Dr Silver mention a top Headache specialist i think his name is dr Silberstein Its in the first couple of minutes into the recording
i was wondering who he is and how comes he hasnāt been mentioned before. Might be worth us doing some digging and getting some info about him and his views on migraines etc
This is literally a definition of meā¦ out take from his slides:
āDizziness or a sense of imbalance is extremely common: this most commonly manifests as āmigraine-related dizzinessā with a feeling of being light headed and spaced out and may be more likely in bright, hot, crowded or noisy places. Some people may feel panicky when this first starts but panic often disappears relatively early in the condition in most subjects. During this dizziness there may be a sense of unreality of self or surroundings and there may be accompanying blurred, spottyor dark vision and/or buzzy or reduced hearing. Some people experience true vertigo with a sensation of surroundings moving and this usually occurs during headache. There may be āvisual vertigoā whereby surrounding visual stimuli create a sense of imbalance or dizziness. Visual vertigo may be provoked by various stimuli including stripes, patterns or carpets, escalators or stairs, supermarket aisles, rotating ceiling fans, flickering televisions, road markings etc. Finally people may just go off balance when walking so that they veer to one sideā
Dr Silver sounds like an extremely capable guyā¦ is anyone a patient of his on these boards? if so what are his ideas about migraine dizziness, what does he go for med wise? and what does he say is the prognosis?
Richy, I saw Dr Silver in October 2012 for a first appt and he diagnosed me with with Migraine Vertigo after I asked my GP to refer me to him on the NHS having heard of him on this forum and also me being located not too far from Warrington where he consults.
He is obviously very knowledgeable about migraine and all its symptoms and he wrote a very thorough long letter to my GP summarising all the things he had asked me about my symptoms at the appt. However, I had to wait over 2 hours for my appt because he spends quite a long time with each patient. Also the appt tended to follow the format of him firing many many questions at me and expecting very concise or yes/no answers which was quite hard sometimes. I have no doubt he knew exactly what he was looking for to make a diagnosis but he did not give any opportunity for me to ask questions and he did not mention about the future/prognosis etc. There was no explanation about why or how migraine/vertigo works etc and no explanation of the reasons for picking the particular meds he was suggesting. He dictated my GP letter during the appt with me and that was my way of finding out what his suggested treatment was. I saw Dr Surenthiran privately about 6 weeks later and now I have transferred from Dr Silver to Dr S on the NHS. I just preferred Dr Sās approach and bedside manner and also his experience of dealing with dizzy people as opposed to headache sufferers.
I did do a full summary of my appt with Dr Silver on these pages back in October if you want to read it. I can tell you that his med recommendations for me were:
Keep on taking 20mg nori but donāt increase it more
Take 300mg per night Gabapentin to improve quality of sleep
Then also add a migraine preventative in this order:
I should also add that Dr Silver did schedule me a follow-up for 9 months after the appt (but I have now transferred to Dr S) and he did say in his letter that a migraine preventative med can be expected to take 3 to 4 months after reaching a therapeutic dose to begin to take effect at switching off migraine.
''Dr. Silverstein elected to reestablish a private practice in 2001, solely directed towards the care and treatment of patients suffering with headaches. This has been an area of interest for him since he established his first private practice in 1981 and strengthened by his personal experiences with similar afflictions.
Over 90% of all patients seen at The Westchester Headache Center are patients who were previously examined by other headache centers and headache physicians without a satisfactory resolution to their headache problem. Opened in 2003, The Westchester Headache Center is successful over 90% of the time in bringing those patients to a satisfactory resolution to their headache issues.
New York City headaches and migraines sufferers access Dr. Silversteinās unique expertise conveniently in Chappaqua New York.āā
Hillsta, are you asking if the 5 meds he prescribed are all beta blockers?
If so, then to confirm only Metoprolol is a beta blocker, the others are anti convulsants and Sibelium is a calcium antagonist.
I read the outline in the materials and there was reference to 15 brilliantly clear days per month. Who has those? Iād sign up for that program in a minute. If you donāt have those is Dr. Silver saying you donāt fit the diagnosis?
I think he is saying if you donāt have 15 crystal clear headache free days per month then you are classified as suffering from chronic migraine. I donāt think I have any!!
