I've been seeing the same neurologist for my migraines for around 15 years. In that period of time, I've taken propranolol, gabapentin, amitriptyline, and venlafaxine as migraine preventives. My neurologist also did three treatments of 16 Botox injections. He now says that topirmate is the last thing left for me to try, but I'm really scared by what I've read about its side effects. I've seen Teri Robert recommend seeing a migraine specialist in some of her posts on Facebook. The closest specialist to me is 90 minutes away. Why should I drive that distance? Will it really make a difference? Thanks for your advice, Jenelle.
First of all, topiramate is far from the "last thing left" for you to try. There are now over 100 migraine preventive treatments in use. For a list of them, check out Migraine and Headache Prevention – So Many Options. Topiramate does have several potential side effects, so your reluctance to try it is understandable. Remember, however, that those side effects don't always occur. You may wish to wait until you've tried other options.
When Botox is used for the treatment of chronic Migraine, the standard protocol is 31 injections. While these injection sites may be adjusted somewhat to better meet the needs of individual patients, reducing them to 16 may not have been adequate. For more about this and the recommended injection sites, take a look at How Many Botox Injections for Chronic Migraine?
One of the biggest obstacles to good migraine treatment is that doctors are taught very little about migraine in medical school. Neurologists do gain more training about treating migraine during residency and internship, but given how many diseases and conditions they must learn about, they still have relatively little training to prepare them for treating migraine. Migraine and headache specialists, on the other hand, often limit their practices to treating only patients with migraine and other headache disorders. This gives them more time to dedicate to learning about those disorders and far more experience in treating them. These specialists often attend conferences for continuing medical education in "headache medicine," follow the relevant journals carefully, and network with colleagues in their field.
While driving 90 minutes to see a specialist may seem daunting, please consider that it can take people who live in a big city 90 minutes just to drive across town. There's a shortage of migraine and headache specialists, so some people have to drive several hours or even fly to see one. You can see how a patient and a migraine specialist can work together in Managing Migraine – Teri Robert and Dr. David Watson.
Whatever you decide to do, please don't lose hope. There are still many options for you to try for migraine prevention and management.
Thank you for your question,
Dave Watson and Teri Robert
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