Its just that for some reason doctors are shit scared of prescribing Lithium. My neuro made me sign a disclaimer after I put a gun to his head for a prescription

My new GP went pale when I started talking aboout lithium and insisted I go to a neuro to deal with the lithium as he was not comfortable with it!

Joe

Sorry to reply again, but a waiver? Are you serious? I hate to give suggestions, but maybe see if you can pass for bipolar and go to a psychiatrist, they don't have a problem writing for that stuff (least all the ones I met). The waiver just seems preposterous.

You present good questions. Regarding blood level tests, it seems bizarre for normally the doctors I have used want to establish a good "base line" to see if you are in therapeutic range. If you are, they prefer to continue to monitor you for, if anything, liability. They also monitor the levels to see if you need an increase or decrease in dosage. Blood level is crucial. Perhaps it is the time frame that you are on it, if not a long duration maybe there is not a need (?) again, good question it does seem odd.

Regarding risk, well it is established that I am not a doctor or pharmacist, but, from experience I can name far worse drugs. The risk with Lithium can only occur if they place you on way to high of a start dose, your kidneys already have issues and or if they do not monitor it if you are on it a long duration of time. Truthfully, I judge a doctor by what is in his office, if I see a bunch of freebie pharmaceutical stuff it is my last appointment--chances are he/she will write for the new stuff to get perks and claim all kinds of b.s. just to avoid writing what is proven to be effective. From a pharmaceutical rep, most of the crap out today is just reformulated stuff anyway (take this as a grain of salt, I only know a limited amount on this).

I cannot advise on the moving part, but I can tell you where there is a larger population the better there is a probability for finding better and more accurate treatment. In my area we have a much larger than average percentage of neurologists, you don't like him or her you can literally drive down the street in some areas and find another. No matter where you go, however, we all know how rare cluster headaches are, finding someone qualified is difficult. Mine is supposed to be and well sometimes I wonder if he isn't just confused, if all isn't just a crap shoot with him. I know of someone that attends UPMC Headache Clinic even the neuro there admits to  only seeing a few clusterheads, for what its worth.

Last, if you are in Richmond, you are about 3 hours from Baltimore, perhaps you could contact University of Maryland Health Center or Hopkins Headache Clinic both are supposed to offer great headache clinics. I see a Hopkins neuro but he is not part of the headache clinic, I am on a wait list for the Hopkins Headache clinic. If the wait is to long try Sinai Hospital in Baltimore they also have a reputable neurology department. Another option is MD General Hospital they too have a headache clinic, but I am not familiar with the reputation. The final option is Howard County General Hospital, look up their neurologists, they have some good ones and they are affiliated with Johns Hopkins.

I took the GABA for migraines; for that it worked wonders. However, the side effects were nasty, I became hostile, short-tempered and the trembles/shakes were a nightmare. For some, GABA does provide a calming effect and help them sleep. When I had the hand tremors I would eat something, only to find that it did not mitigate the shakes.

I experienced the same problem you have, Lithium at a balanced dosage did not cause hand tremors unless I was not eating 3 meals each day. Tremors can occur from Lithium; however, once someone gets adjusted to Lithium the problem tends to become minor or mitigated. Adding GABA to the mix though caused the same issue for me, my hands would shake wildly. I did not stay on GABA long enough to offer you any opinion on whether that can be reduced or not.