Best doctor for headaches?

December 13, 2007 9:12 AM

Is there a "headache specialist" I can go to?

I have been getting headaches most of my life. I had to learn to swallow adult Tylenol in second grade because children's Tylenol didn't work. It was always just something I dealt with though because they weren't that terrible and they'd go away with normal Tylenol.

However, in the past year they've gotten more severe and more frequent. I went to my regular doctor in May and got put on Amitriptyline. It seemed like it was working for the first couple months I was on it, or at least cutting down on the frequency of them (3-4 times a week as opposed to 5-6 times). However, my headaches have been coming back and with more force than before. I am finding myself with really bad headaches that make me dizzy a lot more often than I ever did before. I also have a prescription for Imitrex to take when I actually have a headache. However, I have a hard time justifying taking them when it isn't that bad of a pain because a pack of 9 pills is $20 co-pay.

Anyways, so I made an appointment with my regular doctor for January to see about something new to help with these. However, I don't know if I can skip the regular doctor and just go straight to a headache specialist of some sort. I don't know if that would be a neurologist, or if that's just wasting their time.

I would just prefer to get an appointment with someone that can really help, rather than wait until January 12 for this appointment with my regular doctor where I might possibly have to be referred to someone else. Any suggestions on the best course of action?

Another reason I'm trying to sort this out ahead of time is because I just recently moved to Naperville, IL but my regular doctor is in Rockford, IL. So I'm going to have to take an hour and a half trip to visit this doctor, and I'd like to avoid that if it's not even going to help.

posted by Becko to health (11 comments total)

Absolutely neurologists deal with headaches. Many hospitals have headache clinics. Your primary care physician should be able to refer you to one.
posted by gaspode at 9:36 AM on December 13, 2007

Ah, I missed the last sentence. Maybe call your local hospital and ask about clinics?
posted by gaspode at 9:36 AM on December 13, 2007

A visit to a neuro is definitely a logical the next step. In canada you can't get to one without a referral from a GP or another doctor, I'm assuming it's the same in the states. They are much more knowledgeable on all the different type of headache/migraine preventatives out there (of which Amitriptyline is one). Sometimes you need to try several to find one that works for you. The fact that your headaches are increasing in severity is also something the neuro might also want to look into.

I've pimped it before on AskMe, but you also need to read Heal Your Headache by David Buchholz. Even if you don't go through with his plan (it definitely seems daunting at first) he has a ton of great info in there.
posted by cgg at 9:41 AM on December 13, 2007

I really wish i could see all my typos in the preview... for some reason, my brain refuses to seem them until I've actually posted.
posted by cgg at 9:43 AM on December 13, 2007

Start with a neurologist, one that has cultivated a practice that deals with headaches. A lot of primary care doctors are capable of dealing with chronic headaches but the approach to the problem does have an element of trial-and-error. There is no day you are going to wake up and shout "I'm cured!" Slow improvement is the rule.

While you are waiting for slow improvement, you will still be dealing with the headaches. You will be frustrated. You will doubt the competence of your doctor. I just think it's best to start with a physician whose judgment you trust entirely and commit to working with them over time. Your primary care physician may be able to recommend one, so may your coworkers, maybe someone here will recommend one in your area.
posted by Slarty Bartfast at 9:44 AM on December 13, 2007

I agree that you should see a neurologist. It may be a tough fight depending on your insurance, but if your primary care isn't helping and they are getting worse, then there you are.
posted by Big_B at 9:50 AM on December 13, 2007

Do it. See this question. I have been virtually headache free for more than two years. It absoutely changed my life.
posted by SashaPT at 10:01 AM on December 13, 2007

I used to have bad migraines. Made me go blind, they were so bad.

Ended up that I had a heart condition called atrial septal defect, wherein I had a hole between my right and left atrial chambers. Every once in a while, I would overload my system and screw up my blood pressure just enough to induce a migraine.

I figured all this out because I threw a blood clot one morning and had a mild stroke. All better now because they fixed the septal wall defect. The Docs figured it out, anyway.

There are many reasons why you can get bad headaches. Sinus issues, sleeping wrong, being dehydrated, stress issues (gritting teeth, clenching jaw), neck/skull alignment issues, not enough caffeine if you're a caffeine addict, food allergies. The neurologist is a good first step, but you probably need to pay super attention to the conditions in your life that may provoke your headaches.
posted by legweak at 10:56 AM on December 13, 2007

Another migraine sufferer here, definitely recommending seeing a neurologist! I had such bad headaches that when I was a child, I would tell my mom that my "tumor" hurt. I finally got hooked up with a neurologist when I was in college and things have been much better (not perfect) since then.

I go to a great neurologist who specializes in headaches and eye disorders because my migraines are accompanied by visual disturbances. (Check out the Dept. of Neurology at your closest teaching hospital or university.) We have figured out which medications work best for me, and I've also worked on identifying my triggers. One thing to keep in mind is that you may need to try several different medications/medication combos before you find one that works and doesn't have unbearable side effects. You might want to plan on visiting your neurologist every 3-6 months to reevaluate your treatment. Now that I've found medication that works, I only see my neurologist every 1-2 years, or whenever I notice some new issue.

Good luck!
posted by jrichards at 11:28 AM on December 13, 2007

I would definitely agree with all the advice already given. This is your life, so aim to get the best possible quality our of it while it lasts! You will need to see (and perhaps seek out) a neurologist - and never think in terms of "wasting their time" - all that may happen is that they end up wasting yours, not the other way around...!

There are huge numbers of different types of headaches (it's virtually a science in itself), and you really need expert advice (and probably some advanced investigations) to diagnose what type it is and then what treatment it is most likely to respond to. In the meantime, collect as much data as possible to aid the experts: Describe as accurately as possible where it hurts, when (i.e. associated situations/triggers), how it develops, how it responds (or doesn't) to simple analgesics, what your typical food intake is like (you may be asked to cut out certain foods one at a time), how much physical exercise you generally take, what your family's history is with regard to headache, what psychological & emotional stressors there are in your life, etc, etc.

One other piece of advice: Go easy on the analgesics (Tylenol etc.) - in chronic headache regular high-dose analgesic consumption not infrequently end up MAINTAINING the headache (it's known as analgesic-induced or maintained headache), and you need to watch out for risks to other organs such as your liver!

Why don't you make this your special project and Christmas present for yourself in 2007/8? You could ask relatives and friends to contribute to a "get better Becko fund" in lieu of presents...
posted by kairab at 11:58 AM on December 13, 2007

If you're willing to travel downtown, I see an awesome neuro at Northwestern Faculty Foundation in the Galter Pavilion. His name is Jack M. Rozental.

I can't recommend him highly enough. I came to him after I was taken to Northwestern with the worst headache of my life, which made me completely aphasic. He figured out what was wrong with me (complex migraine induced by electrolyte imbalance) and "fixed" me. Haven't had a migraine since. He explained everything to me from day one. I had to go through a lot of scary tests; he showed me the results and explained how he interpreted them. Amazing bedside manner - maybe because he is so overeducated - he has his M.D., of course, but also a Ph.D. and an M.B.A..

He still keeps up with me (four years later) by calling every now and then to check in.
posted by MeetMegan at 12:37 PM on December 13, 2007