Do you know if your Migraine diagnosis is accurate? Are you confident that you are receiving the most appropriate treatment? A growing body of evidence tells us that doctor choice matters. We’re more likely to receive an accurate diagnosis and appropriate treatment by consulting a neurologist instead of a primary care physician, nurse practitioner, or physician assistant.
Granted, this isn’t universal. Some physicians are skilled at diagnosing and treating Migraine, regardless of specialty. Likewise, not all neurologists specialize in Migraine. For more information about Migraine specialists, see Why, How and Where to Find a Migraine Specialist.
Episodic Migraine is defined as 14 or fewer headache days per month. Even episodic Migraine often requires treatment. If we experience three or four Migraine attacks per month or our attacks are especially severe, our doctor should discuss preventive treatment options with us. Early intervention is essential to prevent the development of chronic Migraine.
Topiramate (Topamax) is one of four FDA approved preventive treatments for episodic migraine. It is the most frequently prescribed preventive. However, there are over 100 different medications that are used off-label to prevent migraine. Common treatments include, but are not limited to, anti-seizure medications, antidepressants, calcium channel blockers, and beta blockers.
Chronic Migraine is defined as 15 or more Migraine or headache days per month. At least eight of the 15 must be Migraine days. Botox (onabotulinumtoxinA) is the only FDA-approved treatment for chronic Migraine. Despite this, many insurance companies require patients to fail up to three other classes of medications before approving Botox.
Getting the right diagnosis
A 2016 study of 188 Migraine patients found that fewer than half of those with chronic Migraine were accurately diagnosed. Recommended treatment of chronic Migraine is different than treatment for episodic Migraine. This high misdiagnosis rate tells us that millions of people living with Migraine are not receiving the correct diagnosis, let alone the optimal treatment.
Getting the right treatment
The 2016 U.S. National Health and Wellness Survey identified 197 patients with Migraine. Researchers collected data regarding type of physician and prescribed preventive treatments. Patients were classified as either at-risk episodic (four to 14 Migraine attacks per month) or chronic (15 or more Migraine attacks per month).
- Of the 121 patients with episodic Migraine, only five were treated with topiramate (Topamax). Six were treated with Botox.
- Only nine of the 76 patients with chronic Migraine were treated with Botox. Topiramate (Topamax) was prescribed for 13 patients with chronic Migraine.
- Patients treated by a neurologist were more likely to be prescribed either Botox or topiramate (Topamax).
- The survey did not include any other treatment options, nor did it specify if topiramate (Topamax) or Botox had been previously used unsuccessfully.
Impact on patients:
Both studies demonstrate the need for improved physician education on both the diagnosis and treatment of Migraine. Given the significant shortage of Migraine specialists, training of physicians in all specialties is essential. Most important, primary care physicians need Migraine treatment guidelines.
What you can do
- Ask your doctor about his/her training in the diagnosis and treatment of Migraine.
- Don’t hesitate to request a second opinion.
- Educate yourself on the diagnosis and treatment of Migraine.
- Consider a migraine specialist, even if you must travel.
See more helpful articles:
Correctly Diagnosing Migraine and Chronic Migraine – The ID-CM
Barriers to Good Medical Care for Chronic Migraine
Migraine and Headache Prevention – So Many Options
Rule Your Migraine by Taking Charge
1 Lee, L, Bell J, Fitzgerald T, et al. (2016). Preventive Prescription Patterns in Migraine Patients by Healthcare Provider, American Headache Society Program Abstracts, June 2017, 166.
2 Pavolovic J, Yu J, Silberstein S, et al. (2016).rPatterns of Chronic Migraine Diagnosis Among Patients with Migraine in an Accountable Care Organization, American Headache Society Program Abstracts, June 2017, 172-173.