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What Kind Of Doctor For Migraines

What Is The Treatment For Migraine With Vertigo

What different types of headaches are there?

Because the diagnostic criteria for vestibular migraine was released fairly recently, theres a lack of information from placebo-controlled trials on how to best treat it, says Mueller.

According to resources on the website of the American Headache Society, there is limited evidence to support the use of triptans to treat dizziness in vestibular migraine. The acute therapies that are typically most effective for vestibular migraine episodes consist of vestibular suppressants and antiemetics .

In some cases, triptans may be effective when used in conjunction with vestibular suppressants or antiemetics if you have used triptans for acute migraine treatment in the past and if your headaches are frequently accompanied by vestibular symptoms.

If a person is experiencing frequent vestibular migraine attacks, the same kinds of preventive medications used for other types of migraine may reduce the number or severity of attacks, says Mueller.

According to Johns Hopkins Medicine, the preventive medications that may be prescribed for vestibular migraine include the following:

Can Migraines Be Prevented

Preventive migraine treatments can be helpful for patients with frequent, severe headaches. The main goal for preventive strategies is to reduce the overall frequency and severity of the headaches. Avoiding known triggers may be helpful. Many people find that regular exercise makes them feel better, although strong evidence is lacking to recommend this as a highly effective migraine treatment. Other strategies may include improving sleep habits or learning to cope more effectively with stress, for example by learning relaxation techniques such as biofeedback or meditation.

Numerous medications also can be used as a preventive treatment for migraine. It is often helpful to start with a low dose of medication and increase it slowly in order to find the best balance between benefits and side effects. Some commonly used medications include amitriptyline, propranolol, and topiramate. Valproic acid and lisinopril are less commonly used. For some patients with chronic migraine, botulinum injections can help reduce headaches. Some vitamins, minerals and herbal preparations are also used to help prevent migraines.

Three Signs You May Need To See A Neurologist For Your Headaches

Headaches are common but some are much more serious than others. How do you know when yours warrants a trip to a neurologist?

The following signs indicate your headaches may be caused by a neurological issue, says Dr. Greg McLauchlin, assistant professor in the Department of Neurology at Baylor College of Medicine.

You take headache medication often

If you get frequent headaches, its tempting to take medication for them regularly. However, McLauchlin says this could be a sign of a more serious condition.

It is important to realize that some over-the-counter medicines can actually make headaches worse if they are taken too frequently, said McLauchlin. Also, over-the-counter medicines can do damage to the stomach, kidneys and liver if taken in excess.

He suggests that anyone who takes over-the-counter medicine to alleviate headaches five or more days out of the month should go see a doctor.

Headaches disrupt daily activities

A visit with your primary care physician is a good place to start for headaches that are not disabling but more of a nuisance. However, immobilizing headaches may warrant a trip to a neurologist.

Patients should see a neurologist for any headache that is disabling, McLauchlin said. This applies to you if you have to stop what you are doing and lie down during a headache.

Additional symptoms

Additional Resources

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Diagnostic Tests For Migraine

Relying on over-the-counter pain medication to treat chronic migraines can lead to overuse of these medications, which, over time, can make migraines worse and unresponsive to treatment, even when the medications are used as directed. Doctors at NYU Langone can help to ensure you are not experiencing headaches or migraines as a result of medication overuse.

To determine if migraines are causing your pain, neurologists at NYU Langone ask about your symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. Your doctor also asks about your medical history and performs a physical exam to obtain a complete picture of your health.

A careful review of your symptoms can help your doctor to determine the type of migraine youre experiencing and if an underlying condition could be the cause.

Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis.

Why Your Mental Health Matters With Migraine And Headaches

What Kind Of Doctor For Migraine

Missed days at work. So fatigued youre in bed all day. Blinded by the dimmest of lights. Is it any wonder that those battling chronic headaches also experience a blow to their mental health?

About 20% of people who experience migraine on 14 days or fewer each month may have depression and/or anxiety, according to the American Migraine Foundation. For people who experience migraine more days a month , depression and/or anxiety is even higher between 30% and 50% for anxiety.12 The same inherited brain chemistry that causes migraine may also be involved in anxiety and depression. Depression increases headaches, and headaches increase depression, so they both must be treated.

For some, depression and anxiety may appear months or years after living with the often-debilitating pain of migraine and headaches. It is not uncommon for migraineurs to say they spend several days a month in bed because of their migraine or headache attacks. For others, depression and anxiety, just like migraine, may run in the family.12

If you find yourself lying in bed day after day, even after your migraine or headache passes, you may be experiencing a residual mental health issue. Talk to your doctor or headache clinic about a referral to a psychologist for talk therapy and home-based strategies.

PPM recently held a video chat House Call on migraine and mental health. Check it out to get some common questions answered as well as a few self-help tips.

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The Impact Of Vestibular Migraine

Vestibular migraine affects up to 3% of the adult population and affects up to 5 times more women than men. Most patients have a personal history of migraine headache and/or motion sickness, as well as a family history of migraine or similar episodic vertigo or dizziness.

