Treatments

Botox
The patient is experiencing severe, chronic, and refractory migraine headaches more than 15 days per month and lasting more than four hours at a time, and the patient has failed or been unable to tolerate multiple other preventive and abortive medications for migraine headaches.  Consequently, the patient should undergo Botox injections using electromyography as soon as possible.
Risks, benefits, and alternatives to Botox were discussed in detail today.  Photographs were taken, and informed consent was obtained.  Botox injections using electromyography were performed on _____ for treatment of chronic and refractory migraine headache with a total of ____ units of Botox injected into the head, neck, and upper torso and with _____ units discarded.  The patient tolerated the procedure well, and post-procedure care was also discussed in detail.

Xeomin
The patient is experiencing severe, chronic, and refractory migraine headaches more than 15 days per month and lasting more than four hours at a time, and the patient has failed or been unable to tolerate multiple other preventive and abortive medications for migraine headaches.  Consequently, the patient should undergo Xeomin (or Botox) injections using electromyography as soon as possible.
Risks, benefits, and alternatives to Xeomin were discussed in detail today.  Photographs were taken, and informed consent was obtained.  Xeomin injections using electromyography were performed on _____ for treatment of chronic and refractory migraine headache with a total of ____ units of Xeomin injected into the head, neck, and upper torso and with _____ units discarded.  The patient tolerated the procedure well, and post-procedure care was also discussed in detail.

Topamax
Risks, benefits, and alternatives to Topamax (topiramate) were discussed in detail today.
We also discussed women’s issues and Topamax, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Topamax, and she understands the importance of adequate contraception.
The patient will begin Topamax at 25 mg each day, increasing Topamax in 25 mg increments, as needed and as tolerated, up to 200 mg p.o. b.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Lamictal
Risks, benefits, and alternatives to Lamictal (lamotrigine) were discussed in detail today.
We also discussed women’s issues and Lamictal, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Lamictal, and she understands the importance of adequate contraception.
The patient will begin Lamictal at 25 mg each day, increasing Lamictal in 25 mg increments according to the provided titration schedule, as needed and as tolerated, up to 200 mg p.o. b.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Keppra
Risks, benefits, and alternatives to Keppra (leviteracetam) were discussed in detail today.
We also discussed women’s issues and Keppra, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Keppra, and she understands the importance of adequate contraception.
The patient will begin Keppra and will continue increasing Keppra according to the written titration schedule, as needed and as tolerated, up to 1500 mg p.o. b.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Neurontin
Risks, benefits, and alternatives to Neurontin (gabapentin) were discussed in detail today.
We also discussed women’s issues and Neurontin, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Neurontin, and she understands the importance of adequate contraception.
The patient will begin Neurontin and will continue increasing Neurontin according to the written titration schedule, as needed and as tolerated, up to 1500 mg p.o. t.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Lyrica
Risks, benefits, and alternatives to Lyrica (pregabalin) were discussed in detail today.
We also discussed women’s issues and Lyrica, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Lyrica, and she understands the importance of adequate contraception.
The patient will begin Lyrica and will continue increasing Lyrica according to the written titration schedule, as needed and as tolerated, up to 100 mg p.o. t.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Depakote
Risks, benefits, and alternatives to Depakote (valproic acid) were discussed in detail today.
We also discussed women’s issues and Depakote, including risks of birth defects and potential for interaction with hormonal contraceptive medications.  The patient should take folate 2 mg each day while using Depakote, and she understands the importance of adequate contraception.
The patient will begin Depakote and will continue increasing Depakote according to the written titration schedule, as needed and as tolerated, up to 1000 mg p.o. b.i.d.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Elavil
Risks, benefits, and alternatives to Elavil (amitriptyline) were discussed in detail today.
We also discussed women’s issues and Elavil, including risks of birth defects.
The patient will begin Elavil 25 mg p.o. q.h.s. and will continue increasing Elavil in 25 mg increments according to the written titration schedule, as needed and as tolerated, up to 200 mg p.o. q.h.s.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Pamelor
Risks, benefits, and alternatives to Pamelor (nortriptyline) were discussed in detail today.
We also discussed women’s issues and Pamelor, including risks of birth defects.
The patient will begin Pamelor 25 mg p.o. q.h.s. and will continue increasing Pamelor in 25 mg increments according to the written titration schedule, as needed and as tolerated, up to 200 mg p.o. q.h.s.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.

Vivactil
Risks, benefits, and alternatives to Vivactil (protriptyline) were discussed in detail today.
We also discussed women’s issues and Vivactil, including risks of birth defects.
The patient will begin Vivactil 5 mg p.o. q.a.m. and will continue increasing Vivactil in 5 mg increments according to the written titration schedule, as needed and as tolerated, up to 15 mg p.o. q.a.m. and 15 mg q. 1200.  We discussed the importance of following the written titration schedule and contacting me if the patient experiences any side effects.