Appointment with Cherchi/Hain... some Q's answered

HI all,
I had another follow up appointment with Dr. Hain today. He was actually running over an hour behind schedule so I saw his partner Dr. Cherchi. This was my first time seeing him and I was pleasantly surprised. I did however note some subtle differences between the two doctors and thought I would share them. As well as the synopsis from my appt.

Since I mentioned I was having one or two “better” days a week we decided to continue my current cycle of meds until October 1st (50 mg of amitriptyline and 50 mg of topamax). If it hasn’t gotten any better by October we will increase the ami. Until I either see results or daytime sedation is reached.

Hain seems more aggressive in the dosage of medication; Cherchi seems a little more conservative (slower/smaller increases).
They both recommended different meds as my next trial should my current one fail. Hain–Effexor Cherchi–Propranolol or Verapamil. I thought that was really interesting.

Questions that I asked:

Q:How long should it take to see results from the “migraine diet”?
A: Usually results are seen in about a month. Typically they are more readily visible in people who experience migraines at intervals. He said that those of us who are constantly dizzy have a harder time b/c you can’t really tell what is impacting the dizziness.

Q: Why does my dizziness get worse as the week progresses and I then have multiple bad days in a row?
A: Build up of fatigue could be possible. When at work you expend more energy. Over the course of the week this builds up.

Q: Why do I have delayed dizziness when pushing myself/shopping etc. (in the day/s after)?
A: I don’t have a good answer for that.

Q:Why do I feel best when I am in a moving car? Is this typical?
A Have you had your thyroid checked? (no) Sometimes when people have a thyroid problem it can present as dizziness that does get better in the car.------ I had a blood test across the street at the hospital and will be informed of the results in 2 weeks.

Q: I have noticed my mental processing speed is slower and I am much more forgetful. Is this from the illness or the medication?
A: Im really not sure; it is hard to say… it could be from either or both.

That is all I can remember for now!!


Hi Sarah,
Thanks so much for sharing your appointment with us. In a way, it was really great that you had a follow up with a different physician. I really hope you get better on this regimen, but it’s at least nice to know you have options.

I always found it so interesting with Dr. Hain that his first two drugs that he tries are Topamax and Effexor. These are two drugs that are very difficult to tolerate for many and have more side effects than most of the other drugs used for MAV. Not to say that they don’t work, but I think a lot of docs feel that before trying a drug like topamax, there are others to try first.

Keep us posted on your progress. I wish you the best.

Hey Sarah,

I think the differences you noted between these two doctors, even within the same Practice, just reinforces that there is no ONE expert on this condition (or any other condition for that matter). Hence the sense in getting second, if not third opinions as well as doing as much research yourself (ourselves) as possible.

Patients are different, have different symptoms and different treatments work (or not). If there were a magic bullet we’d all take it!

It is confusing to get varying or even conflicting advice from different specialists but in fairness I don’t think any of them claim to be all knowing gurus. I’m going to wax a little pop culture here and reference the “wisdom of crowds”. Basically, no single person can ever know everything about a topic, even if they are an expert in their field. Collective wisdom is what you need.

So, in short, I think it’s probably a good thing you saw Cherchi rather than Hain - fresh perspective and all that.


Hi Sarah,

Thanks for the review of your appt. I’m constantly surprised at how they try to interpret “not feeling dizzy in a car” as though it is diagnostic for something. It’s a good question but I think it is ultimately meaningless in providing any sort of information as to the cause of the dizziness. Some feel better sitting in a car not doing the driving (like me), some worse (Emma) some better actually driving (Molly and Emma) or worse (me). I think it’s totally random.

I really hope this new guidance does the trick for you. Molly always speaks very highly of Dr Cherchi.

Scott 8)

Hi Sarah, thank you for the information. I agree with what others are saying…there really is no one expert on this dreaded disease! Good luck with the increased meds and the blood tests. Ben


Just wanted to say that I saw a fantastic neurologist a while back. I told him that my cognitive abilities slow down when I am in a relapse/having a migraine episode. He was totally unfazed by this - had clearly seen it before - and told me that migraine slows the brain.

For me it’s a definite symptom of this condition. In fact almost the worst symptom. At its most extreme I can feel like I am almost in a dream state my brain is so slow and I am so out of it. I had a brief attack the other day brought on by a big trigger. I set off to go to the local mini supermarket totally out of it mentally. I was so slwo of thought that I managed to walk past the nearest tiny supermarket that I go to all the time. I then entered the very large supermarket further down the road, and wandered around it thinking wow, i don’t remember this supermarket (the small one I was intending to go to) being so big. My brain was so slow I actually didn’t realise I was in the wrong place, even though one is tiny and the other is huge.

Anyway, just wanted to reassure you you’re not alone and at least one very good (in fact world renowned neurologist) recognises it as a migraine symptom.


Hi Hannah,

I get the slowed cognition as well. While it doesn’t actually make me feel physically sick, like all the other symptoms do, it is really frustrating. It’s like trying to wade through a mental swamp, wearing a heavy dressing gown, on a foggy day, with a bad hangover. Each thought takes a huge effort.