Need Migraine Specialist / Pain Medication

[Bouffant]

Hi-

I live and work in Indonesia and come to Bangkok for medical care.

I have been going to Bumrungrad for several years for all my medical needs but I am running into a problem there. I can't get pain medication!

In the US -where I was born- it is standard (and humane!) to give the patient with severe migraine problems three types of medication: one is preventative to try to stop you from having the migraines. One is abortive- that stops a migraine headache that has started and does not involve pain killers. One is a "rescue" medicine - a pain killer- for when the first two fail.

After several years of seeing neurologists at Bumrungrad, when I finally complained about the lack of painkillers being prescribed to me, it turns out they just have a hospital-wide policy about giving anymore than a ridiculously tiny amount of pain medicine, regardless of the patient as an individual. (Hopefully that policy is different for those dyng of cancer, but that isn't my problem at present.)

I am not somone "looking for a good time" trying to get recreational drugs or an addict, nor am I irresponsible nor someone who has not used painkilers responsibly in the past. I have GOT to find a doctor, preferably a migraine specialist but I dont care- i can continue to get the other meds from another doctor (although I haven't found one who was very much help to me yet). I need a doctor who does believe that painkillers are a valid part of a migraine treatment plan and who is willing to prescribe them!

I would very, very much appreciate any ideas or recommendations! I really need help here.

Thank you!

Katherine

[Sheryl]

This (the pain med thing) is a chronic problem in Thailand. Thai doctors are very, very reluctant to prescribe narcotics on an outpatient basis. In the case of foreigners, sterotypes about drug-seeking (which unfortunately are true in some cases, making it hard for the rest of us) may further increase a doctor's reluctance. Also it has been my observation that Thais are extremely sensitive to all types of depressant drugs and thus achieve both pain relief and sedation at much lower drug dosages than do other nationalities (even some Asians), and when foreigners complain of lack of pain relief and ask for higher dosages -- legitimately -- it is often not believed because the drug or dose given would have worked for a Thai. Plus of course it is harder for a any doctor to assess the likelihood of drug abuse in a foreign patient than it is in someone from their own culture, often leading to unnecessary suspicion.

Some suggested specialists are listed below but I don't know how they will respond on this specific point. If you have a medical summary from your doctor back home which describes what has already been tried and the recommended treatment, that would be helpful.

If you have not already, make note of any possible link between the migraines and your menstrual cycle and if there is one consider using progesterone (bio-identiocal progesterone, not a progestin), can be extremely effective both as a preventive and averting an attack if taken early on. In Thailand, there are 2 over-the-counter progesterone preparations: Utrogestan (oral micronized form) and Cyclogest 400 (suppository form, can be admistered vaginally or rectally). No prescription required but may take some effort to find. Last time I bought Utrogestan it was in the large pharmacy on Sukkhumvit around Soi 2 (opposite the entrance to the tollway and about 1 block either east or west, forget which). I haven't tried to buy the Cyclogest. It may be more useful for use early in an actual attack though since it is suppository form.

Suggested Doctors:

Prof. Anan Srikiathachorn BNH Hospital Wednesdays 5-6 PM only. he is an Assoc Professor at Chulalonghorn (leading medical school) and heads up their headache clinic. has published extensively on migraine in international peer reviewed journals.

Assoc. Prof Nijasri Charnnarong Suwanwela Modays & Fridays Bumrungrad 4- 6 PM Same affiliation as Dr Anan above

Assoc. Prof. Dr. Kongkiat Kulkantrakorn Bangkok Hospital Sunday 08:00 - 12:00 (1,2,3rd Sunday of each month), Monday 16:30 - 18:00

Wednesday 16:30 - 18:00 Thursday 16:30 - 18:00 Saturday 08:00 - 14:00

He is a US trained neurologist specializing in pain management. Not as speciifically focused on migraine as the two listed above but has published on it some, and very specialized in pain management.