Post by Bob Johnson on Jan 18th, 2011 at 2:33pm
LOCATING HEADACHE SPECIALIST
1. Search the OUCH site (button on left) for a list of recommended M.D.s.
2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.
3. Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.
4. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or 
END PRINTPAGE; On-line screen to find a physician.
5. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or END PRINTPAGE Look for "Physician Finder" search box. They will send a list of M.D.s for your state.I suggest using this source for several reasons: first, we have read several messages from people who, even seeing neurologists, are unhappy with the quality of care and ATTITUDES they have encountered; second, the clinical director of the Jefferson (Philadelphia) Headache Clinic said, in late 1999, that upwards of 40%+ of U.S. doctors have poor training in treating headache and/or hold attitudes about headache ("hysterical female disorder") which block them from sympathetic and effective work with the patient; third, it's necessary to find a doctor who has experience, skill, and a set of attitudes which give hope of success. This is the best method I know of to find such a physician.
6. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or END PRINTPAGE NEW certification program for "Headache Medicine" by the United Council for Neurologic Subspecialties, an independent, non-profit, professional medical organization.
Since this is a new program, the initial listing is limited and so it should be checked each time you have an interest in locating a headache doctor.
=========
The FDA Alert on Serotonin Syndrome: Analysis of 29 Case Reports: Conclusion
Authors and Disclosures
The FDA alert concluded:
Serotonin syndrome following concomitant SSRI or SNRI and triptan use is biologically plausible. SSRIs, SNRIs, and triptans independently increase serotonin levels. Therefore, it is expected that concomitant use of SSRIs or SNRIs and triptans would result in higher serotonin levels than the serotonin levels observed with the use of SSRIs, SNRIs, or triptans alone, potentially leading to serotonin syndrome.[1]
------para. deleted here-----
Although the incidence of serotonin syndrome among patients on SSRI monotherapy has been estimated in the range of 0.5-0.9 cases per 1000 patient-months of treatment,[16] there have been no reported cases of serotonin syndrome due to triptans taken alone.[6] A prospective postmarketing safety study[17] for up to 1 year of subcutaneous sumatriptan use in 1784 migraineurs on SSRIs found no cases of serotonin syndrome. Of the 29 cases obtained from the FDA ( Table 3 ), 7 met the Sternbach serotonin syndrome criteria and no cases fulfilled the Hunter criteria. It is certainly possible that additional definite cases may be reported with greater physician awareness of these potential drug interactions and serotonin syndrome.
Triptans, when administered with SSRIs or SNRIs, might rarely precipitate serotonin syndrome. Does this justify routinely advising our patients of this possibility as the FDA advisory recommends and perhaps unnecessarily alarming them? Some migraineurs might be so alarmed that they would not want to take a triptan that could be quite efficacious. Anecdotally, few physicians are currently advising patients of the possible risk. (When I asked this question to 149 family medicine physicians from throughout Texas during a lecture on migraine in July 2007, only one indicated that he did routinely advise his patients.)
Physicians should be better informed about the information behind FDA alerts and warnings. Case information should be made readily available on the FDA Web site, so that clinicians and researchers can independently evaluate the data. (In my telephone calls to the FDA, I asked why the cases were not made available with the advisory. I was told that that was not FDA policy and that if I believed the FDA policy should be changed, I should contact my congressional representative.)
The evidence does not support any change in the use of triptans with SSRIs or SNRIs. In the unlikely event that a patient does develop symptoms and signs consistent with serotonin syndrome, the syndrome should of course be appropriately treated as discussed. I fully agree with the fine print at the bottom of the FDA advisory: "This information reflects FDA's preliminary analysis of data concerning this drug. FDA is considering, but has not reached a final conclusion about this information. FDA intends to update this sheet when additional information or analyses become available."[1]
[Medscape search, 11/13/09]
----------------------------------------------
Symptoms occur within minutes to hours, and may include:
Agitation or restlessness
Diarrhea
Fast heart beat
Hallucinations
Increased body temperature
Loss of coordination
Nausea
Overactive reflexes
Rapid changes in blood pressure
Vomiting
[w.drugs.com]
=======
=======
The symptoms are likely to catch your attention quickly and so, in light of these comments, your risk doesn't sound high--but good to keep the symptom as a check list. Run your concern by your doc....
