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Does Loestrin Help Cure Aura Migraines?
Question: I have a new doctor. I am a 39-yr old female. I do not need birth control, but she prescribed Loestrin, yesterday, as a form of migraine treatment, even when I described having aura migraines (severe light sensitivity and change in vision). The Loestrin website states not to prescribe it to patients with aura migraines. I don't know if I should take it. Why would I put myself at risk? Do you think I should call her office and tell her I would like something else? I have hesitation now about whether she even listens or knows what she is doing. She also ignored my interest in having allergy testing. Do I need a referral for that? I do not know what to ask for or how to have my concerns met. I have never sought medical treatment for anything before. I am new to this.
Brief Answer:
The doctor is not using best judgement in that decision
Detailed Answer:
Good afternoon.
Your hesitancy to avoid taking a drug such as Loestrin for a condition for which it is clearly NOT indicated and even contraindicated is entirely justifiable. If I were in your position I would ask for a referral to see a headache specialist and definitely AVOID the prescription of Loestrin or anything else that sounds off base to treat migraine headaches UNLESS there is compelling evidence that your headaches are being triggered by something treatable such as a hypo or even hyperthyroid condition. Or if there were clear cut evidence that a sinus or dental infection were the source of your headaches so that something like antibiotics or similar would really be the best treatment for migraines as opposed to ANTI-MIGRAINE medication.
Those would be about the only situations I can think of where prescribing something completely unexpected would be reasonable in order to treat a headache otherwise, no......use the right medication for the right diagnosis and let common sense whisper in your ear if necessary! LOL....so, kudos to you!
I could recite a number of precise medical reasons why the judgment of the doctor is flawed but as you already put it....it's simply contraindicated by the FDA to use in YOUR type of headache and potentially places you at risk for other complications without any real chance of success or benefit.
Loestrin is not a headache drug and in fact, is one of the types of drugs I also LOOK FOR in my Headache Clinic practice as being potentially precipitating or causative of headaches in women.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult required 32 minutes total time of research, response preparation, and envoy.
Many thanks for using this service to ask your questions. Be well.
The doctor is not using best judgement in that decision
Detailed Answer:
Good afternoon.
Your hesitancy to avoid taking a drug such as Loestrin for a condition for which it is clearly NOT indicated and even contraindicated is entirely justifiable. If I were in your position I would ask for a referral to see a headache specialist and definitely AVOID the prescription of Loestrin or anything else that sounds off base to treat migraine headaches UNLESS there is compelling evidence that your headaches are being triggered by something treatable such as a hypo or even hyperthyroid condition. Or if there were clear cut evidence that a sinus or dental infection were the source of your headaches so that something like antibiotics or similar would really be the best treatment for migraines as opposed to ANTI-MIGRAINE medication.
Those would be about the only situations I can think of where prescribing something completely unexpected would be reasonable in order to treat a headache otherwise, no......use the right medication for the right diagnosis and let common sense whisper in your ear if necessary! LOL....so, kudos to you!
I could recite a number of precise medical reasons why the judgment of the doctor is flawed but as you already put it....it's simply contraindicated by the FDA to use in YOUR type of headache and potentially places you at risk for other complications without any real chance of success or benefit.
Loestrin is not a headache drug and in fact, is one of the types of drugs I also LOOK FOR in my Headache Clinic practice as being potentially precipitating or causative of headaches in women.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult required 32 minutes total time of research, response preparation, and envoy.
Many thanks for using this service to ask your questions. Be well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I really appreciate your candid and quick response! It is refreshing to hear that my worries are legitimate and that I should not start taking Loestrin, which was prescribed for me to "treat migraines." The Doctor who prescribed it is obviously a PCP/Family Doctor, not a neurologist. And she only spent about 10 minutes with me. When she heard that my migraines start before menses, she had the bright idea that increasing my estrogen may somehow have an influence on decreasing them, without even looking at any studies to back up her theory. By the way, my thyroid is fine! I even had a stress test and a CT scan that also came back fine. No one has even tested my hormone levels. So I will definitely start looking for another PCP now, and I will ask them to give me a referral to a headache specialist, like you recommended. My next question is about Imitrex. That was also prescribed for me as well. But with aura migraines, when do I take the Imitrex?
Brief Answer:
You are most welcome
Detailed Answer:
I am not in the habit of calling into question other colleagues judgment calls since treating headaches is as much Art as it is Science, however, even when exercising such expressive liberties one must still take basic tenets into consideration and estrogen containing medications in a person with aura is not the best choice to make. Kudos for being astute and interested enough to do a little detective work and seek another opinion. I can only hope that such a treatment regimen has gotten out to very many other less suspecting folks who may be placing themselves at risk by taking that advice.
