What can a neurologist do for my migraines?

September 7, 2011 10:54 AM

I've suffered from migraines all my life, but I've never see a neurologist for them. After a string of particularly disabling attacks, I'm considering asking my GP for a referral. What should I expect from a neurological evaluation? It won't be cheap, so I'd like to know more about what's involved and whether it's worthwhile, in comparison to simply asking my GP to prescribe triptans or other medications I haven't yet tried. (Bonus question: recommend a great neurologist in Sydney, Australia?)
posted by anonymous to health & fitness (9 answers total)

Hm. IIRC they asked me for a history of my migraines (how many years/months I'd had them for, is there a family history, duration of individual migraines, how often per week/month, &c), did an intense battery of physical response tests based on my answers, and eventually ordered an MRI and blood tests. We also went over all my other medications and medical history and eating habits and sleeping habits and whatnot.

In conclusion, triptans are fucking awesome.
posted by elizardbits at 11:52 AM on September 7, 2011 [1 favorite]

IANAD, IANYD, and I'm not sure what a neurologist can do for your migraines, but you should have your blood pressure checked. A good friend of mine had horrible, debilitating migraines for more than 20 years before a cardiologist* picked up on the fact that she had exceptionally high blood pressure. (The one time I drove her to the doctor it was 210 over 170. The doctor wouldn't let her leave the building.) Once she was on a medication to control the blood pressure, the migraines almost vanished. She's down to one or two a year, instead of one or two a week, and the pain is much less than it was.

I know that tons of people have migraines and it has nothing to do with blood pressure, but it can't hurt to have it checked. With that said, I've had the good fortune to know some amazing neurologists. I don't know what the treatment for a standard migraine is, but you should expect CAT scans, MRIs, possibly an EEG, more reflex and motor tests than you thought existed, thorough questioning of your day-to-day life and probably blood tests as well. Good luck - I hope you find someone to help you.

On preview, elizardbits jinxed me.


*My friend's family has a history of high blood pressure and strokes. The cardiologist who was a family friend was checking her after she'd had her first stroke at 41. She had another within two weeks, and luckily has almost no permanent damage, but it was terrifying for everyone involved. So, even though it's highly unlikely, I always say check your blood pressure.
posted by mitzyjalapeno at 12:02 PM on September 7, 2011

I was referred to a neurologist for my headaches. Overall, I understood that the neurologist was looking for other causes of my headaches as a precaution and once they were ruled out, set on to treat them as migraines, with better effectiveness than my gp had.

My visits involved a thorough medical history (with a lot of attention paid to my family as well, and the events around my birth, which seemed strange at first, but I took it to be an indicator of possible neurological damage at birth) and lots of those goofy tests that seem way too easy but I guess would indicate a neurological problem (i.e. walking in a straight line under various contortions, sticking out my tongue, tracking with eyes, etc. etc.). The MD would also have sent me for an MRI, but I had recently done several fMRIs for an experimental study (and thus abnormalities in these scans would have been revealed). In the end, I ended up starting on Topamax with pretty good results, and continuing with triptans. I had a particularly crappy gp at the time who knew less than I did about treatment options for migraines, so I think that it was a good idea to go to a different doctor than my gp, but in the end, I also felt like a good gp might have done similar things to the neurologist. (The gp for instance, offered nothing in terms of prophylactics except betablockers....which I wasn't willing to take. I think most gps are aware of other options.) Still, it was comforting that other possibilities were ruled out. Hope you feel better soon...I took the Topamax for awhile, but as I got into a more regular schedule, my migraines have almost disappeared so I stopped taking it and hardly ever need Triptans anymore either...so whatever you end up needing to do, there's at least one anecdata that it may not be forever :)
posted by Tandem Affinity at 1:34 PM on September 7, 2011

I was referred to a neurologist several years ago for migraines. He did an MRI and quickly pinpointed allergy-related nasal inflammation as the cause. Quick and painless, and I wound up with some cool pics of my brain.
posted by mkultra at 2:06 PM on September 7, 2011

Had a work-up done more than 20 years ago which included a physical, cat scan and EEG. Nothing really helped.

I quit eating gluten 4. Months ago and no more migraines - after more than 30 years!
posted by leslies at 2:32 PM on September 7, 2011

stupid phone punctuation errors - gah
posted by leslies at 5:57 PM on September 7, 2011

Nthing the previous responses: a neurologist will go over your history and do the normal neuro battery -- sticking out your tongue, walk a straight line, checking vital responses, etc. They'll look for abnormalities and possibly recommend a CAT scan, an MRI or other tests depending on what they find.

IANYD, IANAD: If you are going at the recommendation of your GP, and your insurance covers it, then go. If not, then your GP can do all those things. The thing a neuro will do that a GP can't is be up-to-date on the latest research and medicines. If that's worth it to you, then go by all means. If you think this is routine migraine thing that can be treated with something like a triptan or Topamax, then you can certainly start with your GP.

If this is disabling in the "Oh crap this hurts a whole lot way," then you could start with the GP. If it is disabling in the "I can't stop throwing up and everything is colors and I think I might pass out from the pain" kind of way, then head on over to the neuro.
posted by mrfuga0 at 6:45 PM on September 7, 2011

After years of migraines, I went to a neurologist a few years back. I did NOT want to be on triptans, and I didn't really want to be on topamax, but he talked me into the topamax. It was a miracle. I hated the side effects (parasthesia; "the stupids"; hair loss; everything tasting like metal) but it got my headaches down to 3-4 a month instead of 5-6 a week.

migraines are tricky things. any GP can prescribe you a drug, but they likely don't have the neurological background to listen to your history and do an proper exam for all the variuos things that migraines bring to the table. there are many causes and associated problems and so forth that a neuro is trained for that a GP just isn't.

others are right about what your first appointment will likely be like so i don't have anything to add to that.

i vote neuro. wheras my GP just said to try aleve or advil or tylenol, my neuro worked with me to figure out that my daily dizziness was due to my daily migraines that were pretty idiopathic. he was able to use the right words to convince me to try topamax, which my GP could have never done.

oh, and the triptans are to stop a migraine once it's started, but the topamax helped PREVENT them. which was awesome. still shitty side effects tho.
posted by misanthropicsarah at 9:46 PM on September 7, 2011

Another approach might be tricyclic antidepressents, such as nortriptyline or amytriptylline (Elavil in the US). Taken every day at low doses, tricyclics have been used for many years to reduce or prevent migraine. My daughter's neurologist prescribes it for her, and it is very helpful. Her now-occasional migraines require one of the triptans. If money is a big issue for you, this might be worth a try. This class of drugs has been around for ages, and your GP should be comfortable prescribing it. It is also very cheap to purchase is you need to pay cash.

One tip - they really do cause drowsiness when you start taking them, so they are usually taken at bedtime, and a course tapering up to the desired dose over a week or so is very helpful. Otherwise you will be sleepy and feel sluggish in the mornings. Using the taper-up method worked for my daughter, who has early classes.
posted by citygirl at 7:31 AM on September 8, 2011