1. Search the OUCH site (button on left) for a list of recommended M.D.s.
2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.
3. Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.
4. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGE; On-line screen to find a physician.5. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGE Look for "Physician Finder" search box. They will send a list of M.D.s for your state.I suggest using this source for several reasons: first, we have read several messages from people who, even seeing neurologists, are unhappy with the quality of care and ATTITUDES they have encountered; second, the clinical director of the Jefferson (Philadelphia) Headache Clinic said, in late 1999, that upwards of 40%+ of U.S. doctors have poor training in treating headache and/or hold attitudes about headache ("hysterical female disorder") which block them from sympathetic and effective work with the patient; third, it's necessary to find a doctor who has experience, skill, and a set of attitudes which give hope of success. This is the best method I know of to find such a physician. 6. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGE NEW certification program for "Headache Medicine" by the United Council for Neurologic Subspecialties, an independent, non-profit, professional medical organization.Since this is a new program, the initial listing is limited and so it should be checked each time you have an interest in locating a headache doctor.
=========
The FDA Alert on Serotonin Syndrome: Analysis of 29 Case Reports: Conclusion
Authors and Disclosures
The FDA alert concluded:
Serotonin syndrome following concomitant SSRI or SNRI and triptan use is biologically plausible. SSRIs, SNRIs, and triptans independently increase serotonin levels. Therefore, it is expected that concomitant use of SSRIs or SNRIs and triptans would result in higher serotonin levels than the serotonin levels observed with the use of SSRIs, SNRIs, or triptans alone, potentially leading to serotonin syndrome.[1]
------para. deleted here-----
Although the incidence of serotonin syndrome among patients on SSRI monotherapy has been estimated in the range of 0.5-0.9 cases per 1000 patient-months of treatment,[16] there have been no reported cases of serotonin syndrome due to triptans taken alone.[6] A prospective postmarketing safety study[17] for up to 1 year of subcutaneous sumatriptan use in 1784 migraineurs on SSRIs found no cases of serotonin syndrome. Of the 29 cases obtained from the FDA ( Table 3 ), 7 met the Sternbach serotonin syndrome criteria and no cases fulfilled the Hunter criteria. It is certainly possible that additional definite cases may be reported with greater physician awareness of these potential drug interactions and serotonin syndrome.
Triptans, when administered with SSRIs or SNRIs, might rarely precipitate serotonin syndrome. Does this justify routinely advising our patients of this possibility as the FDA advisory recommends and perhaps unnecessarily alarming them? Some migraineurs might be so alarmed that they would not want to take a triptan that could be quite efficacious. Anecdotally, few physicians are currently advising patients of the possible risk. (When I asked this question to 149 family medicine physicians from throughout Texas during a lecture on migraine in July 2007, only one indicated that he did routinely advise his patients.)
Physicians should be better informed about the information behind FDA alerts and warnings. Case information should be made readily available on the FDA Web site, so that clinicians and researchers can independently evaluate the data. (In my telephone calls to the FDA, I asked why the cases were not made available with the advisory. I was told that that was not FDA policy and that if I believed the FDA policy should be changed, I should contact my congressional representative.)
The evidence does not support any change in the use of triptans with SSRIs or SNRIs. In the unlikely event that a patient does develop symptoms and signs consistent with serotonin syndrome, the syndrome should of course be appropriately treated as discussed. I fully agree with the fine print at the bottom of the FDA advisory: "This information reflects FDA's preliminary analysis of data concerning this drug. FDA is considering, but has not reached a final conclusion about this information. FDA intends to update this sheet when additional information or analyses become available."[1]
[Medscape search, 11/13/09]
----------------------------------------------
Symptoms occur within minutes to hours, and may include:
Agitation or restlessness
Diarrhea
Fast heart beat
Hallucinations
Increased body temperature
Loss of coordination
Nausea
Overactive reflexes
Rapid changes in blood pressure
Vomiting
[w.drugs.com]
=======
=======
The symptoms are likely to catch your attention quickly and so, in light of these comments, your risk doesn't sound high--but good to keep the symptom as a check list. Run your concern by your doc....