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New Neurologist or Different Treatment Plan

This is my first post, so please forgive me if this question has been asked in the past. I just need some advice, as I am not getting any answers from my current Neurologist and I find it to be very frustrating.
I've had chronic migraines since I was 15. I am now 38, and this is the first time I have ever enlisted the help of a specialist for my Migraine pain. I suffered through it for 23 years, until I just couldn't take it any more. This neurologist started me out on 25 mg. Topamax once a day, and 10 mg. Maxalt. In the past, I have had a very strong reaction to Imitrex, so I was instantly afraid to try another Triptan. Sure enough, the Maxalt sent me into a 7 day long Migraine attack that even a visit to the ER couldn't remedy.
So I went in to my neurologist to try a different abortive medication, and to talk about prescribing a medication for the break-through pain when the abortives don't work. He increased my Topamax, even though it has caused a great deal of anxiety. He tried to talk me into using another Triptan, which I declined due to past history with this class of drugs. Then he told me that he cannot prescribe anything for the pain except another NSAID, and that he does not prescribe narcotics... EVER. So, Tramadol and Fioricet are completely off the table. Oh, and when I asked him if my chronic neck pain could be associated with my daily headaches, his answer was "probably", and then he walked off.
I came in to see a neurologist because I wanted to get my Migraines and the pain associated with them under control. I have seen this neurologist three times, and my pain is worse, my migraines are not controlled, and he won't prescribe the medications that are necessary to break the cycle of pain. I feel like I am spinning my wheels for nothing.
Are there other treatment options out there that are non-narcotic, not a triptan, and not an NSAID that I can talk to him about? Or is this how all neurologists treat chronic migraines? Is it normal for a Neurologist not to prescribe pain medication for break-through pain?

  1. Hi Jessicx,
    Thank you for your question and welcome to the discussion forum - we're so glad you're here!

    Let me first say a few things about neurologists. They may be fine doctors but have a hard time being experts in one area because they treat so many different conditions such as multiple sclerosis, epilepsy, stroke, Parkinson's and others. Migraine/headache disorders specialists are just that, experts in ONE disorder, migraine and headache. These expert doctors also have extra board certification in headache medicine which is different than being certified in neurology. So my long winded point here is to seek out the help of a true migraine/headache expert. The thing is even though neurologists may say they are 'headache experts' that really may not be the case. Let me share with you information on how these doctors are different and how to find one; and

    There are many other treatment options available, in fact over 100 different medications are available to treat migraine. Something to keep in mind is that it can take up to 90 days before we see a reduction in our migraine frequency and severity when we start new medications. Also during this time potential side effects may lessen. Sometimes I think doctor forget to mention this to us. I know may times I've started a new medication and expected it to work right away, however it just doesn't work like that.

    Breakthrough pain seems to be more difficult to treat, but a necessary component of a migraine management plan. I have a narcotic in my tool box for breakthrough pain to be used when my abortives don't work. Opiates, or narcotics are not recommended to treat migraine pain as they simply mask the pain, they don't stop attacks. When a cycle of pain is long lasting sometimes a steroid dose pack is used or IV infusions. I had an IV infusion Friday to break a nasty migraine cycle. The infusion was saline, magnesium sulfate, pain medication and something for nausea. Here is more information on rescue medications;

    Triptans, or abortives are designed to stop the migraine process. I can't use triptans but do use Midrin equivalents that contain isometheptene mucate, dichloralphenazone, and acetaminophen. Other abotive options include Migranal Nasal Spray and D.H.E. 45. Take a look at this article for more information on abortives;

    I hope this helps,

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