Brief Answer: Treatment guidelines have been given below Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. Firstly, I personally feel that there is no conclusive correlation between Migraine attacks and acidity. On the contrary, migraine is associated with vomiting in a significant number of patients. Further, the commonest causes of your chronic acidity problem are :- * DRUG-INDUCED STOMACH ULCERS AND ACIDITY :- Saridon is a XXXXXXX drug which not only causes increased acidity and worsen the symptoms, but also cause severe ulcers in the stomach, the food pipe and proximal part of the intestine, called duodenum. You have not mentioned the duration since you have been having migraine; the frequency of migraine attacks in a month and the approximate number of Saridon tablets taken during each migraine attack. Regular intake of Saridon will continue to cause acidity and ulcers' formation, despite anti-acid drugs. Hence, I will strongly recommend IMMEDIATE stoppage of Saridon. Most of the patients come to know that they are going to have a migraine attack. Therefore, Sumatriptan is an excellent drug to abort migraine attack, PROVIDED 100mg is taken AS SOON AS YOU HAVE A FEELING that migraine is about to begin. This drug does NOT cause increased acidity or ulcer formation in the stomach. Further, a long-term course (6-12 months) of prophylactic treatment (combination of anti-depressants, anti-anxiety drugs and beta-blockers) of migraine will cure the condition. ** H.PYLORI INFECTION OF THE STOMACH AND INTESTINE :- H.pylori is a bacteria, the infection of which is responsible for chronic- occasionally severe- acidity in nearly 65-90% of the patients. A significant number of patients also complain of occasional diarrhea attacks with abdominal discomfort, nauses, burps, bloating etc.. In long-standing cases, a 3-weeks’ course of anti-H.pylori, followed by Proton Pump Inhibitors (such as, Omeprazole, Pantoprazole, Rabeprazole) for 3-6 months will give permanent cure of acidity problem. As the incidence of worm s in the intestine is very high in India, monthly deworming course(such as Albendazole 400mg daily for 3 consecutive days every month) should be taken regularly. *** ZOLLINGER ELLISON SYNDROME :- In view of the history of acidity problem since childhood, there is a strong possibility of you suffering from this condition. It is usually familial. To apprise you of this condition, Zollinger-Ellison syndrome is a complex condition in which one or more tumors form in your pancreas or the upper part of your small intestine (duodenum). These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid, in turn, leads to ulcers in stomach and duodenum. The only treatment for this condition is to locate these tumors and remove them surgically; along with regular Proton Pump Inhibitors which are very effective in controlling high secretion of acid. Hence, in view of the above, the scientific and rational course of action should be :- 1. STOP Saridon and other pain-killers (that is, NSAIDs) to reduce acid formation significantly. 2. Take Sumatriptan 100mg as and when you are about to have migraine attack. This drug is MUCH MORE EFFECTIVE THAN SARIDON AND WITH MINIMAL SIDE EFFECTS. Simultaneously, start prophylactic treatment for chronic migraine, as advised above. Your doctor will prescribe the advised drugs in appropriate doses. This will take care of your migraine problem permanently! 3. Consult your doctor and discuss my expert opinion/recommendation with him. I am sure he will agree with me and thereby prescribe anti-H.pylori course for 3 weeks. You will yourself be surprised to see the response on completion of this course. On completion of this course, start with Proton Pump Inhibitors, to be taken regularly for at least 3-6 months for permanent cure. Also, monthly deworming course should be taken regularly. THERE IS NO REQUIREMENT FOR ITS DIAGNOSIS, as it would be a waste of money, efforts and time, apart from the inconvenience caused. 4. Also discuss with your doctor about the strong possibility of Zollinger Ellison Sndrom. He will certainly agree with me and order CT scan, Blood Gastrin levels, endoscopy. He will then prescribe appropriate treatment on the basis of these tests’ reports. 5. Lastly, take spice-free food; 5-6 meals in small quantities daily (between breakfast, lunch and dinner and, at bedtime. Finally, I CAN CONFIDENTALLY ASSURE YOU THAT YOUR PROBLEMS WILL BE CURED, PROVIDED YOU FOLLOW MY ADVICE. HAVE FAITH IN ME!! Hope you find my response helpful, informative and enlightening. I will be happy to address to your further clarifications, if any. Fond regards, Dr. Rakesh Karanwal

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Brief Answer: SUMATRIPTAN is the SAFEST drug Detailed Answer: Dear Mr. XXXXX, Nice hearing from you. Firstly, the commonest causes of Migraine attacks are constant worries, mental stress, personal problems, anxiety, depression and emotional upsets. Treating the root cause is the BEST treatment. Please start the following treatment IMMEDIATELY (strictly regularly) :- 1. Tab Serta 50mg daily at bedtime x 15 days; thereafter, take it TWICE daily. 2. Tab Inderal (40mg) 1/2 tablet thrice daily X 15 days; thereafter, increase the dose to one tablet THRICE daily. 3. Tab Alprax 0.25mg thrice daily. Continue this treatment for 6-12 months. You may feel a bit drowsy for the first few days, which will disappear subsequently.You can always send a Direct query to me whenever required. Further, for chronic acidity, Take HP Kit- 1/2 kit TWICE daily for 2 weeks; thereafter, start with Pantocid-D one tablet TWICE daily for 3-6 months. Your acidity will be cured! Dolopar is OK, but Migril- if taken very frequently- can even precipitate heart attacks in susceptible patients. Please take SUMATRIPTAN (SUMANIT) as and when required, preferably with a CUP OF REALLY STRONG coffee. This is the safest of all drugs. if Suminat is taken exactly as advised, you may not even need Dolopar. Feel free to contact me on XXXXXXX Forum anytime. Donn't lose hope! YOU WILL BE COMPLETELY OK within 6 months and your personal, social and official life will revert back to its original state. Fond regards, Dr. Rakesh Karanwal

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