I had an odd appointment with my neurologist yesterday, odd enough that I might be looking for a new doctor. Up until this time, I've liked Dr. R. She took over my old neurologist's practice, which I think he may have left just to be rid of me. I left every appointment thinking that he just didn't know what to make of me. Anyway, Dr. R is just a few years older than I, she has three kids, and she gets migraines. Those last two items are particularly important to me - she knows what it's like to be suffering from a migraine AND running after three kids.
Last year, after Campbell was born, Dr. R put me on a blood pressure medicine because it has proved effective in preventing migraines. Unfortunately, like every other preventative medicine that doctors have put me on, the stuff made me feel awful - dizzy, lightheaded, spacey. I gave it 30 days and then stopped taking it. Dr. R looked pretty unhappy yesterday when I told her why I'd stopped taking the medication and why I didn't want to try any other preventive drugs. I have yet to take one that doesn't make me feel worse while I'm on it.
I went for yesterday's appointment because back in December I had tried to get my pain pill prescription refilled, and Dr. R had denied the refill. When I called to find out why, Dr. R had already left for Christmas vacation. I'm ashamed to admit that I got a little hysterical with the nurse about it all. So she talked to one of the other neurologists, who approved a refill for me. But the nurse said I had to come in for an appointment.
Dr. R completely surprised me yesterday by basically going against what she and every other neurologist I've seen has said about treating migraines. First, she told me that I can only take Imitrex one day out of seven. When I asked what to do if I got two migraines in seven days, she told me that I should take three Advil liquid gel caplets. Her reasoning was that taking too many Imitrex in a seven-day period can lead to rebound migraines. When I asked what I should do for pain when the Imitrex didn't work, she again said Advil. Dr. R claims that taking the pain pills more than once every six months or so leads to rebound migraines.
Then she asked me how much caffeine I drink. I proudly told her only half a cup of coffee a day, only to have her frown and say that I had to give it up all together, again because of the rebound effect. Migraines cause the blood vessels in your head to swell, and caffeine makes them shrink. According to Dr. R, every time you drink caffeine, you shrink your blood vessels, but then they open right back up again when the caffeine wears off, leaving you more prone to migraines.
I'm just not sure I buy all this. My first neurologist, whom I loved, told me not to take Advil when I had a migraine because it had blood thinning properties (the same reason you can't take it when you're pregnant), which can actually make the pain worse. My OB-GYN, when I was pregnant with Ella and couldn't take Imitrex, said to drink a Coke when I got a migraine. So now I have a doctor telling me absolutely not to drink caffeine and not to take pain pills and not to use Imitrex more than once a week.
Basically, I left the doctor's office rather stunned and not sure what to do. I almost want to schedule another appointment with her so that I can ask her some follow-up questions, like:
1. Do you follow this protocol yourself?
2. Where and when did you learn about all this? Did you just attend a migraine conference?
3. What do I do if I give up caffeine and pain pills and the Advil doesn't work and I still get migraines?
4. Can I see another doctor please?
As of right now, I'm willing to give the no caffeine thing a try. It'll be a rough day or two as I get it out of my system, but I don't drink enough for withdrawal to be a big deal. I was going to start this morning, but I was scheduled to be helping parent in Lily's preschool class, and I couldn't face the thought of spending five hours with 12 pre-k kids without caffeine. So I guess tomorrow's the day.
But I still think I'm going to look around for a second opinion.