Headache Specialist, Inderal and Bubble Study?

Went to a new headache specialist today. The wait was long, an hour to be seen My husband was griping the entire time as he came with me to meet the new doc.

I went in and he looked over my file. He asked me about my history, I happily told him. He said I was having too many migraines even with the topamax so he wrote out a script for Inderal. He ran neurological tests for fibromyalgia (not sure why but good to cover all bases), tested my reflexes and gave me something similar to a DUI test LOL. My blood pressure was high-normal, probably from being antzy after waiting so long and being razzed by my hubs about it. After all that he told me he'd like to test me for PFO (patent foramen ovale- a defect in the heart) by doing a bubble study.

I realized that this guy is anti-abortive and rescue treatment for migraines. I was honest about all meds I take but he told me even fioricet w. codeine 2-3X a week is too much. He didn't want to give me anything at all. I told him flat out that if I didn't take anything for the pain at least half the time I'd have zero quality of life. He clearly doesn't get migraines because after that he didn't say anything, although he threw me samples of Axert...one of the only triptans I have not tried.

I'm down to find a cause for the migraines if there is one. He diagnosed me as having menstrual migraines with aura (I know this came up in the forum at one point...apparently doctors do diagnose menstrual migraines!). I'd like to know how menstrual migraine diagnoses relates to a hole in my heart. That part confused me.

I do not want to take Inderal. I think topamax was doing well for a preventative as far as chronic migraines go. I went from 4X a week down to about 2, sometimes worse depending on the weather and my menstrual cycle. The severity of all of my m's have decreased dramatically on topamax. Can I expect much more from preventatives? I haven't heard many people having better success than I have at the same level of chronic migraines so if I can avoid becoming a walking pill box..I'd rather not take it. I am going to talk to my primary neuro about the Inderal and see what they say tomorrow. What experiences do you guys have with it?

Also, has anyone had the bubble study done? Please give me some insight on it. I am so scared of this test...it sounds kind of nervewracking. Injecting agitated saline into me via IV and tracking it through my heart? Eepa. I don't know, I'm just scared and being a ninny but I'd really like to hear some personal experiences from my friends.

Thanks.

They run the tests just to rule out anything obvious and to make sure that you have normal responses. Well as normal as we can get. I've never had a "bubble test" but it sounds rather benign. Although if it's checking for a hole in your heart, there are other less invasive tests out there. I can't remember what I had done (might have been ultrasound, it's been 5+ years) but they found a mild heart defect and I know I had an ekg and it must have been ultrasound cause it remember it scrunching my boob (not entirely pleasant) trying to get a good picture.

2 migraines a week...dang that sounds good to me - sign me up! It is quite obvious that the new doc really doesn't get what you are going through. My headache doc doesn't want me using fioricet either but he gave me other items to cope. It's something about the contents, but if you need it to cope...I'm sure that you've tried others and you do what works for you.

My impression is to take everything to your primary neuro and discuss it with him. I know it would be wonderful to find an ultimate cause and to lower the frequency even more but if you are seeing results and you tolerate the drugs....why mess with something that works albeit imperfectly?

I'm probably not the one with the most experience or know what's achievable but if you don't feel right about doing something - don't. It's your body and your decision, you make the best choice given the information you have.

He seemed rather concerned that during bad weather and my period those weeks spike up to 4-5X a week again. I don't care! The other weeks during the month are good now and I can control them with meds, whereas before the topamax nothing worked. I could down enough pills to kill a horse and it wouldn't work! All the triptans in the world didn't do anything, nor did vicodin, percocet, fioricet w/ codeine...nothin'!

Yes, Fioricet isn't great because it has high MOH potential. The barbituate and codeine in it makes it a powerpunch for rebounds. I have figured by now that if I were to get rebounds I'd know it and I'd have them already. During the weeks topamax wasn't working I was taking lots of fioricet and didn't care. It was take the darned pills or leave my daughter to scream in her crib all day while mommy cried in her bedroom in the dark. I took the pills and didn't give two craps about MOH and still don't. I am aware of it, but if I need to take the meds I take them. Right now I am taking them 2-3X a week which is pretty good compared to the old times.

I'd use vicodin if it worked. I'd rather use triptans if they worked, but they don't. I keep trying them though, I'm not sure why. I still have hope for them.

