You might benefit from seeing a *team* of doctors.
If you have mild or infrequent migraines, you might be able to manage them on your own with an occasional ibuprofen. However, if migraines start to take over your life, you might need help. When this occurs, you might be stuck wondering, which doctors treat migraines, anyway?
How Your Primary Care Physician Can Help
“[If] over-the-counter medication [is] not working for you, that tells you that you've sort of reached the limit, so of course the next step has to be to go to your physician,” says Kaveh Alizadeh, MD, plastic surgeon and headache specialist at Westchester Medical Center.
It’s the job of your primary care physician (such as an internist or family care physician) to rule out other causes of unmanageable headaches. They may assess your other overall health concerns and vital signs, such as high blood pressure.
“Once you've gone through that step, they're likely to put you in the first regimen of medications that will help with your headaches,” says Dr. Alizadeh. This may include acute migraine medications such as triptans or ergots. Learn more about how to talk to your doctor about migraine treatment here.
How a Neurologist Can Help
“If you increasingly notice that you're becoming a victim to your headache—you're constantly … avoiding scenarios, avoiding things that you love to do because of your headaches—I think it's important to seek the next level of treatment,” says Dr. Alizadeh. “That next level of treatment is a neurologist with a special interest in headaches.”
A neurologist is a physician who treats disorders of the central nervous system (the brain, spinal cord, and nerves). Neurologists may specialize in a wide array of conditions—from strokes to multiple sclerosis—so it’s beneficial to find one who specializes in headaches and migraines.
The advantage of seeing a neurologist for frequent or severe migraines is that they can help fine-tune your treatment regimen. They may prescribe an alternative acute treatment, or they may suggest preventative treatments for migraines.
How an Interdisciplinary Team Can Help
Beyond a primary care physician and a neurologist, there are actually several fields of medicine that may specialize in migraines. These alternative perspectives may be extremely beneficial for difficult-to-treat migraines.
“If you've been under the care of a neurologist for six months or longer and you're still not seeing any change, I think it's time to go to the next level,” says Dr. Alizadeh. “That next level is for you to go to an academic center where they have an interdisciplinary team of doctors that have come together to manage the most extreme cases of migraines.”
An interdisciplinary team of doctors to treat migraines might include:
- An internist or other primary care physician
- A neurologist who specializes in migraines
- A pain specialist, such as an anesthesiologist or someone who focuses on headache medicine
- A surgeon, such as a plastic surgeon and/or a neurosurgeon
- A psychiatrist and/or a psychologist
“Hopefully, the consensus of that group will be able to provide a pathway for you,” says Dr. Alizadeh. Learn more here about how to tell if your migraine treatment is working.
Dr. Alizadeh is a board-certified plastic surgeon and the chief of plastic and reconstructive surgery at Westchester Medical Center and New York Medical College.
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Now, everyone thinks that migraines really belong
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to one category of headaches,
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where in fact there's many different ideologies,
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and what's important as a physician
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and as a healthcare provider is for us to be able to drill down
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on the specific cause that is really
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the impetus for these headaches.
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Now, if you're starting to have problems
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and you're going and taking over-the-counter medication
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and it's not working for you,
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that tells you that you've sort of reached the limit,
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so of course the next step has to be
to go to your physician.
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The most important thing for your general practitioner
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is to rule out a number of things
that could cause headaches.
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So we want to make sure that if you're having a headache,
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for example, that you don't have high blood pressure.
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Once you've gone through that step,
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they're likely to put you in the first regimen of medications
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that will help with your headaches,
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but if you increasingly notice that you're becoming a victim
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to your headache,
you're constantly making decisions,
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avoiding things that you love to do
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because of your headaches, I think it's important
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to seek the next level of treatment,
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and that next level of treatment is a neurologist
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with a special interest in headaches.
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These group of neurologists can give you
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a lot more wider array of options.
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Well, if you've been under the care of a neurologist
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for six months or longer
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and you're still not seeing any change,
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I think it's time to go to the next level.
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That next level is for you to actually go
to an academic center
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where they have an interdisciplinary team of doctors
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that have come together
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to manage the most extreme cases of migraines.
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Usually it's composed of
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a neurologist with an interest in headaches,
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a pain specialist, and they tend to be anesthesiologists
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or are focusing on headache medicine.
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You need a surgeon who's also interested in this,
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and that surgeon could either be a plastic surgeon
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because we're interested in peripheral nerves,
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or a neurosurgeon, or it could be both,
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and their job is to actually block the nerves,
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so they may actually find triggers,
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they may find areas in your body where the nerves
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can be numbed and help your pain go away,
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and in addition, you also want to have a psychiatrist
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or a psychologist
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to make sure that there's no psychiatric
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or psychological overlay components
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that could be aggravating your symptoms,
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and hopefully, the consensus of that group
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will be able to provide a pathway for you
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to get to see the light without having pain from the light.