Migraine and Headache Treatment - How It Should Be

Patient Expert

One of the biggest problems we can face with Migraines and headaches is finding the right doctor to work with us toward better disease management.

We've had to learn -- many of us, the hard way -- that even neurologists and pain management doctors are not necessarily Migraine and headache specialists. When we stop and think about it that makes sense. Neurologists and pain management specialists treat a wide range of illnesses, diseases, and injuries. It would be virtually impossible for them to stay up-to-date and specialize in any one area. Migraine and headache specialists, however, usually treat only Migraine and other headache disorders.

In the process of looking for a doctor to work with, some of our readers have asked what it's like to go to a Migraine and headache clinic. Several have specifically asked about the Jefferson Headache Center in Philadelphia.

It was at that clinic, working with Dr. William B. Young, that I finally got the help I needed to regain control of my life from Migraine disease and chronic tension-type headaches.

Your experience may vary, but below is information about my experience with both my first appointment and my first follow-up appointment. I hope it helps you better know what to expect and makes your first visit easier and less stressful for you...

As I walked in,

  • the reception area (waiting room) was dimly lit with incandescent lighting. No fluorescent lighting here.

  • the room was peaceful and quiet - no noise from television or radio.

  • the colors were soft and muted.

  • there were signs requesting that nobody wear cologne or perfume here.

  • I was greeted by a very professional receptionist who spoke softly, was gentle and friendly, and treated me with respect.

Had I died and gone to Migraineur's Heaven? No, I'd gone to the Jefferson Headache Center at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, to see Dr. William B. Young.

If you've read many of the posts in our forums, you've seen that many people who have Cluster Headaches, Migraine, or other headache disorders have problems finding doctors who:

  • take them seriously,

  • treat them with respect,

  • and are knowledgeable in current treatment methods and medications.

The last point, being knowledgeable in current treatment methods, is somewhat understandable, especially for general/family practice physicians. Most of them have too-busy practices, and are trying to keep up with treatment advances in every area of health care. General practice neurologists encounter a similar situation. Although their scope is narrowed to neurological disorders/diseases and injuries, there are still a vast number of conditions about which they must be continually learning to remain current. Though it sometimes seems to us that no progress is being made, there is a vast amount of ongoing research in the field of headache disorders, new uses determined for current medications, and new medications reaching the market at a good pace. Only the most brilliant and dedicated of these general practice doctors and neurologists have a chance of knowing about the most recent research into the cause of these disorders, the most recent and most effective medications, and other methods of treatment.

On the other hand, headache/Migraine specialists and the doctors at headache/Migraine clinics treat only patients with headache disorders. Their focus, therefore, is not divided among various types of disorders. They are more able to maintain a high level of current knowledge. The fact that they chose headache disorders as their specialty indicates that they take headache disorders seriously, and are more likely to understand not only the pain of the disorders, but the other effects on our overall physical and emotional health.

As with any medical specialty, not all clinics and doctors work in the same fashion, but to give you a more complete picture, I'll detail the rest of my visit.

The first appointment:

I was told in advance that the appointment would last five to six hours and would include a psychological evaluation and a visit with a psychiatrist. An information packet was sent to me with directions to the clinic, some basic information about Migraine, and a short, standardized personality test to complete and bring back with me.

When I checked in at the reception desk, they gave me a brief information form to complete got a copy of my insurance card, and gave me a multi-page personality test to complete. A few minutes later, Nurse Lois came out to greet me. We went to an examination room where she checked my vital signs, took a detailed medical history, and asked many questions about my Migraine history. As she worked, she entered all the information into her computer, which is on a network so that the doctors can easily access the information later in the appointment. Lois was professional, kind, and caring. When we finished she showed me to a small waiting area outside the exam room where I could complete the personality test.

A few minutes later, Dr. Tramuta, the psychiatrist, escorted me to his office. I was admittedly apprehensive about this part of the visit because, as many other Migraineurs, I've had too many doctors take the attitude that Migraine is "all in our heads." My apprehension was short lived. Dr. Tramuta understood my feelings, and we talked about them. His job is to assess patients for depression, which is much more prevalent among people with headache disorders than it is in the general population, and assess the patient's ability to cope with a chronic pain illness. We spent about an hour discussing Migraine, my general health, and how I deal with health issues. He told me that although I would not be automatically scheduled to see him on my subsequent visits, I may call at any time and request that a visit with him be scheduled.

After a short lunch break, it was time to see Dr. Young, my new neurologist. Since I had taken films from a recent MRI with me, he was able to view those films and discuss them with me as he performed a standard neurological exam. He confirmed my previous diagnosis of Migraine, with and without aura. He pointed out the blood vessels on the MRI films, telling me that they were in perfect condition, making me a good candidate for using triptans (Imitrex, Maxalt, Zomig, Amerge, and Axert) as Migraine abortives. After the examination, we sat in his office and discussed treatment options. He gave me his opinion of changes to make in medications for Migraine prevention and the use of Imitrex tablets and injections as Migraine abortives. We discussed rebound headaches, and the proper use of my medications to ensure that I didn't bring on rebound. He provided me with a preprinted sheet with a phone number to call of medication refills and a number to call if Migraine pain persisted more than 48 hours. Since the clinic is an eight-hour drive form my home, should I experience an attack with pain in excess of 48 hours, he will work with my primary care physician or local emergency room to see that I receive proper care. Since he had prescribed Imitrex injections for me, and I had never used them before, Nurse Lois brought in the Imitrex Stat Dose (self injector), showed me how to use it, and watched while I injected myself. She then sat with me for about 20 minutes and checked my blood pressure to be sure that it wasn't elevated by the Imitrex. The in-office Imitrex trial was so that I would not be frightened by the mild side effects that are expected immediately following an injection and to be sure that there would be no adverse reactions to indicate that I shouldn't use Imitrex. After Dr. Young and I spoke for another few minutes, I was on my way, armed with instructions, prescriptions, and a follow-up appointment set for nine weeks later.

The follow-up appointment: Nurse Lois met me in the reception room promptly at the appointed time. She checked my vital signs, recorded changes in my health and other medications, and asked questions about my Migraine attacks since my first appointment. There was a short wait for Dr. Young, as he needed to see a patient in distress. Although Dr. Young was a bit behind schedule, there was no sense that he was hurrying to catch up. We discussed and adjusted my medications, talked about my progress and his treatment plan for me. We also discussed other health issues that may be affected by some of the same things that affect Migraine, and he recommended discussions with my other doctors. Approximately 90 minutes after my appointment time, I had my next appointment scheduled, and was on my way.

Summary: Headache disorders and Migraine disease are complicated and need appropriate and adequate treatment. This treatment may not be available from your primary care physician or through a general practice neurologist. When this is the case, headache and Migraine specialists and clinics offer specialized care that can be literally life saving and greatly increase our quality of life. If you feel you are not receiving the best care for your Migraine Disease, Cluster Headaches, or other headache disorders, these specialists and clinics should be considered. You may need to travel a bit to reach one, but it will be well worth the effort. For a listing of specialists and headache clinics, click HERE.

Follow me on or