The bubble test is silly. I think I have to be nakee for it. I am super self concious about my boobs, so that is really scary...more scary than the IV will ever be for me. I can deal with the IV about as well as I can eat a piece of cake. I like needles, which is why I stayed the he!! away from heroin when I was a kid!

I do worry about air/agitated saline running through my heart. That freaks me out.

Thanks though. After my chat with the primary neuro I'll let you all know how it goes.

This is interesting, LG. What I want to know is, doesn't this dr. understand that some people just don't respond to triptans? That's the primary reason you have to take more fioricet, right? Because you can't take/don't respond well to triptans. I wonder what he says to migraineurs who take 3 or 4 triptans a week on average?

I think I've been on Inderal, but I can't remember. Which means if I was on Inderal, it must not have worked well enough to be memorable. I'll have to go back through my records to check. Did he prescribe it as a painkiller?

I'm wary of any doctor who doesn't believe in either preventatives or abortives. How can they treat pain? I'm all for curing the cause of the migraine, but I haven't heard of too many people who've had their migraines cured, so I'm skeptical about that!

I love these dr's who are so dismissive when we tell them, if I didn't take these medicines, I wouldn't be able to function, or as Gia said, "I'd have no quality of life." I've said similar things to my doctors in the past, and got the "Umm hmm" head nod in response. I'd like to see them try to have a quality of life with constant migraine pain! See if they can dismiss it so easily then.

Let us know how it progresses, Gia. I hope it works out for the best. And let us know what your primary doctor says about it all!

gia,

there is nothing invasive about a bubble study, outside of having an IV line place. the bubbles aren't air, they are saline. this is done with an echocardiogram. a tech will use a small "pump" to circulate saline, and the echo will try to pick up any "bubbles" through structural defects in the heart.

truly nothing painful about this, and i wouldn't get too concerned about having a PFO.

as for inderal (propanolol, a beta blocker), it can be very helpful with migraines, but one must watch bp as it can drop bp. it can help, but may make you feel very tired and you may gain weight.

throwing more medication into the mix when your migraines may be relatively well controlled may just make things more complicated.

btw, Inderal (Inderal LA is a long acting from of propanolol) is taken a few times a day. the long acting is brand name and can cut down on how often you need to take it.

I believe that some people that had a hole in the heart also had M. when they closed the hole away went the M

used Inderal 5 days. slept all the time. same M or headache.

Dr. gave me 30 days fiorcet. when I said it helped alot he said well you cant have anymore its addictive.{ so

I bought on line } but hes the same jerk that said its not M cause you dont have Aura. never went back there.

PF - thanks for the info on a bubble test. I didn't think it was invasive...echocardiogram (this is what I had and brain was total swiss cheese). You do get to wear a funny gown (the hole is in the front) and wearing nothing from the waist up underneath, and it doesn't hurt (well other than boobs being a bit manhandled - but a lot less worse than you take with even a mild HA).

Beta blockers....hmm that's strange. My gp had me try those before referring me to a headache specialist - they did nada. From what I've been told, they will often try these first and see if there is an effect - little side effects other than lowered bp. One of those things the average doctor can do and not cause horrible side-effects in the patient. Kind of strange that you are on something that works and it's not the first meds that are normally tried and they want to go back that far.

Hope your appointment today goes well LG.

thanks guys.

Okay I feel a little better about the bubble study but PF, your a male right? Sorry..I don't mean to be crass but I am the type of woman that wears her bra to bed. I don't like to reveal my tatas to anyone hehe. Thanks for clearing most of my fears up, but I'm going to be nervous about someone looking at my breasts. My mom mostly scared me about the bubble study.

Sorry about the mean doc. riley. I'm happy that my neuro gives me the fioricet w. codeine because it is literally the ONLY thing that works that I've found. I've tried so many things and was starting to get very desperate. They finally gave me that and wheph, I was really relieved. Now I get a script of 60 every month, this month I got a refill but haven't needed to use it. They are very good about understanding what a migraine does to your life, probably because the head neuro of the office gets migraines himself.

Your right about the PFO, too. Apparently 1 out of 4 people have this PFO defect and some people get migraines from this. Sometimes if you get the hole fixed, the migraines go away. There are not enough studies out there to actually prove that, though. I don't know what I would do if they found it. Messing around with your heart with no studies to back it up is a risky thing but when you are desperate I guess you'd try anything. I'll keep you all updated. My bubble study is in march but I wont get the results until april 22nd. This guy is really busy.

