HELP, HELP (MEB) Neurology Notes for MEB

usafvet

PEB Forum Regular Member
Can someone help with explaining the notes from doctor for MEB. Also, where does this fit into rating scale..:confused:
Thanks to all
USAFVET 25 yrs active duty
Neurology Notes for MEB
HPI: Patient is a pleasant 43 year male with a 5 year history of chronic daily headaches he states began during his deployment to Iraq in 2004. Over the last 18 months or so, he has also developed migraine headaches occurring 1-2x per week, accompanied by photophobia but not nausea. He endorses an aura of photopsias prior to the development of a migraine headache. They are alleviated with lying in a dark room. Headaches are holocephalic. He sees a pain management physician who already placed him on topamax 25 mg per day and Imitrex prn about a month ago. The Imitrex helps his acute headaches slightly, but does not bring his pain down to baseline levels. He denies any focal neurological symptoms.

Patients follow up. Now on Topamax 75 or 100mg nighly (pt take 100 mg when his headaches are bad) his chronic daily headaches are no longer “daily”, but 2-3 times per week. His migraine frequency has not changed. He has had an interim open MRI brain that did not describe any secondary headache cause per the report. He was recently diagnosed with depression and placed on Celexa earlier this month. The Maxalt I prescribed for him as an abortive has been ineffective
Assessment/plan
Chronic daily headaches, improved, frequency is approximately 40-50% where it was at prior to prophylactic therapy.
Migraine headache: Not improved on initial trial of prophylactic therapy, but complicated by variable compliance (pt is not on a steady dose of Topamax, but varies it against medical advice). Given that he was recently diagnosed with depression and placed on an SSRI, I think that increasing the dose of Topamax is the best choice rather than adding a B-blocker (contra-indicated in depression ) or a TCA (relatively contraindicated with SSRI). Have advised patient to increase Topamax to 125mg daily 2 tabs AM, 3 tabs PM X 2 weeks then 150 mg 3 tabs AM and 3 tabs PM with follow up in 6 weeks. The increase of this medication may also help his chronic daily headaches. Also, I have advised him to change his headache abortive therapy from Maxalt (it’s ineffective) to start Zoming MLT 5 mg, take at headache onset
Signed\\ Chief, Neurology
 

xeno

Super Moderator
Staff Member
PEB Forum Veteran
It documents frequency and pain scale. The rest is a consult. The only thing I see missing (that maybe a problem) is how long your migraines last, when you do get them.
 

usafvet

PEB Forum Regular Member
Jason,
Can you give feedback? The notes below are for /about my headaches. The board requested more information from the first narrative. I don’t agree with his notes because I was being seen by another doctor off base before going back to the military doctor. Also, appointments are hard to get and I have had other medical problems to deal with also.
Please read both and give feedback, I feel like I’m getting screwed …
I spoke today by telephone with XXX regarding his continuing headaches, and addressed the questions per his Dec 9 Informal physical evaluation board request for more information. Currently, XXX experiences 2-3 headaches per week, a decrease by 50%, since he began using Topamax 100 mg, twice per day. The headaches are rated as an 8/10 on a 1-10 pain scale, last 6-8hrs, and usually require him to lie down in a quiet room for relief (they are prostrating). It should be noted that he been seen for this problem of total of two times in my clinic, and has not made an appointment to see me or called me regarding his headaches since August 2009. Also, he was sent to neurology for the purpose of evaluating this issue for MEB purposes without any significant attempt at prophylactic treatment of his headaches. This is how his headaches stand as of this writing, improvement with additional therapeutic agents may be possible.
1. Can someone help with explaining the notes from doctor for MEB? Also, where does this fit into rating scale.
Thanks to all
USAFVET 25 yrs active duty
Neurology Notes for MEB
HPI: Patient is a pleasant 43 year male with a 5 year history of chronic daily headaches he states began during his deployment to Iraq in 2004. Over the last 18 months or so, he has also developed migraine headaches occurring 1-2x per week, accompanied by photophobia but not nausea. He endorses an aura of photopsias prior to the development of a migraine headache. They are alleviated with lying in a dark room. Headaches are holocephalic. He sees a pain management physician who already placed him on topamax 25 mg per day and Imitrex prn about a month ago. The Imitrex helps his acute headaches slightly, but does not bring his pain down to baseline levels. He denies any focal neurological symptoms.

Patients follow up. Now on Topamax 75 or 100mg nighly (pt take 100 mg when his headaches are bad) his chronic daily headaches are no longer “daily”, but 2-3 times per week. His migraine frequency has not changed. He has had an interim open MRI brain that did not describe any secondary headache cause per the report. He was recently diagnosed with depression and placed on Celexa earlier this month. The Maxalt I prescribed for him as an abortive has been ineffective
Assessment/plan
Chronic daily headaches, improved, frequency is approximately 40-50% where it was at prior to prophylactic therapy.
Migraine headache: Not improved on initial trial of prophylactic therapy, but complicated by variable compliance (pt is not on a steady dose of Topamax, but varies it against medical advice). Given that he was recently diagnosed with depression and placed on an SSRI, I think that increasing the dose of Topamax is the best choice rather than adding a B-blocker (contra-indicated in depression ) or a TCA (relatively contraindicated with SSRI). Have advised patient to increase Topamax to 125mg daily 2 tabs AM, 3 tabs PM X 2 weeks then 150 mg 3 tabs AM and 3 tabs PM with follow up in 6 weeks. The increase of this medication may also help his chronic daily headaches. Also, I have advised him to change his headache abortive therapy from Maxalt (it’s ineffective) to start Zoming MLT 5 mg, take at headache onset
Signed\\ Chief, Neurology
 
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