Dr. Beh describes his typical patient with vestibular migraine as a woman in her late 30s or 40s with a history of migraine and motion sickness. While migraine may improve with age, vestibular symptoms often increase. These symptoms can affect a patients daily life, including their ability to drive, work and travel.

There isnt a cure for vestibular migraine. But with the help of an experienced headache specialist, many patients learn to manage their triggers. That can help them live a normal life.

The Doctor That You Partner With For Migraine Can Have A Major Impact On Your Progress So Choose Wisely

Migraine is a complex disease with a wide range of symptoms, and management plans are often as complex as the disease itself. Unfortunately, most general practitioners do not keep up with the latest research for Migraine, sometimes because they simply don’t have enough time or, perhaps, interest.

In an ideal world, every person with Migraine would have access to a trained, certified specialist who is engaged and up-to-date on the disease. But there is only 1 headache specialist for every 90,000 people with Migraine.

Specialists often have large caseloads of patients and long waiting lists to see them. An attentive GP or neurologist can be just as valuable if they are curious about Migraine.

Undergraduate medical training includes just 4 hours of headache and Migraine training. This abysmal stat is useful to be aware of when choosing what kind of doctor you want to work with to move your Migraine plan forward.

Most people with Migraine benefit from a detailed care plan to help avoid attacks and keep them out of the emergency room. The doctor that you choose for Migraine should not only be informed but also prepared to work with you as a partner to create this plan.

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How Can I Find A Good Headache Specialist

Ask a trusted physician or any friends with migraines to refer you to a headache specialist, preferably one who is a member of the American Association for the Study of Headache . Alternatively, some excellent web sites for migraine patients can recommend a headache doctor in your area. Here are a few:

National Headache Institute Can Help

Best Headache Migraine Doctor Sarasota Fl Neurologist

Dr. Payman Sadeghi, an experienced and highly educated neurologist, founded National Headache Institute. He recognized there was no cohesive, evidence-backed protocol for diagnosing and treating chronic headache pain for either headache or migraine patients.

Over the last several years, Dr. Sadeghi has assembled a team of the foremost headache care leaders. From three locations nationwide, National Headache Institute is the paragon of care for anyone who wants to experience headache relief.

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Cgrp Monoclonal Antibodies For Vestibular Migraine

People with VM were excluded from the trials of anti-CGRP Migraine treatments so not much is known about their efficacy as a Vestibular Migraine treatment, yet Dr. David Dodick remains “cautiously optimistic” about them for the future.

For Dr. Shin Beh, some initial success is being seen among dizzy patients. He says, “I’m finding that the CGRP monoclonal antibodies are helping Vestibular Migraine patients. I have a handful of patients on them at the moment. With more people using them, I’m sure we will draw a much clearer picture. For the Migraine rescue oral CGRP small-molecule blockers , I am waiting to hear back from the patients on their efficacy. They are still pretty new to the market, and I suspect insurance companies are still figuring out how to deal with them.”

What Symptoms Must You Have To Be Diagnosed With A Migraine

Migraine with aura . This is a headache, plus:

  • Visual symptoms or vision loss.
  • Sensory symptoms .

Migraine without aura . A common migraine is a headache and:

  • The attacks included pain on one side of your head.
  • Youve had at least five attacks, each lasting between four and 72 hours.

Plus, youve experienced at least one of the following:

  • Nausea and/or vomiting.
  • Lights bother you and/or you avoid light.
  • Sounds bother you and/or you avoid sounds.

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What Are The Types Of Migraines

Migraine without aura The most common type of migraine is one without an aura. Most migraines have no warning sign that they are about to happen. Symptoms can include a pulsing or throbbing pain. With common migraines, the pain can be made worse by physical movement, nausea or vomiting.

Migraine with aura The aura before a migraine can last 10 to 30 minutes. It can signal serious pain is ahead.

Migraine without head painThis kind of migraine is also known as a silent migraine. This kind of migraine can create an aura, visual disturbances and nausea.

Hemiplegic migraineWith this kind of migraine, you can have weakness on one side of the body with visual aura symptoms. Some people have a feeling of √Ępins and needles√Ę or even a loss of feeling on one side of the body.

Retinal migraineThis kind of migraine can affect vision. It can also cause short-term loss of sight in one eye.

Long-term migraineThis type of migraine varies in severity, and each one can be different. This kind of migraine can last more than 15 days.

Ice pick headacheThis type of migraine feels just like the name sounds, as if you are getting stabbed in the head with an ice pick.

Cluster headacheWith this type of migraine, you can have a burning pain around and above the eyes, temples or the back of head. You can also have red or swollen eyes.

Cervicogenic headacheWith this type of migraine, you have pain in your head that is caused by pain in the neck. It can be caused by a wound or sore on the spine.

Allergy Or Sinus Headache

What Kind of Doctor Treats Headaches?

Headaches sometimes happen as a result of an allergic reaction. The pain from these headaches is often focused in your sinus area and in the front of your head.

