My Turn for a New Migraine Specialist
One thing about even the best Migraine treatment regimens is that there will probably come a time when something happens, and they're not as effective as they once were.
There can also come a time when a change in Migraine specialists is in order, even when your current specialist is a fine doctor.
I find myself in a situation where both of the statements above apply to me and my Migraine regimen. For several years now, I've been fortunate enough to often have two months between Migraines - sometimes, even more. That, however, came to a halt in August, and I've been averaging two Migraines a week. Certainly, that's still better management than some Migraineurs have, but it's not a welcome change for me. It's also not something I'm going to let continue. On the other hand, I think I know what has caused my Migraines to increase, so that gives me a place to start. For about 10 years now, I've been taking 400 mg of verapamil ER, both for Migraine prevention and to control high blood pressure. In August, I ended up in the hospital because my diastolic blood pressure reading (the bottom number) was dangerously low. That problem seems to be related to weight loss and has now been resolved, but resolving it meant reducing the amount of verapamil I'm taking. That's when my Migraines increased.
When I first needed a Migraine specialist, there were none here in West Virginia, so I traveled to Philadelphia to see Dr. William Young at the Jefferson Headache Center. After some years with Dr. Young, he suggested that Dr. John Claude Krusz in Dallas manage my preventive maintenance because it wasn't requiring any changes, and I see Dr. Krusz a couple of times a year for work related purposes. Now that I need to work closely with a specialist for a while, it no longer makes sense to attempt changing my treatment with Dr. Krusz so far away. The good news is that we now have a great specialist in West Virginia, Dr. David Watson at West Virginia University in Morgantown.
Last week, I drove the two hours to Morgantown for my first appointment with Dr. Watson. The staff in the reception area were efficient, kind, and cheerful. Always a good sign. The nurse who checked my vitals was as great and personable as the reception staff. Dr. Watson was - as I knew he would be - thorough, observant, knowledgeable, and insightful. He appreciates educated patients who are taking charge of their health and don't expect him to write a prescription that will immediately fix everything. He didn't just decide what I need to do and hand me a prescription. He reviewed my Migraine patterns with me, discussed other medical conditions and their impact, all of my medications and supplements, and talked with me about what the options are. I've had good success with medications usually prescribed for heart issues and blood pressure control, but we agreed that changing levels of those medications isn't a good idea at this point because of the problems I've recently had with blood pressure. We discussed Botox, but since my Migraines don't fit the criteria to be classified as Chronic Migraine at this time, we'll leave Botox in reserve and hope I never get there.
So, here's the plan... I used to take zonisamide (Zonegran) for Migraine and tension-type headache prevention, and it was helpful. When my cardiologist prescribed a beta blocker for my heart, I tapered off the zonisamide to see if the beta blocker would take the place of the zonisamide. It did well at that time. So, we're going to try it again with a very slow taper. I'll start at just 25 mg a day, increasing by 25 mg per week until I get to 100 mg. Then we'll see how frequent my Migraines are with zonisamide at that dosage.
Dr. Watson and I are both hopeful that adding zonisamide back into my regimen will reduce the frequency of my Migraines again. We didn't discuss a specific goal in terms of how many Migraines per month, but my personal goal is to have no more than one Migraine per month. As we see how things go, I'll keep you posted on my progress and my new Migraine specialist.
If you recognize Dr. Watson's name from some of my other posts, it may be from posts about Headache on the Hill. Dr. Watson and I have visited Congressional offices several times now to discuss NIH funding and other issues that are important to all of us with Migraine and other headache disorders. Here's a photo from this year's event...
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