Migraine and mental health

Greetings, - This is such a good and important question. I don't believe we have any formal models to share regarding the coordination of services/records between neurologist/migraine specialist and psychiatrist outside of the general best practices that exist encouraging doctors to coordinate and collaborate when relevant in best interest of the patient. Sometimes, unfortunately, it falls to us, as the patients, to ensure this happens. For example, I am followed by my migraine specialist and my GP/OBGYN. There are natural overlaps in my care and some of my medications. Over the years, I've had to be clear about who is in charge of which part of my needs. Hormones, for instance, are a trigger for migraine- but my migraine specialist let me know that he prefers my GP/OB to handle scripts related to that part of my life. That doctor always requests an updated medical file from my migraine specialist to ensure that there are no conflicts related to the medications I'm being prescribed. As I said, some of this also falls on my shoulders to doublecheck that both doctors have updated records from each other. As my hormones shift over time and I enter into menopause, I've had to change my medications on this front- and ensure that each doctor is on board with the evolving approach- and how those changes fit into my overall treatment strategy.

As to your second question/point re: the potential psychoactive side effects of some migraine medications- this certainly can occur given that many medications prescribed for migraine were not created for migraine. SSRI's (designed for depression), and Topamax (a medication designed for seizures) are just a couple of many that were found to also be effective as migraine preventatives.

As someone who has had migraine for 45 years, having tried many medications for it, I might go so far as to say that most medications used for migraine come with side effects. And, unfortunately, when coupled together- interactions occur and more side effects and symptoms can emerge.

For these reasons and more- having a doctor you can trust is key. Someone who can take both the overarching and detailed view of your record - to closely evaluate these matters regularly and monitor them carefully.

To this end, we encourage people with migraine to be evaluated and treated by migraine specialists- doctors who receive specialized treatment in the complex neurological disease that is migraine. Do you have such a doctor? If you'd like a list of migraine specialists in your area we can send you some links.

I hope this helps somewhat. Do you have more than one doctor who are coordinating your care? Have you found ways to ensure that they are working together?

Thank you again for this important question. I hope it inspires a good discussion in our community. Warmly - Holly (team member)