This is A Real Headache.

March 13, 2013 6:15 PM

Migraines are ruining my day. I can't see a neurologist for three months. What can I do in the meantime?

I have relatively frequent headaches and suffer from migraines. Over the last few days, the head pain has been bad and pretty constant. I know the next step is to see a neurologist, but haven't been able to find one in town who can see me until the summer. The thought of leaving this untreated that long makes me whimper.

Will a primary care physician/internal medicine physician be able to help me at all in the meantime? Or would going to one just be wasting my time and a co-pay?

(Assume that I am already doing basic things like watching my diet, avoiding my known triggers whenever possible, laying down in a dark room, drinking plenty of water, taking Excedrin, etc.)

posted by anonnymoose to Health & Fitness (27 answers total)

Your regular doctor should be able to help you in the interim.
posted by elizeh at 6:21 PM on March 13, 2013 [2 favorites]

First off, you're right that you should see a neurologist, but if you can't get in for 3 months, definitely go see your GP. They can send you for a CT or MRI to make sure there's no major issues going on in your head that might be causing these headaches. Also, they can prescribe prophylactic meds. A low dose of beta blocker like propranolol, or an antidepressant like amitriptyline might be worth asking about. They can also give you a script for meds to abort a migraine in progress like sumatriptan (Imitrex) or fioricet. They can run some labs to see if you have any deficiencies that might be exacerbating your headaches. I would ask about supplementing magnesium and vitamin d. Mag in particular can work wonders for migraines.
Also, making sure that your sleep and meal schedules are fairly regular can help a lot. Another thing to monitor is caffeine intake. Caffeine is a double edged sword. It can stop a migraine, but it can also bring them on.
Good luck!
posted by brevator at 6:29 PM on March 13, 2013 [2 favorites]

You know, the whole "Headache pain! Go straight to a specialist!" thing is pretty recent. For years, GPs were the first port of call, and they have a virtual armoury of excellent drugs with which to treat you. Don't suffer and certainly don't wait; go see your doctor.
posted by DarlingBri at 6:45 PM on March 13, 2013 [1 favorite]

If nothing else, your GP may be able to help you get in to see the neurologist sooner. Definitely worth a visit.
posted by judith at 6:48 PM on March 13, 2013 [1 favorite]

Your GP should definitely be able to help. Our community only had a family doctor for ages and my mother was always able to get Imitrex and the like.
posted by checkitnice at 6:50 PM on March 13, 2013

If your headache pattern has changed, I agree you should see a neurologist. My own personal experience was the neurologist(s) suggesting I go straight on preventative medicines, rather than investigate possible causes. As I was leery of that, we agreed on a few other steps (IANAD, IANYD):
Vigorous exercise at least three times a week.
High-quality magnesium supplements
Feverfew and Butterbur supplements
Good sleep hygiene
Acupuncture

One or all of these helped.
posted by heigh-hothederryo at 7:00 PM on March 13, 2013

Also, taking an NSAID with the Imitrex seemed to help.
posted by heigh-hothederryo at 7:02 PM on March 13, 2013

Agree with heigh-hothederryo that you can power-boost a prescription med with an over-the-counter. I take Relpax but if it doesn't kick in within about 15 minutes or I've let the headache go too far before I can take something and it's really bad, my neurologist recommended I also take an Anaprox, which is an Rx but the equivalent of four Aleve.
posted by Sweetie Darling at 7:06 PM on March 13, 2013

(Also agree that your GP can help while you're waiting to see the neurologist.)
posted by Sweetie Darling at 7:07 PM on March 13, 2013 [1 favorite]

You should definitely see your regular doctor immediately. He or she will be able to start you on a treatment right away and order CT scans or MRIs if necessary.

Where I live, we are not able to see a specialist without a referral from a GP, so I made an appointment with my GP when my migraines increased in frequency and severity (and they were getting VERY bad). I did not end up needing a neurologist.

