Re: Fist Trimester Migraines
From: Andrew Folley (agfolley@hotmail.com)
Sat Dec 3 04:08:41 2005
Anna
Thanks for the great suggestions. I never heard of using the nasal
lidocaine or the B2 riboflavin. andy
>From: annam@uic.edu (Anna Meenan, MD)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Fist Trimester Migraines
>Date: Fri, 2 Dec 2005 19:51:43 -0600
>
>Are they episodic intractable migraines or chronic daily headache? (The
>latter can be caused by chronic use of even tylenol for headaches.) Are
>they undiagnosed cluster headaches? Interestingly enough, demerol is no
>better than placebo for migraines, and narcotics in general are not
>recommended for migraines. You could try 4% lidocaine, 15 drops in the
>nostril ipsilateral to the pain. Can repeat q 5 min X 4 total doses
>(pregnancy category B) (Diamond, Seymour 1; Wenzel, Richard 2 Practical
>Approaches to Migraine Management. CNS Drugs. 16(6):385-403, 2002.)
> >From the same reference, Chlorpromazine 50-100 mg IM, or
>Prochlorperazine, 10-25 mg IM(category C)
>Naprosyn, 825 mg, may add 550 Mg in 60 min,avoid in 3rd trimester, also
>toradol 30-60 mg IM, may repeat in 6 hours, no more than 3X per week,
>also avoid in third trimester.
>
>Avoid migraine triggers: cured, aged, fermented, or pickled foods, esp.
>meats and cheeses, nuts, soy, MSG, nitrates, nitrites, and yeast.
>
>Also avoid disruptions in routine, get adequate sleep, eat at regular
>intervals, and avoid stress.
>
>Prophylaxis: Riboflavin (vit. B2) 400mg per day (biggest dose available
>is 100mg. Need to take 4 per day.
>
>Hope this helps.
>
> Anna Meenan, MD
>
>At Fri, 02 Dec 2005, Andrew Folley wrote:
> >
> >Anyone have some annecdotal suggestons for severe intractable migraines
>in
> >early pregnancy???
> >I am sure everyone has had the patient with the intense recurrent
>migraine
> >and nausea at 12-16 weeks intractable to fioricette #3, Darvocet,
>Percocet
> >etc. Some we have placed on inderal LR 120mg for prevention to no avail.
> >Often times they are in and out of ER for Demerol or IV morphine or
> >hoppitalized shortime etc. Neruo consults cat scans etc. I am leaning
> >toward giving Imitrex or Zomig ODT (Oral Disintegrating Tablets). Any
>other
> >ideas???? steroids? SSRIs?? Lobotomy???? andy
> >
> >>> > > >
> >>> > > > I'm curious about something in that statement. Knowing that in
>the
> >>>US
> >>> > > > it is standard of care to test for and to treat GBS, what would
>you
> >>>say
> >>> > > > to a relative that moved to a country that did not practice
>along
> >>>those
> >>> > > > same lines?
> >>> > > >
> >>> > > > It is that way in at least a few of our host nations where our
> >>>service
> >>> > > > women and dependants are seen. Should that be seen as a breech
>of
> >>>US
> >>> > > > standards, or just being assimilated into their culture and
> >>>practices
> >>> > > > and deemed an acceptable risk as we are in their country?
> >>> > > >
> >>> > > > Glen
> >>> > > >
> >>> > > > ________________________________
> >>> > > >
> >>> > > > ________________________________
> >>> > > > ________________________________
> >>> > > > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
>Of
> >>> > > > Raymond Stephen
> >>> > > > Sent: Wednesday, November 30, 2005 1:17 AM
> >>> > > > To: Multiple recipients of list OB-GYN-L
> >>> > > > Subject: RE: Dr.Klein, where are you
> >>> > > >
> >>> > > > The difference between obstetrics in the USA and that in Britain
> >>>comes
> >>> > > > down to a fundamental difference in the organisation of medicine
>in
> >>>the
> >>> > > > two countries - socialised medicine (the NHS) and capitalist
> >>>medicine.
> >>> > > > Despite all its faults the NHS allows for an integration of
> >>>obstetrics
> >>> > > > into a model which covers all needs under one organisation. The
> >>>thread
> >>> > > > about GBS highlights the fact that different societies have
> >>>different
> >>> > > > rates of Streptococcal colonisation, and what is appropriate in
>one
> >>> > > > country is not in another.
> >>> > > >
> >>> > > > Steve
> >>> > > >
> >>> > > > ________________________________
> >>> > > >
> >>> > > > ________________________________
> >>> > > > ________________________________
> >>> > > > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
>Of
> >>>Henry
> >>> > > > Gregor
> >>> > > > Sent: Wednesday, 30 November 2005 12:02 PM
> >>> > > > To: Multiple recipients of list OB-GYN-L
> >>> > > > Subject: Re: Dr.Klein, where are you
> >>> > > >
> >>> > > > Amen! Clearly Zach is correct in noting the degradation of this
> >>>topic to
> >>> > > > trivial responses, which is not the same as saying the thread
>topic
> >>>is
> >>> > > > trivial. However, it is an apples and orange thing to compare
> >>>practices
> >>> > > > from two different venues w/o noting (albeit sadly, no doubt)
>that
> >>>what
> >>> > > > occurs in one place or the other is not free of the cultural,
>legal
> >>>and
> >>> > > > other sociological factors that impact on the process. Gosh, I'd
> >>>like to
> >>> > > > do midwifery in GB, with a social compact society that accepts
>both
> >>>the
> >>> > > > advantages and any possible disadvantages inherent to the
>process.
> >>>For
> >>> > > > the many reasons noted earlier, that practice model doesn't work
> >>>here.
> >>> > > > To say folks should work for change is admirable, though it is
>not
> >>> > > > gonna' happen...perhaps we should all think "Serenity Prayer"
> >>>here..as
> >>> > > > in Lord give me the wisdom to...etc., etc. (I suspect most
> >>>respondents
> >>> > > > have no trouble acknowledging the aptness of the prayer.)
> >>> > > >
> >>> > > > We might all remember the line re a fa! natic being one who
>cannot
> >>>stop
> >>> > > > talkiing about a subject and who cannot change the subject.
>Gail, I
> >>>hope
> >>> > > > you ultimately do well without your nicotine.
> >>> > > >
> >>> > > > Hank
> >>> > > > RModugno@aol.com wrote:
> >>> > > >
> >>> > > > In a message dated 11/29/2005 7:00:47 PM Eastern Standard Time,
> >>> > > > ricechaz@gorge.net writes:
> >>> > > >
> >>> > > > I wouldn't jump to the assumption that anyone posting
> >>> > > > here is guilty of trivializing our patients problems.
> >>> > > >
> >>> > > > Especially Zach Newton!
> >>> > > >
> >>> > > > Robert Modugno MD MBA FACOG
> >>> > > >
> >>> > > > Marietta, GA
> >>> > > >
> >>> > > > ________________________________
> >>> > > >
> >>> > > > ________________________________
> >>> > > > ________________________________
> >>> > > >
> >>> > > > Yahoo! Music Unlimited - Access over 1 million songs. Try it
> >>> > > > free.
> >>> > > >
> >>> > > > .com/unlimited/>
> >>> > > >
> >>> > > > Tasmania Together 5 Year Review: Have your say
> >>> > > > http://www.tasmaniatogether.tas.gov.au/
> >>> > > >
> >>> > > > Tasmania Together 5 Year Review: Have your say
> >>> > >http://www.tasmaniatogether.tas.gov.au/
> >>> > > >
> >>> >
> >>>FREE!
> >>> >
> >>
>
|
|
