Suggest treatment for headaches, significant weight loss and biliary colic

Posted on Sat, 24 Jan 2015 in Headache and Migraines
Question: I am recovering from Post Concussion Syndrome for the past 7 months. I have had significant cognitive problems (processing speed delays, working memory issues) and significant speech impacts including Aphasia (word finding) and Dysphagia (word forming, saying the wrong consonant sounds, repetition of the beginning of word sounds). This led to finally getting a referral to Speech therapy and Cognitive Rehab after my scores on showed no significant improvement in my attention, speed and memory had not improved in many months. Additionally, 3 separate people had written letters to my provider about serious concerns about my speech, my response time and my memory. All were able to articulate what my symptoms appeared to them to be like although the 3 people knew me in different areas of my life (my spouse, a colleague and a friend) and none of the individuals had ever spoken to each other). I have a Master's Degree, was highly articulate prior to my injury including being a public speaker and my memory and processing speed was above par prior to my injury to my right frontal lobe.

Two weeks ago, my symptoms suddenly made a drastic improvement. I have not yet started my therapies as my appointment is not until January 6th. I fought for this appointment for several months. The only thing that changed was 6 weeks ago, I was started on Nortyptiline 10mg. It was increased 2 weeks ago to 20 mg. This was originally added for help with my headaches. It was increased as it seemed to be effective with the headaches, but also was counteracting the side effects of the Topamax I am on, which included significant weight loss. At the same time, another doctor also started me on Neurontin at 300mg to deal with the tingling I was getting from the Topamax, but also to deal with biliary colic that I have had going on for sometime. My speech problem that was apparent to everyone around me is almost completely unnoticeable. My word finding issues are still there, but nowhere near to the point that they were. My cognitive issues also seem to be drastically improved. They align with the change in medication. Is this a coincidence, or could this be from the medication change?

I am concerned in that I fought very hard for this referral for Cognitive Rehab and Speech Therapy as my case is a Workman's Comp case. If I go to this appointment and my symptoms are not present, I may never get this referral again. If this is from the medication change and the improvement will stay, then I am not as concerned. If this is an anomaly and my symptoms may return suddenly, I am concerned. Could this be attributed to the increase in Nortyptiline and/or addition of Neurontin?

Thanks in advance for your help. I love this service. It's been amazingly helpful for someone like me with a complex medical history.
Answered by Dr. Eris Ranxha 1 hour later
Brief Answer:
Just improvement

Detailed Answer:
I am sorry for the symptoms you are suffering
I read your query and understand your concern
It is true that medication (nortriptiline and gapapentin) helps in your recovery but they have just helped in earlier recovery
You will be fine again even without treatment ( medication )
Neurontin and Topamax are needed due to your partial seizures and should be taken for a long time in correlation with your clinical status
Dear you should not be concerned about your appointment because even if you are better from your previously status, you still have cognitive impairment and those are easily detected by specialists
I would be more helpful to you about time of improvement if you provide me with your brain CT or MRI
In my opinion you will be better with passing of days and speech therapy will definitely help you in full recovery
Hope I had answer all your questions and clarified your doubts
Feel free to ask other questions or queries
Wish you all the best and fast recovery
Best regards
Dr Eris Ranxha

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Answered by
Dr. Eris Ranxha


Practicing since :2009

Answered : 686 Questions


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