Dr Silver mention a top Headache specialist i think his name is Dr Silverstein. Its in the first couple of minutes into the recording
i was wondering who he is and how comes he hasnāt been mentioned before. Might be worth us doing some digging and getting some info about him and his views on migraines etc
ā End quote
Hello Hillsta. That docās name is spelled a bit differently than you wrote ā¦ Stephen Silberstein. Heās written a number of interesting articles and books such as this one in which he summarises findings about the effectiveness of migraine preventative meds.
Iām a newbie here although unfortunately not new to these symptoms. I was diagnosed by Dr Silver last week as having MAV and chronic migraine. I have had this for 5 years and was originally diagnosed with Labyrinthitis which I never really believed. I listened to the audio file on this website and then read all the articles I could find by Dr Silver. I felt, like others have said, that he was describing me exactly so I got a referral and now have a daignosis. My experience was a bit different from Jemās as I only had to wait about 20 minutes for my appointment and I was with Dr Silver for about 50 minutes so I guess patients after me had a longer wait. He did fire questions at me too, more questions than I have ever answered in any hospital appointment I have ever had. He does know exactly what he is looking for as indicators for migraine and yes it turns out I have had migraine symptoms all my life without knowing it. I took a list of questions and he answered them all fully and because I had already been doing his lifestyle changes we talked more about the medications I will be trying and his order of preference. My situation is a little different because I also suffer from chronic nerve pain and have recently changed from gabapentin to pregabalin to see if I can get more pain relief so I am currently titrating the pregabalin. Dr Silver said he would have used this as a 2nd or third line med for migraine but as I am on it already and tolerating it well then weāll start with pregabalin although he doesnāt feel it will help too much. Then I try propranolol, topiramate, epilim, flunarizine and zonisamide. He mentioned there are some others too beyond this but I didnāt recognise their names so canāt remember them. Dr Silver is a real expert in migraine and I feel very happy to be under his care.
Welcome to the Forum. Your in safe hands. I am under the care of Dr Sureinthran but if i was looking for a second opinion or wanted to change docs i would definitely see Dr Silver.
Did he give you any other tips or advice on lifestyle or diet etc?
Dr Silver is an hour away from me which is a factor in me choosing him. His lifestyle measures are:
No caffeine - can have up to 3 cups of decaff a day but using caution as they have trace amounts of caffeine. I have one decaff coffee at breakfast and that is all which is fine. No chocolate although Milky Bars are fine (I was very pleased about this) but no other brand of white chocolate is allowed.
No painkillers.
Eat regular meals, never skip a meal.
Drink 3 litres a day.
Regular sleep pattern. Aim for 8 hours a night. Go to bed at the same time and get up at the same time. No naps.
I have been doing all of these without issue. Most of these I was doing anyway, the caffeine removal has been the only change to me. I asked about the migraine diet that I know Dr S in Kent uses (whilst I am a newbie here for posting I have been lurking for a long time and spent the first few years on dizzytimes) but he is not a believer in the diet. I would struggle with the diet Dr S gives because I am vegetarian and if I eliminated all dairy products and eggs I would have to become a vegan and as I do all the cooking so would my partner.
I am about to go and stuff my face on milky bars!!
Itās strange how all the docs have different opinions regarding the diet. Dr Silver doesnāt really believe in the diet. Dr S has a different diet to DR Buchholz which I know a lot of other people follow!!
lol at the Milky Bars!! I now have a good stash in the kitchen cupboard.
Yes, they all have very different opinions on the diet. Dr Silver said there is no medical evidence for the diet whereas there is medical evidence on caffeine and painkillers aggravating or exacerbating migraine. He did say some people may not have a problem with caffeine but we canāt screen people to know who is and who isnāt affected. He would rather have a blanket āno caffeineā approach. It is better to overdo the lifestyle rather than having to medicate more heavily. Seems a sensible approach to me.
He didnāt say anything about exercise and I didnāt ask. I try to go for a walk each day and swim once a week.
Kath I am glad your GP referred you and you finally got your appt with Dr Silver! I am pleased you found it helpful and apart from the Gabapentin/Pregabalin which you were taking for the nerve problem, his med choices for you are just the same as mine were. I never asked Dr Silver about white chocolate at my appt but am so glad he said you can eat Milky Bars as I have recently been having lots of them and they have done me no harm. I asked my partner to buy me the Milkybar Cow Shed for Easter this year! Itās addictive!
So will you see how it goes with the Pregabalin for a few months before you considered trying another med? Are you still taking the amitriptyline?
Did he schedule a follow-up appt for you? x
