Ways a Migraine Specialist Can Help

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Gregory J. Esper, MD: The first thing that I would say is that migraine is the most common type of headache. Migraines will, if they're really bad, stop people functioning in their tracks. Most general practitioners are familiar with migraine and its treatments. I think that the problem for a patient comes when the general practitioner has done what they can for the migraine, but the migraines are severe in intensity and greater in frequency than the practitioner is comfortable with.

If I had 30 seconds to examine a patient with headache, I'm going to focus on the eyes. I want to look at their visual fields to make sure that their visual fields are full. Now, if I had more than 30 seconds to examine a patient, I'm going to do other aspects of the neurological exam. But if I'm pretty sure it's a migraine, what I'm going to do is I'm going to have a discussion with the patient, and I'm going to go through all of those historical factors that I elicited.

Do you drink red wine? Are you eating aged cheeses? Are you sensitive to peanuts? Are you getting enough sleep? What's your stress level like? And I'm going to address the non-pharmacologic, the non-medicinal things first. There are home and herbal remedies that a lot of patients take, and they never come to the attention of doctors.

If you're a patient and you feel like your headaches are out of control, that's when you need to see a doctor. If you feel like you're taking too much medication, that's when you need to see a doctor. If you can't function at work, that's when you need to see a doctor. If you're missing days at work, go see a doctor.