Re: Fist Trimester Migraines
From: Peter Wein (pwein@unimelb.edu.au)
Sat Dec 3 22:32:39 2005
Can't you blokes (and sheilas) use generic names - it's a real bugger
for those in the rest of the world.
You need to distinguish between treatment and prevention. The triptans
(suma and zolmi) are probably ok for treatment. Pizotifen and
cyproheptadine are both 5HT antagonists that can be used for prevention
and are Category A.
Tricyclics can work - also anticonvulsants like valproate - ok once past
neural tube stage, gabapentin and topiramate. Calcium blockers esp
verapamil some effect. NSAIDS as prophylaxis provbaly ok in early
pregnancy, also ACE inhibitors - not later though.
Acupuncture might work, as may biofeedback, cognitive behaviour therapy.
Riboflavin high- dose 400 mg/day has one RCT. I think botulinum toxin
also has worked.
Are you sure it is migraine?
Peter
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/
>>> > > >
>>> >
>>
>
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