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    Got Migraines? See a Professional, Experts Advise

    WebMD Health News
    Reviewed by Gary D. Vogin, MD

    Although negotiating your way through the healthcare maze can be a headache in itself, people who have recurrent, disabling headaches and think they may be suffering from migraines can help themselves by seeking the right professional care, headache experts say.

    Jill Lieberman, a 30-year-old Atlanta resident, has been suffering from migraines for about five years. "When I first got [migraines], I had no way of predicting them and I had not yet gone to the doctor," she says. "So it completely affected my personal life. I was on vacation once and pretty much missed the whole vacation because I had to stay in the hotel room."

    Not surprisingly, people who have migraine attacks will try almost anything to relieve the pain. But the old saying "A doctor who treats himself has a fool for a patient" could apply to patients as well, warns Stephen D. Silberstein, MD.

    "One of the great tragedies is that a patient might figure out he has a migraine, try over-the-counter medications, get minimal, if any, relief, and keep making the same mistake over and over again," says Silberstein, a professor of neurology at Jefferson Medical College of Thomas Jefferson University and director of the Headache Center at Thomas Jefferson University Hospital in Philadelphia. Silberstein is a member of the U.S. Headache Consortium, a group of six medical organizations that banded together to develop guidelines for the diagnosis and treatment of migraine headaches.

    According to the American Headache Society, migraine headaches affect about 28 million Americans -- 13% of the population -- but less than half of all migraine sufferers have been diagnosed by a doctor. Migraines, for those who are fortunate enough never to have experienced them, are not garden-variety headaches, but a disabling condition characterized by throbbing pain, usually on one side of the head, and often accompanied by nausea and vomiting and by extreme sensitivity to light and/or sound.

    According to the consortium's guidelines, presented at a recent scientific meeting here, there are 10 specific steps patients can take to help ensure that they get the appropriate treatment:

    • Know your diagnosis. "The treatments are different for migraine, tension, or sinus headaches, and I don't think it's appropriate for patients to go out to drugstores and pick herbs and spices and everything else if they're having disabling headaches," Silberstein tells WebMD. The headache consortium recommends keeping a daily "headache diary" that can help patients identify times and situations when headaches are most likely to occur.
    • Find a doctor who understands headaches and has an interest in working with patients to find the best treatment. The doctor can be a primary-care physician or a specialist; the consortium emphasizes that in most cases, migraines can be diagnosed without expensive tests.
    • Tell the doctor exactly how headaches affect your life -- inability to work or concentrate, mood changes, visual problems, etc.
    • Avoid headache triggers. For some people, the trigger is certain types of food or drink -- like chocolate or nitrites (chemicals used to preserve hot dogs and other meats), and coffee or alcohol (particularly red wine). For others, it may be lack of sleep or changes in sleep patterns, or stress.
    • Find the appropriate medication for your attacks.This could be an over-the-counter medication -- such as aspirin, Tylenol, or Advil -- or a prescription drug. "Look for the drug that will not only offer relief from pain, but will, as we call it, 'abort' the headache," or stop it from developing further, Seymour Diamond, MD, executive chairman of the National Headache Foundation and director of the Diamond Headache Clinic in Chicago, tells WebMD.
    • Don't overuse pain medication. Overuse of either prescription or over-the-counter painkillers can cause rebound headaches, in which a new headache is triggered as the medication wears off.
    • Have at least two treatment options available."Ask your doctor to prescribe a 'rescue' medication that you can use if your regular medication fails," the guidelines advise.
    • If one medication doesn't work, try another. If a drug doesn't give satisfactory relief after three migraine attacks, ask the doctor for a different medication.
    • Ask your doctor about preventive drugs. People who have two or more migraines per week may benefit from preventive medications that can be taken on a regular basis. Preventive drug therapy requires patience, however, because the benefit builds slowly over a period of several months.
    • Consider alternative therapies.People who can't take medications (such as women who are pregnant or nursing, as well as those who are concerned about rebound headaches from taking too much medication) may be able to find relief from non-drug treatments such as relaxation training or biofeedback. Just be sure to tell your doctor about all treatments you want to try.

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