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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55965
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I have been suffering from chronic, daily headaches for over

Resolved Question:

I have been suffering from chronic, daily headaches for over 20 years. They are resistant to all forms of treatment and remain undiagnosed. The headache is NEVER gone and I suspect that after years of mass doses of NSAIDs (specifically, Ibuprofen) that rebound headaches are a very real possibility. My problem, I can't find any doctor who can treat me other than to say (in a rather cavalier manner), "just stop taking them." Well, that isn't a viable solution. Please help!
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 8 months ago.
Hello
Persistent daily headaches is one possible diagnosis.
Intractable migraine is another.

If you have no diagnosis it is clear you have not seen a headache specialist [neurologist] in 20 years?

Or have there been tentative diagnoses...no doctor could have billed insurance without some form of diagnosis?
Customer: replied 8 months ago.

I've been to a slew of doctors over the past 13 years. Things I've tried:


--triptan-based meds


--opioids


--chiropractic maniuplation


--physical therapy


--massage therapy


--detox diet


--botox injections (around my head)


--steroid facet joint (cervical) injections


--radiopathic denervation


--hypnotism


--anti-depressants (e.g. Cymbalta)


--off-label meds (neurontin, topamax, elavil)


--accupuncture/accupressure


--trigger point injections


 


The ONLY thing that made me pain free for 2 weeks, a 3-day hospital stay where I received DHE IV followed by two weeks of steroids. The doctor retired and abandoned my case.


I was on Percocet for 4 years, when I realized it didn't help the pain, but made me "not care" and by the last year, I was physically dependent on it. I took the initiative to get off of it when I realized I was taking it to avoid withdrawal symptoms. I used Suboxone to end the cycle. I have been off of the Sub for a few months now.

Expert:  Dr. Thomas, MD replied 8 months ago.
Someone certainly had a diagnosis during this time.
Or diagnoses.

What does the neurologist say?
Customer: replied 8 months ago.

I've received two diagnoses: NDPH (new daily persistent headaches); atypical migraines.

Expert:  Dr. Thomas, MD replied 8 months ago.
OK
And in all of this work up have you had magnesium levels checked, and if so what were they
Customer: replied 8 months ago.

I have an appointment with an osteopath in 2 weeks for exactly that purpose. However, I am not optimistic that even if my magnesium levels are outside of normal range, that treatment will not alleviate the pain. So many things have failed. Is there no doctor or facility that can treat me for NSAID rebound headaches? Why did the DHE IV help?

Expert:  Dr. Thomas, MD replied 8 months ago.
DHE helps with migraine; this is typical of ergotamines.

A few more questions
Did you have an MRI of the brain, with what findings
Of the neck, with what findings?
Customer: replied 8 months ago.

I have had several MRI's and an MRA. All came back normal. Also had the neck done, results were unremarkable.

Expert:  Dr. Thomas, MD replied 8 months ago.
If there were no findings on neck MRI, then why the injections?
Customer: replied 8 months ago.

I have *some* arthritis in my lower back (L3/L4) and after the first facet injection, my headaches became a bit milder but the pain returned. So we tried them in my neck.

Expert:  Dr. Thomas, MD replied 8 months ago.
OK
I would try an oral ergotamine....as one suggestion, since IV ergotamine worked.

And:
Check magnesium levels.
If below 2.5 supplement effectively.

The manipulation at this point should be OMT, osteopathic manipulative treatment, by a real expert that does 100% of his practice as OMT. A DO.

A nutrient dense, anti-inflammatory diet. This is scientifically based.
See the book Eat to Live By Dr. Joel Fuhrman, or the book super immunity by Dr. Fuhrman.

In addition I would make sure this is completely whole food. That food is never stored in plastic. And that no food you eat is processed.

Stop all caffein.

Continue to hold the NSAIDs. Rebound aspects should clear up on their own.

Given that you responded to DHE, and given that you seem to have rebound from NSAIDs, then I would consider these migraine.
Use reply to let me know if you have further questions.
Please do not forget a positive rating.

Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55965
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
Dr. Thomas, MD and 2 other Medical Specialists are ready to help you
Customer: replied 8 months ago.

Are you suggesting that the rebound effect will end if I eat a whole food diet? I worked with a naturopath and did that for 6 weeks, to no avail. As for magnesium, what about the levels would make you think that they are contributing to my issue? I am curious as I found out about magnesium on a social forum. Why hasn't any of the dozen or so doctors suggested this to me. Further, I asked to try cafergot and was told by the pharmacy that it is no longer manufactured. Having said that, what other forms of ergot-based medications would you suggest I ask about? Do they cause rebound effects? Lastly, how is osteopathic manipulation different from what the chiropractors and physical therapists tried?

Expert:  Dr. Thomas, MD replied 8 months ago.
I am not suggesting a whole foods diet, that is only one aspect of the reference I gave you, and try 3 months, not six weeks.

50% of patients with migraine will respond to magnesium replacement, regardless of levels. 90% of those with migraine and mitral valve prolapse.

I can not speak for your doctors. I am highly trained, double board certified in internal medicine and integrative medicine, trained in functional medicine, classical homeopathy, etc. Frankly, I would not expect most conventional physicians to give you all of these recommendations.

I suggest trying cafergot orally. It would have less risk of rebound.

OMT has nothing at all to do with chiropractic or physical therapy. It stabilizes the primary respiratory movement, which is the movement of the cerebral spinal fluid in relation to the skull bones, sacrum and connective tissue, as well as the reciprocal tension membrane around the brain.

You can find docs like that here.
www.cranialacademy.com.


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