. 
    You need the CGRP antibodies, when they are released (theoretically can switch off CH) or BOL (I hear there will be an update soon on the status of this). I presume you are aware of the vitamin D protocol, melatonin etc.
    Peace and good wishes,
    BMcG
  10. Like
    BostonHeadacheDoc got a reaction from Ricardo in Gammacore for Chronic Cluster Headaches   
    Dear Kristofer,
    Sorry to hear of your trouble. Some advice- if it is at all possible you should attend the Clusterbusters Annual meeting Sept in Denver. You will find out there are people who have had chronic CH for longer and all sorts of advice from many who have found success from an even worse position (like Bob Wold!). Seriously you need to be there. You need to talk to other chronic CH folks,- how many have you met?
    Opioids have no role in cluster headache. Before you construct a rebuttal to that, just think, how bad you are, on opioids and ask yourself, are they working??? Your body has been hijacked (by opioids) currently, but that can be dealt with. BTW The FDA does not have a maximum opioid dose, but may suggest a maximum for certain products like Actiq
    With the data we have, Gammacore has been shown NOT to work in chronic cluster headache, in 2 well conducted clinical trials. 
    You need the CGRP antibodies, when they are released (theoretically can switch off CH) or BOL (I hear there will be an update soon on the status of this). I presume you are aware of the vitamin D protocol, melatonin etc.
    Peace and good wishes,
    BMcG
  11. Like
    BostonHeadacheDoc got a reaction from Ricardo in Gammacore/electrocore   
    I contacted the company that makes the gammaCore device. I am satisfied that the signal is an electrical one, and not just a sound. spinebob I am happy to continue this conversation as needed, you may have more information. I appreciate your skepticism, but in this case it does not appear to be true. I am not an engineer! 
    Regards,
    Brian E McGeeney, MD, MPH, MBA
     
    BostonHeadacheDoc 
  12. Like
    BostonHeadacheDoc got a reaction from Ricardo in Gammacore/electrocore   
    I contacted the company that makes the gammaCore device. I am satisfied that the signal is an electrical one, and not just a sound. spinebob I am happy to continue this conversation as needed, you may have more information. I appreciate your skepticism, but in this case it does not appear to be true. I am not an engineer! 
    Regards,
    Brian E McGeeney, MD, MPH, MBA
     
    BostonHeadacheDoc 
  13. Like
    BostonHeadacheDoc got a reaction from Ricardo in Gammacore/electrocore   
    I contacted the company that makes the gammaCore device. I am satisfied that the signal is an electrical one, and not just a sound. spinebob I am happy to continue this conversation as needed, you may have more information. I appreciate your skepticism, but in this case it does not appear to be true. I am not an engineer! 
    Regards,
    Brian E McGeeney, MD, MPH, MBA
     
    BostonHeadacheDoc 
  14. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  15. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  16. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  17. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  18. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  19. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  20. Like
    BostonHeadacheDoc got a reaction from fella1234 in Remission Over   
    Hi blueblueblue,
    So how is the migraine coming along? - only kidding! Sorry to hear of your troubles and welcome to the group. There is an extremely active closed discussion group on a certain other social media platform that you will be told about, featuring many of the Clusterbusters group members. You need to attend the annual Clusterbusters meeting in Denver, middle of Sept 2018.
    I am happy to facilitate an early office visit on your request-if you are interested message me with your contact info, I have not been on here in a while but will keep an eye out now.
    Regards,
    Brian E McGeeney, MD, MPH, MBA
    Neurology Dept, Boston University School of Medicine and Boston Medical Center. 
  21. Like
    BostonHeadacheDoc got a reaction from Tony Only in Dr Elliot Shevel   
    Don't do it.
    I meant to comment on the other thread but never got around to it. There are a number of surgeons offering a surgical 'cure' of migraine and occasionally cluster headache as well. It appears this man ligates arteries, branches of the external carotid, and in addition can remove certain small facial muscles.
    Unfortunately this is all nonsense to me. These are brain disorders, and such procedures could never produce a 'cure' and it is very hard to find a biological rationale for improvement either. I have seen victims of migraine surgery but not cluster surgery like this...as yet. This man likely knows very very little about headache medicine- he is a surgeon with NO training in headache medicine and does NOT manage headache patients. I am open to odd treatments if there is some biological rationale but it is nonsense here. Happy to discuss further if needed.
    'noninvasive surgery'- is n't that an oxymoron? It is easy to think that such procedures should only be last resort- but that is wrong- they should not be done at all.
    Sorry if I am stern here, but I do not like vulnerable people being taken advantage off by, at best, misguided physicians.
    Peace.
    BostonHeadacheDoc  :-/
  22. Like
    BostonHeadacheDoc got a reaction from Tony Only in Dr Elliot Shevel   
    Don't do it.
    I meant to comment on the other thread but never got around to it. There are a number of surgeons offering a surgical 'cure' of migraine and occasionally cluster headache as well. It appears this man ligates arteries, branches of the external carotid, and in addition can remove certain small facial muscles.
    Unfortunately this is all nonsense to me. These are brain disorders, and such procedures could never produce a 'cure' and it is very hard to find a biological rationale for improvement either. I have seen victims of migraine surgery but not cluster surgery like this...as yet. This man likely knows very very little about headache medicine- he is a surgeon with NO training in headache medicine and does NOT manage headache patients. I am open to odd treatments if there is some biological rationale but it is nonsense here. Happy to discuss further if needed.
    'noninvasive surgery'- is n't that an oxymoron? It is easy to think that such procedures should only be last resort- but that is wrong- they should not be done at all.
    Sorry if I am stern here, but I do not like vulnerable people being taken advantage off by, at best, misguided physicians.
    Peace.
    BostonHeadacheDoc  :-/
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