Migraineurs: Can a neurologist really help?

March 4, 2005 11:24 AM

Chronic migraine sufferers, have you seen a neurologist? Did it help?

I've had migraines for 20 years, treated them with various meds and learned to live with and work around them. I have a new primary care doctor who is encouraging me to see a neurologist. I guess I always just assumed they'd be my lot in life, you know (mine are both hereditary at least 4 generations back and hormonal), so I never really considered going to a specialist. Those of you who have seen a neurologist, was the doc any help beyond "keep a journal, avoid triggers, here are some new meds"?

posted by SashaPT to health (22 comments total)

I haven't seen a neurologist, but I almost did. I had only had migraines for about a year and I was already going crazy from them. I can't imagine living with them for 20 years, so IMO, it would be worth getting it checked out. If you're a female, have you tried taking BCP without the placebos? My doctor has me taking them for four months before taking the placebos, and the result is that the headaches are far, far more manageable. Note that this only works with pills that are monophasic - not the tri-phasic (three levels) that many pills feature these days. This works as more of a preventative measure than a treatment, but it's worth a shot if your circumstances allow for it.
posted by fionab at 11:29 AM on March 4, 2005

GO. Assuming you have medical insurance, an MRI is a good thing for you to get.

I went through a bout of migranes a couple years ago and went to see a neurologist. The MRI revealed that the most likely cause was sinus inflammation (allergies). It's probably not your cause, but apparently an MRI is an excellent tool for tracking down the source of these things.

It was also kind of comforting to get a professional confirmation that all those years of, uh, "recreational activity" haven't done any permanent damage.

Plus, you wind up with some cool pictures of your brain. :)
posted by mkultra at 11:36 AM on March 4, 2005

I am a chronic migraneur and incidentally a neurologist, so you can decide for yourself which way I'm biased.

I never saw a neurologist, but I wish I had done when I was a teenager. Migraines can be fixed, and primary care docs aren't always particularly versed in the little niceties.

So I'd say, go give it a try.
posted by ikkyu2 at 11:41 AM on March 4, 2005

I saw a neurologist for migraines a couple of years ago, but it didn't help at all. He ran all sorts of tests and in the end prescribed Imitrex, which works well if you catch it early enough.
posted by smich at 11:43 AM on March 4, 2005

I have a herniated disk in my neck which causes pretty severe headaches - if left unmedicated they'll get close to migraine level. Fortunately, my best friend is a neurologist and he has me on Topamax and it, along with some cranialsacral massage, has by and large resolved the problem for me.
posted by glyphlet at 11:50 AM on March 4, 2005

I've had migraines for 21 years, starting when I was 10. Throughout my teens, my parents took me to a neurologist often. I had MRIs, CT scans, EEGs--if it's a test that's ever given to headache sufferers, you name it and I've probably had it.

Did it help? It took a long time of trying different combinations of different medications, but yes, finally it did help. Now that I'm in my early 30s, I find I don't need the prophylactic medication any more, because I tend to get migraines just as often when I take it as when I don't. I have Imitrex for when I feel one coming on, though it doesn't always work.

If you have decent medical insurance, then I think you absolutely should go. The neurologist may not find anything useful, and may not find a course of medication that keeps your migraines in check. On the other hand, he/she might. Seeing a neurologist is highly unlikely to make your migraines any worse, so what have you got to lose?
posted by cerebus19 at 11:53 AM on March 4, 2005

Have had migraines since I was 9. Saw a neurologist in HS (and didn't get copies of my MRI). Didn't help, and there are still no drugs that help me (tried Imitrex and dissolving tablet version of Zomig). Luckily I get "holiday" migraines of the classic variety, so they are only a couple times a year and their course is predictable.
posted by scazza at 11:55 AM on March 4, 2005

I get approximately 2 migraines each month. I just got back on health insurance through school last semester and, while taking care of getting an Imitrex prescription (initially prescribed by my gynecologist), the nurse practitioner I saw wrote me a referral to a neurologist. I'm hoping something good with come of it and I can come away with some sort of prevention as, like others have mentioned, Imitrex doesn't always work.

A friend of mine saw one and, for her particular case, although she didn't have high blood pressure, taking blood pressure medication has helped prevent them.
posted by stefnet at 12:07 PM on March 4, 2005

a former girlfriend of mine was helped a lot by chiropractic -- apparently the headaches all started because of tension/stiffness in the neck and jaw, or something
posted by matteo at 12:59 PM on March 4, 2005

For some alternative ways of preventing or minimizing migrane headaches (which isn't to say that a neurologist wouldn't be the best option), see this thread from December 2004.

More on point - what's the downside of seeing a neurologist, other than some time? If your insurance pays for most or all of the charges for the consultation and any resulting tests, it seems to me worth doing.

