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ACAD-AE-MED  July 2006

ACAD-AE-MED July 2006

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Subject:

Re: Migraine/Triptan therapy

From:

"Reid, Cliff" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Fri, 28 Jul 2006 20:02:02 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (61 lines)

Diclofenac suppositories are fab, particularly for patients with gastroparesis. I suffer occasionally from migraine and a full blown attack will leave me photophobic and vomiting. PR diclofenac sorts me out. I usually prescribe 100mg PR diclofenac and a kip in a dark room for my patients with migraine. I don't like giving metoclopramide, prochloperazine, or chlorpromazine since I've experienced akathisia with all of them and I believe we underestimate the frequency of unpleasant side-effects from these drugs because patients don't know to report them.

Dr Cliff Reid  
Consultant in Emergency Medicine 
North Hampshire Hospital NHS Trust 




Disclaimer - July 28, 2006 
This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to which they are addressed. Any views or opinions expressed are those of the author and do not represent the views of the North Hampshire Hospitals NHS Trust unless otherwise explicitly stated. The information contained in this e-mail may be subject to public disclosure under the Freedom of Information Act 2000. Unless the Information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.


-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Vic
Sent: 28 July 2006 19:56
To: [log in to unmask]
Subject: Re: Migraine/Triptan therapy


I suffer from Migraine occasionally and make sure I carry a triptan around
in the car, in my bag, at home, and on holiday. I find I have 20 minutes
from the start of the right inferotemporal scintillating scotoma to the
onset of the headache and a triptan aborts it completely if taken at that
stage. Now I know lots of people react differently so this is just personal
experience but I know it has helped others.

I really suffered as a kid, but basically I was bullied by big brother (some
of you know him - he's in medicine too). My migraines resolved largely when
I realised at the age of seven that I could win the fight if I kicked him in
the gonads (Stress relief, empowerment etc). I started with migraines again
as a GP, then read the label of this new Red Bull drink I'd taken a fancy
to. Then a few years ago I started having daily migraines. I was actually
having one when a young lad came in with his mother. He was getting
migraines too. Mum asked if I had a list of things he shouldn't eat and I
went on Google to find one. I found this
http://altmedicine.about.com/od/popularhealthdiets/a/migrainediet.htm
I had started having banana smoothies for breakfast. If I don't have more
than three bananas a week I'm fine. I've given the printout to hundreds of
patients now and they almost all report that the migraines get a lot less
frequent. As for the others - they just have to learn to kick the bugger in
the balls!

Vic Calland

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 28 July 2006 07:47
To: [log in to unmask]
Subject: Migraine/Triptan therapy

What is the accepted wisdom on the management of acute migraine these days? 
Do most people stick with the tried-and-tested methods of analgesia, 
anti-emetics and fluids? Or do many of you now use triptans, and if so, in 
which particular patients or perhaps as a routine? Am finding it very 
difficult to find any good evidence or consensus on this particular 
question. Any advice gratefully received.

AF 

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