Bubbs, the Inderal is supposted to be used as a preventative. This guy does NOT believe in aborting or killing the pain at all. He believes that there are ways to prevent all migraines. I am all for trying it, but I honestly don't know if that is possible in my case after reading all I have. I can still try but like I said, I'm not willing to become a walking pill box to do it. Medications as I see it can do just as much harm as good in the long run.

I'm down to find a cause for the migraines if there is one. He diagnosed me as having menstrual migraines with aura (I know this came up in the forum at one point...apparently doctors do diagnose menstrual migraines!). I'd like to know how menstrual migraine diagnoses relates to a hole in my heart. That part confused me.

That's one of the funny things about migraine....Contradictory and confusing theories.

BTW, I also tend to have normal-high BP when I am visited by a new doctor. I am always very agitated and anxious.

I hope that this new guy will find some good solutions for you.

Bye

LG,

When I had my echo, you remain covered. The hole in front is just so they can get the ____(dang can't remember what they call the wand-thingy) to your skin but you stay covered. You may have one breast partially exposed and I understand the modesty thing but it's sort of like going to the ob-gyn. When they are doing their thing "down there" you put your mind a million miles away. And the echo technician really isn't looking at your chest - they are moving the wand and watching a screen to make sure they are getting the right picture. They may have to look down every once in a while just to make sure they are still in the right area. You've had a baby, this is easy (closed room with not a crowd watching)

Becky

Becky,

I know this is rediculous, but I'd much rather expose my va-jayjay than by boobs. I'd MUCH rather go to the OB/GYN.

Thanks though, It does make me feel better to know that. Hopefully I will have a female technician and I will feel even better about the situation. Maybe I can request one? What's the worst that can happen, they say no? At least I tried!

Ah, as soon as someone said "beta blocker," the lightbulb went on. I did have Inderal, it was the first preventative I ever tried, about 13 years ago. My mind is mush on what I've taken in between the Inderal and everything else I've tried as preventatives, abortives, rescue meds, etc. etc. But yes, I did try Inderal, I remember the weight gain. It didn't do jack for me

But no two migraineurs are the same, I'll keep my fingers crossed it'll work for you, LG.

I'm having a bad day today, every other word I type is misspelled, I keep having to fix them. LOL I'll have more to say later. But... I think you can def. ask for a female tech, and maybe you can keep your bra on, if you wear a sports bra with no underwire?

LG,

You are a strange one...I'd prefer no one saw either but if I had to chose - it's be upper. The other is just a bit too personal for me. Look where this conversation went...think we scared off the men folks At any rate, I did have a lady tech (she was probably old enough to be my grandmother) and I think with the way things are, if it's not a female technician they almost have to have another woman in the room (the medical clinic would be slapped with all sorts of *&(* (flipping meds have turned my brain to mush again) impropriety cases) but certainly do request one.

And unfortunately, no you can't keep stuff on - think about any time they do an ultrasound. It has to be on bare flesh to get the best image. I would have preferred it the other way too (at that point in my life was a bit more self conscious...that sort of wears away with age a bit ).

It always does help if you sort of know what to expect. A lot of what makes us nervous is the unknown and if you can alleviate that you go in and it's a much more pleasant experience.

LOL yeah I know I'm weird. Most people are the opposite but I am so self concious about my tatas. They aren't really bad or anything but I just don't want anyone to see them. I don't even like my husband to see them, although he does get special privileges!

Okay boys, you all can come back now, I'm done talking about my upper half!! HAHA


I do agree that the unknown frightens me more than the test itself. I also get concerned about the results, especially for tests revolving around my heart. I have this notion that my heart is a huge major organ that is VERY important..possibly more important than my brain. I know my brain is funky already so that is not news to me. If there were something wrong with my heart too I'd be pretty upset. It would be a mix of happiness, frustration and walking into unknown territory. What if I do have PFO and they fix it and I still get migraines? That would suck. I'm not going to think about that much until I get the test though. No need to add unnecessary stress to a situation that isn't even here yet!

gia,

holy cow, lol.

1st thing you have to learn about medicine and modesty....they are professionals and sometimes you do need to get used to shedding modesty. For cardiac echos, usually they can do them with a gown on on a sheet and keep just about everything covered. echo techs are in high demand and are professional--if not, every schmuck that wanted a cheap peep would be doing it (FYI, the job pays easily ~80,000 a year).

i've had many echos, in fact had one this morning with some other tests.....and yes i'm a guy--if not, i have a very hairy chest for a chick (the nurses shaved patches for the EKG tabs--there's my TMI).

