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Most of us begin treatment our Migraines with our family doctors, which is the logical thing to do. They know us, our medical history, and our needs best. Unfortunately, many of our family doctors quickly run out of ideas for treating us. Their training in treating Migraine and other headache disorders is limited, and with all the various illnesses they treat, it’s difficult for them to stay current in every specialized field. If their attempts at devising a successful treatment plan for you don’t meet with success in a reasonable period of time, a referral to a specialist is in order. Your doctor may suggest this before you do. If not, don’t hesitate to ask for a referral to a neurologist or a Migraine specialist. This brings me to an interesting point: Neurologists aren’t necessarily Migraine specialists, and Migraine specialists aren’t necessarily neurologists. Seeing a neurologist is a reasonable step, but many of us find that a time comes when we need to find a true Migraine specialist.
Changing doctors or adding a new doctor to our team can be a difficult decision. There can be some emotional attachments that make it difficult too. Here are some points to remember:
- No doctor, regardless of how good they are, is the right doctor for everyone.
- We can’t let the fact that we like a doctor tie us to him or her if he or she isn’t able to help us.
- Good and caring doctors understand when patients want a second opinion.
When is it time to add a specialist or change doctors?
When our doctor doesn’t like to answer questions.
Some doctors don’t like to answer questions, and they don’t want their patients looking for information on the Internet. Too bad. Dr. William B. Young, of the Jefferson Headache Center in Philadelphia, once said to me, “An educated patient is a better patient. I’d far rather have a treatment partner than a dish rag.” He went on to comment that Migraineurs need to learn about their Migraines, partly because we have to make our own treatment decisions when we have a Migraine. We can’t call our doctor every time we have a Migraine, so we need to decide when to take our medications, and sometimes, which medication to take. We can’t do that if we aren’t educated about our Migraines. As for information on the Internet, yes, there are some sites with bad information. How to determine which sites are accurate is a topic for another time. For now, suffice it to say that there are excellent sites too.
When our doctors aren’t up-to-date or what they say is inaccurate.
Some doctors haven’t learned anything new about Migraines since medical school. Others have learned some, but aren’t keeping up with research and information in the field. If that applies to our doctor, it’s time for a change. Here are a few examples:
- Doctors who say that Migraines are “vascular headaches.” This theory has been disproven repeatedly. Changes in the blood vessels of the brain may or may not occur, and when they do, they occur after other events.
- Doctors who don’t know about the various medications used for Migraine prevention. There are now over 100 in use.
- Doctors who are still prescribing pain medications for when we get a Migraine rather than looking at the Migraine abortive medications such as the triptans (Imitrex, Maxalt, Zomig, etc.) and the ergotamines (Migranal Nasal Spray and D.H.E. 45 subcutaneous injections.
When the doctor offers no plan for getting help after hours, on weekends, and during holidays and their vacations.
No, we can’t expect our doctors to be available to us every hour of every day. We can, however, reasonably expect them to have a plan in place for times when we need help outside of regular office hours.
When we don’t make progress in our Migraine management after a reasonable time.
Obviously, it’s not realistic to expect any doctor to hand us an effective Migraine management and treatment plan immediately. This takes time and patience. If, after a length of time, we’re not making progress, it may be that the doctor we’re seeing isn’t the right one for us, and it’s time to move on. How long we work with a doctor before changing varies from one case to another.
When the doctor’s staff is a problem.
Many people have told me of instances where office staff members have been rude or dismissive, didn’t relay messages to the doctors, or were problematic in other ways. If this happens, we need to find a way to let the doctor know there’s a problem. Until they investigate, doctors will usually hesitate to say much about their staff members, but if the problem continues, and it’s hindering our care, there’s often not much choice but to change doctors.
Wrapping It Up:
The selection of doctors is one of the most important aspects of our health care. We literally put our lives in doctors’ hands. If you’re having trouble bringing yourself to change doctors, remember that.
We need to do a bit of homework when choosing a new doctor for our Migraines. There are doctors who call themselves Migraine specialists when, in fact, they know no more about Migraine disease and its treatment than the “average doctor.” One of the best ways to choose a doctor is to choose one who comes recommended by his or her patients. There are several well known Migraine and headache clinics, but it’s better to choose a specific doctor rather than choosing a clinic or facility. It is, after all, the doctor who works with us to manage our Migraines. It’s the doctor who really makes the difference.
Always remember these points:
- The person with the most at stake gets to be in charge. When it comes to our health, the person with the most at stake isn’t the doctor. It’s us.
- Optimal health care can be achieved only when patients are educated about their health and patients and physicians work together as treatment partners in an atmosphere of mutual respect.
If you find the decision to find a new doctor difficult, remember the two points above. If you know it’s time for a change, but you need a bit of a “pep talk,” leave a reply below, please.
It can take time and patience, but we no longer have to just live with difficult Migraines that rob us of our health and quality of life.
If you need help finding a Migraine specialist, take a look at my listing of Patient Recommended Migraine and Headache Specialists.
Live well,
© Teri Robert, 2010
Last updated December 11, 2010
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"I had my first migraine when I was 12. I thought I was going blind, the spots in my vision all grouped together and everything went black. The pain was intense and felt like my head would crack open above my right eye." 
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I was referred to the pain clinic at UC Davis for trigger point injections/occipital nerve blocks AFTER the UC Davis Headache Clinic said they weren’t taking new patients! When I met with the medical director at the UC Davis Pain Clinic, he belittled me and said “if you’ve had this pain for so long, you should be used to it by now” and every time I referred to my pain – he corrected me by saying, “you mean, your headache” as if it was a minor issue. He was the worst, most non-compassionate doctor I’ve ever been to. PLEASE search for a good dr so you never have to experience what I went through. What a sad and pathetic excuse for a pain dr.
[...] If you haven’t asked your doctor those questions, write them down so you can ask them at your next appointment. Your doctor should be willing to help you set up a plan for what to do under various circumstances. If he or she isn’t, it’s time for a new doctor. [...]
Hi Taz,
It sounds like you’re having a tough time. Hang in there though, okay? It can take quite a lot of looking before you find a doctor who is the best fit for you. That “good fit” will make all the difference though. Not all doctors are the same, nor are all patients. This can be a discouraging journey at first, but one that is well worth it
Playing Devil’s Advocate: a good thing to remember too, is that doctors are people, just like you and I are people, and this means they have good days and bad days. We sure hope that the good days far outnumber the bad days, but sometimes it takes more than one visit to get a really accurate feel if this is the doctor that can help you. Listening though is key…
My last headache specialist was much more interested in my other neurological issues, almost ignoring the intractable Migraine I was there to see him for that first visit. In the end it turned out that he was one of the most helpful doctors for my personal situation. If I’d had a choice that first day I saw him, I wouldn’t have returned – actually I didn’t at first because I was so discouraged. There were no other qualified doctors for hours around me so I had no choice but to go back. I was nearly in tears because I really felt that I was in the wrong place… but that second visit was a completely different story, and made all the difference to me. It doesn’t always work out this way, but it’s good to remember that sometimes it does.
That said, I know how hard it is to spend so much time and money looking for the right doctor, and being disappointed by poorly run offices and appointments that don’t seem to get anywhere. It sounds like Teri might be a really good person to talk to about this as she is much closer. Like her, I send many wishes that you are able to find better treatment in the new year, and hope that you will keep in touch with us here to share your experiences as your journey progresses. You never know who else you may be helping along the way…
Ellen
Hi, Taz!
I’m sorry you’re having such a rough time. The right doctor is so very important, as you already know. This is exactly why I think it’s better to choose a specific doctor rather than choosing a clinic. It’s the doctor, that person, who really makes the difference.
I don’t know where you live in Pennsylvania. Depending on where you live, Long Island may be closer than some of the specialists I know in Pennsylvania. Still, there are quite a few in Philadelphia and a couple in Pittsburgh. If you want to check them out, you can find their contact information on http://www.helpforheadaches.com/doctors/migraine-headache-specialists-pennsylvania.htm.
Will you please keep me posted on what’s going on and how you’re doing? I truly hope that 2011 brings you closer to better Migraine management.
Happy New Year!
Teri
geez its almost as if that message was meant for me I switched from my doctor in ny I live in pa A very well noted dr opened a office 20 mins from here so it was easier for me than the trip to long island. I wasn’t too crazy about him form the start I get daily migraines since going to him my pain level hasnt changed and Im on no prevetatives and only on an abortive that doesnt hep for only 2 days a week. When I went in nov he said come back in jan when I went to check out they said they didnt have his january sched someone would call me. Almost 4 weeks later i call and was told he was booked couldnt be seen till march that would be 4 months later.. The girl in scheduling wouldnt even let me talk to the office. i sent them email they change appointment to jan 19th. but I just think I will go back to long island to my other doc this is not the first time they did this to me. I tried so hard to make this work this doctor seems more interested in my dr in ny then what he can do to help me. They say he is an excellent doctor and was at the mayo clinic. I just dont see it. I feel like a number and not a patient plus he doesnt remeber what i told him last visit where my prev doc remembered something from a few years ago.So you post really stood out to me.