Migraine headaches are commonly misdiagnosed as sinus headaches. In fact, up to 90 percent of sinus headaches are actually migraine, according to the American Migraine Foundation. People who have chronic seasonal allergies or sinusitis are susceptible to these kinds of headaches.

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What To Tell Your Doctor About Your Headaches

According to the headache expert Peter Goadsby, MD, PhD, a professor of neurology at the UCLA Goldberg Migraine Program in Los Angeles, a valuable tool in diagnosis is your headache history.

A thorough history, aided by your detailed notes, can pinpoint causes, triggers, and even potential solutions. Make careful notes about your headache experiences before you go to the doctor. Include the following:

  • When the headaches occur
  • What, if anything, makes them feel better or go away
  • Whether sound, light, or noise bother you during headaches
  • Whether there are any changes in your vision before or during headaches, such as blurriness, black spots, or flashes of light
  • How well you slept the night before your headache
  • If you are a woman, when your headaches occur in relation to your menstrual cycle
  • Any unusual weather at the time of your headaches
  • Food or drink that you have consumed in the 24 hours before the headache
  • Activities you were engaging in when the headache began or just prior to it
  • Previous headache diagnoses and treatments youve tried

Dr. Goadsby recommends using a monthly calendar so that the pattern of headache days is clearly visible to you and your doctor.

If you are having severe or disabling headaches, dont wait a full month to call for an appointment make notes about what you recall or are experiencing and see a doctor as soon as you can.

Referral To A Specialist

A GP may decide to refer you to a neurologist, a specialist in conditions affecting the brain and nervous system, for further assessment and treatment if:

  • a diagnosis is unclear
  • you experience migraines on 15 days or more a month
  • treatment is not helping to control your symptoms

Page last reviewed: 10 May 2019 Next review due: 10 May 2022

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What Are Treatment Options And Ways To Lessen The Impact Of Symptoms

If you are affected by vestibular migraine, its important to notice your triggers. In other words, know what experiences or situations seem to come before an attack. Most of them are very similar to migraineweather changes, not enough sleep, stress, menstrual cycle, bright light, flashing lights, missing meals, food-type triggers like caffeine, chocolate or alcohol, says Dr. Beh. Your triggers can be very unique and sometimes difficult to pinpoint, so it is important to keep track of them.

Consider what happens before, during and after a migraine attack. How do you feel? Is there something in particular that seems to come along with your migraine symptoms? Keeping a headache journal is a good way to identify patternsand to share this information with your doctor. Note specific examples of all your symptoms, such as dizzy spells or visual disturbances. Tracking your symptoms, noting possible triggers and discussing treatment options with a doctor can help prevent and relieve vestibular migraine attacks.

Symptoms Of Ocular Migraines

Tests That Determine Cause of Headaches

Q: I have had ocular migraines for many years. I have the classic jagged strobe effect. No big deal usually.

But last year I had a weird and different thing happen that still worries me. All of a sudden my eyes crossed and stuck that way. My fingertips went sort of numb, and the side of my tongue and bottom lip went numb. When I tried to explain this to the nurse, I sounded like a stroke victim.

I saw a neurologist, and he felt it was just a more intense type of ocular migraine. Have you ever heard of this? The MRI showed nothing significant. S.

A: By definition, this would not be a classic ophthalmic migraine, because the symptoms are outside of what is seen. Therefore, I personally would not classify it as a “more intense type of ophthalmic migraine.” These symptoms could be associated with some of the more common non-ophthalmic migraine phenomena. Dr. Slonim

Q: My husband began having symptoms of something very strange. We looked online and found your site. It turns out he was having an ocular migraine.

Your explanation and even better the visual little flash movie explained exactly what he was having and put our minds at ease. We were both thinking brain tumor or aneurysm . So thank you for putting together such an amazingly informative website.

In reviewing your log, you or your doctor may find a consistent pattern of triggers related to your episodes. Avoiding these triggers might help reduce the frequency of your episodes. Dr. Slonim

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What Causes Ocular Migraines

Q: I’m very concerned. This is my third attack of ocular migraine. The first time it ever happened was when the microwave oven at someone’s home was on with nothing in it for over 20 minutes. Not knowing this, I used the microwave oven and heated some items. Thirty minutes later, I had symptoms.

I actually thought I got radiation in my eyes. Could that be possible? And can things like this trigger an ocular migraine? M.L.

A: As long as the door on the microwave was closed during those 20 minutes, the outside environment should have been protected from any microwaves trying to leave the oven. The microwaves do not build up in the oven. So when you opened the oven door, there would be little chance, if any, that you were bombarded by a high dose of microwaves that were stored up before you opened the door.

Remember that ophthalmic migraines do not originate in the eyes. They originate in the brain, but the symptoms are visual because they affect the visual cortex . Dr. Slonim

Q: I would like to commend you for the fine article on ocular migraine. Especially helpful were the photos, which I recognized from my own attack. I have been doing some heavy dieting and I think that might have triggered the attack. D.B.


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