In my case, my doctor prescribed zolmitriptan (Zomig). It worked just fine as long as I took it immediately; I had to carry it with me at all times so I could take it within 30 seconds/a minute of onset (which was easy for me to identify as they always started with a visual aura). Eventually the migraines stopped being so frequent and severe, so I let my prescription run out. I get them very, very rarely now. They're treatable with ibuprofen gelcaps when I do get them.

Good luck. Migraines are awful and I hope you are able to find relief for yours.
posted by hurdy gurdy girl at 7:14 PM on March 13, 2013

Yes go see the GP...I have been extolling the benefits of PT and massage for my headaches lately. THey have a migraine component (I can reduce symptoms with triptans), but there is also a musculoskeletal component that can be treated (for me) with muscle relaxants, PT, massage, and Atavan, and a good GP's going to explore all these possibilities. Feel better!
posted by Tandem Affinity at 7:17 PM on March 13, 2013 [1 favorite]

So obviously ymmv but my I found that taking over the counter meds didn't help my migraines much and gave me rebound headaches. Something to think about.

What did help is identifying some triggers - shoulder pain from carrying a heavy bag was one, but the biggest was not eating enough protein and letting my blood sugar get too low. I eat more protein now and never get headaches any more. For awhile chocolate was a trigger for me but now it isnt. Keep a notebook and see if you can identify your triggers - you may see a pattern in only a few days.
posted by mai at 7:17 PM on March 13, 2013

If your GP can't help you, maybe s/he can help you get in at the specialist.

That said, try pushing back harder on the specialist's office. Impress upon them the fact that this is urgent and debilitating.
posted by radioamy at 7:46 PM on March 13, 2013 [1 favorite]

As everyone else has noted, primary care is definitely not a waste of your time.

The way the medical system is designed, you can nearly always start with a primary care physician - specialists are there to assist after primary care physicians feel that their initial workup is completed and further help is needed, or if a case turns out to be more complex/difficult to treat than expected. Since it sounds like you haven't tried any prescription migraine medications at all yet, you are in a good position to benefit from consulting your PCP.
posted by treehorn+bunny at 7:47 PM on March 13, 2013

Go to your PCP and try whatever they can give you. If it doesn't work, that's one less thing the neurologist has to try before he can do something that might work (like Botox- FYI, some insurance companies want to see that you've exhausted your oral drug options first before they'll pay for Botox as a migraine treatment).
posted by ThePinkSuperhero at 7:48 PM on March 13, 2013

In addition to what everyone else has suggested, keep a log of what you eat and when along with when you start feeling the headache/migraine coming on. This will help you identify any foods that trigger them. Everyone is a little different but this way you can establish a correlation and then experiment to confirm it.
posted by VTX at 8:16 PM on March 13, 2013

Ask your doctor to prescribe you L-Tryptophan. Took my first one 17 months ago (1 gram at bedtime) and went from having 3-5 migraines a week for years to having.... none.
posted by tenaciousmoon at 8:16 PM on March 13, 2013

I do a lavender aromatherapy thing with essential oil that seems to alleviate my migraines. It may help you as well.
posted by mchorn at 11:34 PM on March 13, 2013

buy the book :" Heal Your Headache" http://www.amazon.com/Heal-Your-Headache-Program-Taking/dp/0761125663
and read it
posted by dougiedd at 11:44 PM on March 13, 2013

I am a migraineur like you. I used to have daily headaches and I relied on Alleve. But this may not be a good suggestion depending on your other health issues (like, I have ulcerative colitis and this was BAD decision).

But you could try OTC migraine products or see a PCP. They should be able to prescribe you something like triptan derivative, until you see a neurologist. BTW, maintain a headache diary. The neurologist mostly would like to see it. It is very important you record as much data as you can.