PFO had gotten a lot of attention regarding migraine and risk of stroke. i wouldn't get too hyped about this, again. not everyone that has PFOs have any symptoms, and mostly PFOs are fixed (via catheterization) if it poses a stroke risk, and not to prevent migraines.

i've had many, many procedures that require access to the body's largest arteries and most often cardiologists do their procedures in this area--the groin. so modesty gets thrown out the window, but people are very, very professional. you wouldn't believe some of the hillarious stuff they say in the ORs and cath labs when they doing the prep.

My, my. You all are a hoot today! TOTALLY not what I thought this threat would be about!

IMHO this guy sounds like a butt head!! I personally wouldn't bother w Inderall. I tried it it did absolutely nada. And how much of a headache specialist is he without treating people in a way that provides relief from their pain?

I'd chaulk him up to a waste of time and keep w what you have.

Sorry this is brief I'm in lots of pain and meds are startin to kick in so I keep having to correct errors in typing

goodluck buddy!

LG,

Inderal may work for you. If I recall it did help some folks here on Ronda's. But for me it was awful. It lowered my blood pressure to the extent I was just about falling over. I had abdominal pain, anxiety, but the worse was the extremely frightening. violent, bloody nightmares every night. I mean in-your-face battle field violent. Oh, and it did nothing for the migraines.

Chris

Porsche Fan wrote:gia,



as for inderal (propanolol, a beta blocker), it can be very helpful with migraines, but one must watch bp as it can drop bp. it can help, but may make you feel very tired and you may gain weight.

i am havin some relief from migraine with this beta blocker, weight gain is an issue for me, which i am trying to keep on top of, but the pros are outing way the cons at the moment, my advice would be always take it with food, never on an empty stomach, or b4 you have had breakfast, be prepared at first to feel a little light headed, and feel cold at times, your bp, and pulse will come down, (not a prob for me as the amitriptyline that i am on as well increased both these things, so beta blocker just brought it back down to acceptable level) so if you have low bp or pulse you may need to keep an eye on this,

my taste has altered, not as senstive as it was, and i do find i can get a bit forgetful, but i think the Ami hasnt helped so cant be sure it is the beta blocker,

for me at the moment the beta blocker is helping so i am prepared to stick with it, i hope it can give you some relief as well,

Hi LG

I tried propranolol as one of my first line preventatives about 10 years ago. It did help reduce both frequency and severity a bit. Not the 50% that a clinical trial would consider a success, but maybe if taken with something else it could have been useful. A lot of people seem to get help with the combination of propranolol and amitriptylline. I had to stop taking it as it made my hair fall out quite diffusely so it ended up pretty thin. This is very very rare, and it did grow back on stopping it.

As I generally tend towards low BP (90-100/60-70) I was a bit wary of a beta blocker, but it didn't lower my BP at all, although my pulse did drop. I went up to a 160mg long acting dose a day.

I also had the bubble test for PFO. I had a front fastening gown and it was all fine. As part of the test I had a trans oesophageal echocardigram, which involves swallowing the probe. A local anaesthetic spray was used to numb my throat and although it was a little uncomfortable it wasn't too bad. I was also given IV midazolam as a sedative (also causes memory loss of the procedure) and IV morphine for the pain of swallowing the probe and to suppress coughing with the probe in place. A PFO was found with bubbles passing through it at rest and also with a valsalva manoeuvre (eg straining to increase intra abdominal pressure).

I think I did act a little weirdly on the midazolam (uninhibited) but can't really remember. Bit embarassing, especially as I worked with the people doing the procedure at the time They also saw my tatas, and later when I had the PFO closure, which goes in through your femoral vein in your groin, a whole lot more We were all very professional about it, but still Hopefully you will have the protective veil of anonymity!

The closure itself was done nearly 4 years ago, and didn't help. It actually seemed to make things worse, which my neuro now thinks may be due to an incomplete closure, although it was checked afterwards. But at least my stroke risk is reduced. I have migraine with aura, which one of the more recent trials (MIST II or III???) seemed to show would benefit most from PFO closure.

If you have any other questions I'm always happy to help

Amy