As far as timing of triptans and migraine headaches (with or without aura) there have been some very elegant studies done looking at the optimum time these medications should be taken. The most common party line on taking ANY headache medicine has always been....."Take your medicine AS SOON AS YOU FEEL the first sign of problem..." And for the most part and for most medication types...that advice still holds. For triptans, however, there is a slight tweak to that long held and time honored belief such that the 1st dose of any triptan is best taken 20-30 min. AFTER first symptoms of aura...or HEADACHE itself (if no aura exist) initiate. A 2nd dose of that medication SHOULD BE TAKEN at 60-90 minutes AFTER the 1st dose IF there are residuals or left over symptoms from either the headache pain or the aura itself. In other words, the goal is to AGGRESSIVELY and FULLY QUASH the headache and its symptoms. That means.....we are looking for the medication to take the migraine episode from an 8 or 9/10 (as an example) down to a ZERO/10 in 2 hrs. or less. The time frame is important because it represents the agreed upon bright line of how long any medicine is allowed to take to quell or QUASH a headache in order for it to be considered A SUCCESS! So, if a medicine is taken and the headache takes 3 or 4 hours to completely subside....we do not call that medication a success....we look for something else or we look for something to add in order to bring the time frame down to complete relief to 2 hrs. or less. One also needs to abide as strictly as possible to the recommendation for triptan which states.... NO MORE THAN 2 doses within a 24 hr. period and no more than 4 doses within a SEVEN CALENDAR DAY period. That applies to tablets, injections, sprays, wafers, and patches. More frequent dosing than the recommendations allow can lead to MEDICATION OVERUSE HEADACHES and those are bad...very bad.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding this or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
I wish I knew where you were from if in the U.S. I'd invite you (if you weren't too far away) to the lovely city on the North Shores of Lake XXXXXXX (Cleveland, Ohio) for comprehensive and attentive headache treatment and education! And with Spring destined to show up one of these days....many other things about XXXXXXX could potentially interest you such as our baseball, basketball, and football teams! Then, there is the Rock 'n Roll Hall of fame coupled with some of the largest and most replete museums in the world and of course, The Republican National Convention this summer....you should see the mess that everything is right now downtown! LOL!!
Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive just to know down the road what's been discovered.
This consult required 61 minutes total time of research, response preparation, and envoy.
Many thanks for using this service to ask your questions. Be well.
You are most welcome
Detailed Answer:
I am not in the habit of calling into question other colleagues judgment calls since treating headaches is as much Art as it is Science, however, even when exercising such expressive liberties one must still take basic tenets into consideration and estrogen containing medications in a person with aura is not the best choice to make. Kudos for being astute and interested enough to do a little detective work and seek another opinion. I can only hope that such a treatment regimen has gotten out to very many other less suspecting folks who may be placing themselves at risk by taking that advice.
As far as timing of triptans and migraine headaches (with or without aura) there have been some very elegant studies done looking at the optimum time these medications should be taken. The most common party line on taking ANY headache medicine has always been....."Take your medicine AS SOON AS YOU FEEL the first sign of problem..." And for the most part and for most medication types...that advice still holds. For triptans, however, there is a slight tweak to that long held and time honored belief such that the 1st dose of any triptan is best taken 20-30 min. AFTER first symptoms of aura...or HEADACHE itself (if no aura exist) initiate. A 2nd dose of that medication SHOULD BE TAKEN at 60-90 minutes AFTER the 1st dose IF there are residuals or left over symptoms from either the headache pain or the aura itself. In other words, the goal is to AGGRESSIVELY and FULLY QUASH the headache and its symptoms. That means.....we are looking for the medication to take the migraine episode from an 8 or 9/10 (as an example) down to a ZERO/10 in 2 hrs. or less. The time frame is important because it represents the agreed upon bright line of how long any medicine is allowed to take to quell or QUASH a headache in order for it to be considered A SUCCESS! So, if a medicine is taken and the headache takes 3 or 4 hours to completely subside....we do not call that medication a success....we look for something else or we look for something to add in order to bring the time frame down to complete relief to 2 hrs. or less. One also needs to abide as strictly as possible to the recommendation for triptan which states.... NO MORE THAN 2 doses within a 24 hr. period and no more than 4 doses within a SEVEN CALENDAR DAY period. That applies to tablets, injections, sprays, wafers, and patches. More frequent dosing than the recommendations allow can lead to MEDICATION OVERUSE HEADACHES and those are bad...very bad.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding this or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
I wish I knew where you were from if in the U.S. I'd invite you (if you weren't too far away) to the lovely city on the North Shores of Lake XXXXXXX (Cleveland, Ohio) for comprehensive and attentive headache treatment and education! And with Spring destined to show up one of these days....many other things about XXXXXXX could potentially interest you such as our baseball, basketball, and football teams! Then, there is the Rock 'n Roll Hall of fame coupled with some of the largest and most replete museums in the world and of course, The Republican National Convention this summer....you should see the mess that everything is right now downtown! LOL!!
Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive just to know down the road what's been discovered.
This consult required 61 minutes total time of research, response preparation, and envoy.
Many thanks for using this service to ask your questions. Be well.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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