Download New Patient Questionnaire from Montefiore Headche Center's website, so that you know what things are important. On 2 pages, it even asks you which medications you have tried. May be it is a good idea to research these drugs before visiting a neurologist so that you know what he/she is talking about the medications. Will also help you guide through, if you take other Rx medications.
posted by zaxour at 5:52 AM on March 14, 2013

Seconding the idea to keep a journal of what you eat to see if you can identify any more triggers. But don't stop there; also keep track of sunlight exposure (another common trigger), caffeine intake (ditto), sleep pattern, etc. etc.

Are you sure you are having migraines? Do you have visual auras, sensitivity to light, nausea? Is the pain one-sided? If it's just a "bad headache" you need different treatment than if it's a migraine.

One thing I haven't seen listed here that helps some people with migraine is contrast therapy. there are two ways of doing it. One way is to lie on your back with an ice pack under the base of your head, and a hot compress on your forehead. The other is to alternate hot and cold towels around the neck.
posted by parrot_person at 6:37 AM on March 14, 2013

Definitely see your GP. I have a relative who had weekly migraines until her extremely high blood pressure was treated. They stopped instantly. There are any number of avenues your GP might fruitfully explore.
posted by rocketpup at 6:58 AM on March 14, 2013

I know that everyone's different, but for me, caffeine turned out to be not just a trigger, but a very dominant trigger. It was miraculous to realize that if I stopped completely (even chocolate, white chocolate and decaf coffee) I don't get migraines anymore.

I mention this because you wrote that you take excedrin, which has a significant amount of caffeine in it.
posted by umbú at 7:16 AM on March 14, 2013

Try acupuncture! And commit to going a few times before you expect to see results. I had migraines my entire life and was on daily medication for a DECADE before trying acupuncture (I wanted to get pregnant and needed to get off the meds). I went through a few months of regular treatments and have been relatively migraine-free for about two years now. It seriously changed my life and I wish I'd tried it sooner.
posted by jrichards at 8:44 AM on March 14, 2013 [2 favorites]

Seconding acupuncture and massage as something you can start right away. But you should also see if there's some kind of physical changes you can make (see Tandem Affinity's musculoskeletal issues).

I suffered with terrible headaches for years. I found out that they were almost always caused by extreme tension in my upper back and neck (which seems intuitive and easy to diagnose, but the tension builds so gradually, you won't even notice it until you're suddenly in extreme pain). And that tension was caused by how I sat at my desk all day. No amount of ergonomic adjustments made a difference. Acupuncture and massage helped, but they were just helping the symptoms.

I needed to address the core problem. I decided to try standing while working. That has helped me more than everything else combined. My headache frequency has reduced dramatically. I haven't been to an acupuncturist since I moved to a new state, but I do get regular massage to ensure that the tension doesn't build up to levels that cause me pain. I also regularly stretch my neck and shoulder muscles to keep the tension at bay. And I <3 my Theracane.
posted by MsVader at 9:44 AM on March 14, 2013 [1 favorite]

Definitely talk with your doctor about beta blockers; my PCP started me on mine, and only when that wasn't enough did I seek out a neurologist.

You say you're taking Excedrin--are you taking Excedrin Migraine? That has really helped me. I've also gotten my neurologist to prescribe an anti-nauseant so that I can function without vomiting when a migraine hits--it helps with that and helps me sleep.

If you're in the middle of a migraine that won't quit, urgent care and/or the ER are options. They have the big-time drugs that can shut things down, and assuming you have insurance, urgent care in particular is just a co-pay. My neurologist also referred me to my hospital's outpatient treatment center for something called a "Kenicki cocktail" that is used to break persistent migraines--I don't know if your PCP could send you for that, but it might be worth looking into. I hope you feel better soon--migraines are the pits.
posted by epj at 10:36 AM on March 14, 2013

FYI - don't be fooled by Excedrin's marketing. The migraine formulation isn't any different than the regular stuff (acetaminophen, aspirin, caffeine).
posted by MsVader at 11:20 AM on March 14, 2013