Personal note: quite a long time ago, after a whole bunch of medical evaluations and tests, which didn't find any organic problem, I was refered to a clinic that did biofeedback, and that worked for me. Your mileage almost certainly will vary.
posted by WestCoaster at 1:17 PM on March 4, 2005

Yes, saw a neurologist. He didn't cause any damage, but he didn't help much more than my internist, who had already prescribed Duradrin to take at onset. Duradrin whacks me out but it works. Mostly, although I sometimes have "ghost" migraines for days after....

l.
posted by lustra at 1:50 PM on March 4, 2005

Scazza, what does the phrase "holiday" migraines mean? It surely can't mean that the holidays make you so stressed out that you get a headache, I think. Is it more like, "I only get them a few times a year so I just take a day off of work"? If it's the latter, then that's what I have.
posted by matildaben at 2:27 PM on March 4, 2005

My father got migraines every 2 weeks or so until he read a book that recommended eliminating refined sugars from his diet. He did so, and he now gets them maybe once a year.

Then again, he reverted to eating refined sugars a few years ago and the migraines still didn't come back, so your mileage may vary.
posted by sirion at 3:28 PM on March 4, 2005

I suffer from migraines (as much as once a week as little as once a month) I have seen two neurologists and have had a CAT scan. The Cat scan showed an abnormality, problem is, the abnormality was nowhere near the location of my migraine attacks (behind the left eye). He said not to worry, abnormalities turn up in almost everyone. Of course, that didn't stop me from worrying, but he did suggest I try again in a year to see if it turns up again.

The second neurologist was purported to be the best in the city. He couldn't tell me anything new, except offer a few samples of the latest Imitrex like drug, and suggested I try a preventative medication. Not to derail your thread here, SashaPt, but I wonder if anyone could add their experiences w/preventative migraine medications. Has anyone had success with them? If this is bad form, I'll open a new question that specifically deals with the topic.
posted by btwillig at 4:17 PM on March 4, 2005

I've had migraines since I was 10, and I have seen a neurologist. I didn't find him to be all that helpful- sure, I had lots of expensive scans to guarantee that I didn't have a tumor- but he only offered me narcotics prescriptions.

I've had much better luck with my internist, who gave me Imitrex for the migraines that slip through anyway, and Propranolol to try to prevent them. Since going on the propranolol about six months ago, I haven't had a single migraine, which is a world record for me. My longest stretch before that was a month.
posted by headspace at 4:31 PM on March 4, 2005

I'd be curious about the preventatives, too - but maybe a new thread would be helpful for future search purposes? I'm still learning the best practices 'round here.

Thanks to everyone for the input. I went ahead and made an appointment - can't get in to see her until May 26 - but also found out that she doesn't participate with my insurance so, while they'll cover part of it, there's no discounting and it will be significantly more expensive. I've called the PCP back to see if she has any other recommendations but if she says this neurologist is the best (she runs a headache clinic) then I'll suck up the extra $.

In the meantime, I got a sample of Relpax to try. I tend to build up a tolerance to prescriptions over time, and it's taking two Zomig to knock out what one used to do. The same thing happened with Imitrex and fiorinal.
posted by SashaPT at 4:31 PM on March 4, 2005

Will post a separate question, thanks.
posted by btwillig at 5:07 PM on March 4, 2005

I used to think I had migraines, but after a while I self-diagnosed myself as having cluster headaches. Anyway, had quite a variety of meds, finally my doc sent me to a chiro, which worked. It won't prevent new 'seasons,' but it will pretty much finish off existing seasons, after say 4 or 5 sessions..
posted by carter at 5:29 PM on March 4, 2005

Interestingly enough, LSD is making a resurgence in cluster and migrane headache research, I recently read (NewScientist, I think). It's properties as a vasoconstrictor seem to alleviate the symptoms in many sufferers.
posted by jimfl at 6:19 PM on March 4, 2005

I went to a neurologist when I was thirteen. I got the MRI (they gave me the photos of the inside of my brain!) and some other scan that was, I think, an electrical readout of what was going on where. Took a week to get all the conductive jelly out of my hair.

I had to come back weekly for a while, for biofeedback instruction. This meant I was in a comfortable chair, with electrodes stuck to my forehead, listening to a relaxation tape on headphones and trying to keep my muscle tension below a certain line. The only thing that did was teach me how to make myself fall asleep. It's not a useless skill, but it doesn't help much when my head hurts.

A few years later, I realized the migraines had spawned about the same time as my perfume allergy had. From there I've treated it, if you could say that, by dodging smells and carrying a stash of painkillers everywhere I go.
posted by cmyk at 6:36 PM on March 4, 2005

I saw one once but it was to see if there was any damage caused by the medication I was taking at the time, my GP wanted to know if the damage was permanent (it wasn't). The neurologist didn't do anything else for my migraines.
posted by squeak at 1:27 AM on March 5, 2005

I am circling back around VERY late to report that I did go to a neurologist in May of '05 and have been nearly migrane-free since. I haven't missed a day of work or had to drive home with my thumb jammed in my eye in more than six months. It's a freakin' miracle.

Here's my new regimen, YMMV of couse: she put me on Atenolol to regulate blood flow issues (and some borderline high blood pressure), and prescribed Anaprox (high-dose Aleve) as well as Relpax (which I had been taking) for pain. More helpful than anything, she told me to take the medicine as soon as the "uh-oh I'm getting a headache" feeling hit, not the actual migrane (I used to ignore the uh-oh, hoping it would go away, which it never did). She also assured me that it would be very difficult for me to over-medicate, which was another one of my anxieties.

So, it was definitely worth it and I'm grateful for the advice, which was the little poke I needed to take action.
posted by SashaPT at 2:24 PM on February 6, 2006