PRHC Closed from June 20th – June 30th

This is the week for the annual scientific meeting for the American and International Headache Societies.  I’ve had the opportunity to attend these invaluable meetings for most of the past thirty years. It is where cutting edge research in headache causes and treatments are presented.

While I had this week blocked off for the meeting, this year will, unfortunately, be different.  I have a family emergency that I must attend.  My 93 year old mother in Tennessee needs my help to care for her.  She lives in a rural area without Internet access and limited cell phone reception.

What This Means for Our Patients

During this ten day span, it will very difficult to reach us and I regret the inconvenience. Because I cannot run the clinic without Kaaren’s help, she has kindly agreed to take her annual vacation during my absence so no one will be in the clinic to answer phones during this time.

New Appointments or Appointment Changes

If you need to schedule an appointment or change an appointment you can either leave a voice mail or send an e-mail to I suggest the e-mail route if possible because in previous long absences our voice mail has filled up or sometimes is it hard to hear the message clearly.  Please send your full name, date of birth and a phone number where we can reach you.


If you need a refill, please have your pharmacy send an electronic request.  While I’m taking care of my mother, if I can get away and drive to a nearby city where there is Internet access, I might be able to address these requests sporadically.

We have noticed that 80% of the refill requests that come in, come from patients who have missed their follow up appointments.  I try to always give a patient enough medication refills until their next appointment.  So if you have missed an appointment, please schedule one and we will take care of refills in that context.

A Headache Crisis

It will be hard to reach me in Tennessee. If you did, I would not be able to access to your records without the Internet.  Therefore it will virtually impossible to provide quality advise or treat you from that distance. This is the limitation of a small, mostly one provider practice. Dr. Moren works on Fridays but does not take call and he will not be reachable by patients.  I suggest that if you need help that you go to the resources you used before your met us. This would include your PCP, urgent care centers or Emergency Departments.

Side Effects

If you have an allergic reaction to a medication, that medication must be stopped immediately. If you think you are experiencing side effects, discuss it with your pharmacist. The simple solution to side effects is to stop the offending medication until we can talk.  The only medications, which we prescribe, that needs caution with stopping are:

1) Beta blockers. Don’t stop them abruptly if your are taking high doses, such as Nadolol > 80 MG per day, or Propranolol > 180 MG per day. The reason is, you can have nuisance palpitations during the withdrawal.

2) Anti-seizure drugs in a seizure patient. If we are prescribing an anti-seizure drug (topiramate, zonisamide, pregabalin (Lyrica) or Depakote) AND if you have had a history of seizures, taper off of the medication slowly.  If you have never had seizures, you can just stop them.

3) SSRI Drugs.  Anti depressants in the Prozac family can be hard to stop if you have been on them for at least several weeks.  The longer you have been on them, it seems the harder they are to stop.  I suggest that you cut the dose in half until you can talk to us.

Please be Patient Upon Our Return

I will be back in the office on June 30th.  As usual, I will come in very early to work on phone calls. However, please be mindful that we have schedules full of important patients. We typically work through lunch and take no breaks to accommodate the demand and to help as many patients as possible and have no spare time during the day to take calls. After these long absences, we have had as many as 70-80 phone messages waiting for a response. Since each phone call takes approximately 30 minutes to manage (including charting), it can take several early mornings and evenings to work through them all and we work through them in the order they came in.  But please remember that all of our patients are very important to us and we are working as hard as possible to help as many as we can get and stay well.

J. Michael Jones, MPAS-C