Should I Consult A Neurologist For Persistent Pain In Head While Taking Ultam ?

Posted on Mon, 23 Dec 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 23 Dec 2013 Answered on

Fri, 17 Jan 2014 Last reviewed on

Question : I have had a pain since two months ago in my head: wake up in the monrning and start to bother me on the top of my head on the left. Sometimes on other areas. The pain grows as I move around and take too much medicine that it hurts my stomach. in the last 25 days I have had an MRI and a Cat scan, and both are negative. The Doctor prescribed Ultam 50MG oral tablet to take as needed every 6 hours. The doctor also told me to se a Neurologist. I take upto 6 aleves throughout the day and still the "pain" persists. What do I expect from neurology? What questions can I ask? Is this a good Idea of seeing a neurologist for my headache? Any comments?

Answered by Dr. Shoaib Khan (7 hours later)

Brief Answer: Non-complicated migraine Detailed Answer: Hello sir and welcome. Thank you for writing to us. The condition you have is most probably a migraine headache. If your MRI and CAT scan has returned normal results, then the most probable cause is a migraine without any serious condition causing it. Treatment of migraines is mostly with the help of either a special medication made for migraine headaches called sumatriptan or with propanol which is belongs to a group of drugs essentially introduced to control hypertension. The neurologist will be able to rule out all other more serious causes for the migraine, and make an accurate diagnosis. Things you should ask him are to introduce medication that will not irritate your GIT or cause any other side effects, and to make sure he/she makes an accurate diagnosis, which is most important. Rule out all neurological, vascular and ophthalmic causes. Yes sir it is certainly a good idea to visit a neurologist as a neurologist is the only specialist who you should be consulting with such a presentation. My only comments would be regarding the emphasis I have already paid on making a most accurate diagnosis. I am sure most of the other causes have already been ruled out thanks to the clean MRI and CAT scan, which should mean initiation of migraine treatment will be all that is required to provide you with complete relief. I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (12 hours later)

Thanks Dr. I got prescribed Amlodipine TAB 2.5 MG one daily and Amitriptyline 10MG before bed. If it works, how long before I feel any better? I talked to my doctor about what you said and I hope this is similar to what you suggested. Thanks.

Answered by Dr. Shoaib Khan (3 hours later)

Brief Answer: Yes sir, these medications should help Detailed Answer: Hello sir and welcome. Yes, these medications are close to what I suggested and should start helping you soon. We could assume a time frame of about 7-10 days before they start taking effect, and a duration of 2-4 weeks within which you should start feeling relieved. I hope and pray you recovery soon and experience a healthy life thereafter. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes sir.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (9 hours later)

Thank you Dr.

Answered by Dr. Shoaib Khan (9 hours later)

Brief Answer: My pleasure entirely Detailed Answer: Hello sir. It is my pleasure entirely, I wish you a complete and rapid recovery. Please do not hesitate to write back to me for anything at all. I am always available to help. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (2 days later)

Dr. I feel a little lightheaded even when I am in bed now, do you think I should stop the medication or it is usual? Also, the 4th of december I stop taking lorazepam with phenobarbital, I took one MG on the 22 and one MG on the 23th of December. I have not taken more. Do you think that I should go back to taking Ativan?

Answered by Dr. Shoaib Khan (34 minutes later)

Brief Answer: No please do not; depends on your doctor Detailed Answer: Hello once again sir. Lightheadedness is commonly seen with use of the recently prescribed medications and is also quite commonly seen in patients diagnosed to have GERD, so the cause could be any one of these two. I would not recommend a discontinuation of the prescription, but I do understand that the lightheadedness can result in discomfort and would thus advise you to revisit your prescribing doctor. As for the Ativan, if this was prescribed by your doctor and asked not to discontinue, then it would be best not to discontinue this medication without informed consent and approval of your doctor. But if your doctor has requested you to discontinue ativan as he/she has started you on amitriptyline, then it is best to discuss with your doctor the pros and cons of both medications and choose the one most suitable for you. I hope you find my response helpful. Please feel free to write back to me anytime, and regarding any clarifications you have. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (1 hour later)

so, lightheadedness might be only at the start of taking amitriptyline?

Answered by Dr. Shoaib Khan (3 minutes later)

Brief Answer: Not necessarily sir Detailed Answer: Hi sir. No sir, this is not necessarily true. Some individuals do experience the lightheadedness for a short duration only during the beginning of the course. Whereas others continue to experience it for as long as they have been on the drug. So, if at all you are uncomfortable with this side effect the first thing would be to confirm that the drug itself is causing this symptom, and request for a substitute or wait for a while to see if this side effect subsides with time. The decision is entirely yours to make sir. Hope this is only temporary and subsides soon, followed by nothing but good health. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shoaib Khan (7 hours later)

Thanks Dr. I think it is a little chance that it is amitriptyline, because I have had lightheadedness before I started amitriptyline. By the way, is this dosage of 10MG a minimum one? Could it be increased? I hope this works. But in the case that it won't, is there an alternative such as injections or so for my headache? Of course, I will have to talk to my Dr. first about any suggestion. Thanks

Answered by Dr. Shoaib Khan (6 hours later)

Brief Answer: GERD more likely; yes, minimum dose; yes there are Detailed Answer: Hi sir. I feel the cause is more likely to be the GERD, as stated earlier as well. I would recommend an evaluation by your doctor who diagnosed the same, I am sure they will be able to help. As for the amitriptyline dosage, yes this is the minimum dosage. The dosage usually ranges from 25 - 100 mg based on the patients individual requirement, but your dose will be altered and advised based on your requirements sir. As for the headache, yes there are injections to provide you relief from the headache. But then again, these are just for temporary relief. We need to find the cause and treat the condition, not the symptoms. I hope you understand, and I wish you recover at the earliest sir. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar