When you’re first experiencing migraine, it can be difficult to know where to get help. This is particularly true if you’re not yet sure what you’re experiencing (i.e. don’t yet have a diagnosis). The following list contains information about the different types of medical providers who may be able to help you diagnosis, treat, and/or manage your migraine symptoms.
If you’re living with chronic migraine, a headache specialist is likely your best bet for medical care. Headache specialists are more knowledgeable than other doctors about migraine disease, its causes, and the most current methods for treating it. They also tend to work exclusively with migraineurs and patients with other headache disorders and therefore may be more open to the emotional and physical realities of day-to-day life with chronic pain. However, there is a shortage of migraine and other headache specialists in the United States, which means you may have to look elsewhere for care. (For help finding a migraine specialist in your area, click here.)
If a headache specialist isn’t available in your area, a neurologist may be the next best bet for migraine-specific treatment. Neurologists specifically treat the brain and central nervous system, and therefore generally have more information about migraine disease than primary care doctors. (However, because they treat all of the brain, they often don’t have as much information about migraine as a migraine specialist would.) Neurologists also tend to have more information about and access to preventative and abortive treatments than primary care doctors. However, not all neurologists know enough about migraine to be much help. Finding one who can really help you might take research and time.
Some migraineurs swear by their chiropractors, saying the spinal adjustments do wonders in reducing their migraine pain and frequency. Others, however, have tried visiting a chiropractor with no luck and/or report increased symptoms. In short, chiropractors may be able to help some migraineurs ease their pain, but it isn’t for everyone. For more on whether it might be right for you, read Should You See a Chiropractor for Migraine?
If you’re seeing a busy migraine specialist or neurologist, you may be surprised how little you actually see him or her. After your first few appointments (or whenever the doctor thinks he/she has a pretty good handle on your case) you will likely start seeing the physician’s assistant for most of your appointments. A PA practices medicine under the direct supervision of a licensed physician. The exact nature of a PA’s duties and responsibilities will vary according to each doctor’s practice and each state laws, but most examine, diagnosis, and treat patients, including prescribing medications and ordering and interpreting lab results. (I, for example, almost never see my neurologist anymore. The office almost exclusively schedules my appointments with the PA.) Generally – though not always – this means that if your neurologist or migraine specialist has a PA on staff, you’ll be able to get appointments faster.
In some states, a nurse practitioner functions identically to a Physician’s Assistant (see above). In others, an NP can work on his/her own, without the direct supervision of a licensed physician. Regardless, an NP with a neurology or headache specialty will be able to treat and manage your migraine symptoms.
Psychologists do not specifically manage migraines, and they cannot prescribe medications. However, they can help you manage the many mental health comorbidities (like depression and anxiety) that often exist alongside migraine. Some even specialize in treating patients with chronic illnesses and/or chronic pain. (Visit the APA’s website for help finding one.) Talk therapy and/or cognitive behavioral therapy can greatly increase quality of life for those of us living with chronic migraine.
A psychiatrist is like a psychologist in that he/she specializes in mental disorders. However, a psychiatrist, unlike a psychologist, can prescribe medication. If you are one of the many migraineurs who also suffer from a mental disorder like depression, anxiety, or bipolar disorder, a psychiatrist can help you manage those illnesses with medication.
Internal Medicine Physician
Many internal medicine physicians practice as adult primary care doctors. Most migraineurs end up seeing their primary care doctors about their migraines first, and are then referred to a neurologist or migraine specialist for diagnosis. Some internal medicine physicians also are headache and/or migraine specialists. If you want to know if yours is, just ask.
Most women consider their obgyns to be their primary care doctors. As such, many obgyns will prescribe you some migraine-specific medications, but most prescribe only a few types (whatever they feel most comfortable with) and only after you have a diagnosis from a neurologist or headache specialist. For this reason, you may want to consider finding a true migraine doctor to handle your treatment. If you are pregnant, however, your neurologist or headache specialist may elect to turn your migraine treatment over to your obgyn until you deliver. (This is what mine did.) This is because your obgyn is more familiar with each drug’s affects on a developing fetus, and your migraine doctor may not want to carry any risk of harm to the baby. Generally, once you deliver, your migraine treatment will revert back to your migraine doctor.
Surgery, such as nerve decompression surgery, is a treatment option for some migraineurs. A migraine surgeon can perform these surgeries. For tips on finding a good surgeon, read Finding the Right Migraine Surgeon.
Some migraineurs experience vision changes during, before, and/or after a migraine attack. These might include blurred vision, tunnel vision, double vision, photosensitivity, and/or visual hallucinations. An ophthalmologist doesn’t treat migraines, but he/she can evaluate you to make sure you don’t have an underlying eye condition causing or contributing to your symptoms. Annual eye exams also can help reduce migraine attacks by ensuring you have the proper tools to reduce eye strain, which can be a trigger for some migraineurs.
An otolaryngologist specializes in the ear, nose, and throat. Like the ophthalmologist, an otolaryngologist does not directly treat migraine. However, many migraineurs suffer from sinus complaints, tinnitus, dizziness, and vertigo. An otolaryngologist can evaluate you to make sure you don’t have an inner ear or sinus problem that is causing and/or contributing to your symptoms.
There is evidence that migraines and allergies are linked in some people, and many migrainuers report fewer migraine symptoms when they have better control over their allergies. An allergist can help you learn which substances and foods you find problematic, which can give you more ideas for managing your migraines. (For example, if you have a lot of food allergies, you could try eliminating them from your diet and see if that helps minimize your migraine attacks.) An allergist also can help you treat and manage your allergies.
Pain management specialist
A pain management specialist may help manage pain levels for chronic or intractable migraineurs. This is particularly true if you are using controlled prescriptions for rescue treatment, such as narcotic pain relievers and/or some benzodiazepines (e.g. Klonopin). If you do go to a pain management specialist, you will likely have to sign a form promising to only obtain the controlled substances from your pain management doctor and not any other doctor, including your neurologist or headache specialist. You will also likely have to keep frequent appointments.
Some migraineurs have migraines that are triggered or aggravated by dental problems, such as teeth clenching and/or grinding. Dentists and dental devices can help alleviate these problems, thus reducing migraine pain and frequency. Beware, however, of dentists claiming complete migraine relief.
If you’ve been seeing a doctor for migraine and you’re not sure if you should check out one of the other types of providers described above, read Teri Robert’s piece Is It Time to Try a New Migraine Doctor?