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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© David Watson and Teri Robert, 2017.
Dr. David Watson is a UCNS certified migraine and headache specialist and the director of the West Virginia University Headache Center. Dr. Watson takes a special interest in migraines, cluster headaches, and tension-type headaches. He strives to stay up-to-date on current research and treatments and regularly attends continuing medical education conferences. “Dr. Dave” is also very active in the migraine community, taking part in and leading advocacy efforts to benefit the entire community. He is the founder and chairman of the board of Runnin’ for Research, a nonprofit organization that helps interested patients and doctors set up races in their areas to raise research funding for headache disorders. He’s also a regular participant in the Alliance for Headache Disorders Advocacy’s “Headache on the Hill” event and is co-secretary of the American Headache and Migraine Association. You can follow Dr. Watson on Twitter.
Teri Robert is a leading patient educator and advocate in the area of migraine and other headache disorders, and has been writing for the HealthCentral migraine site since 2007. She is a co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association. She received the National Headache Foundation’s Patient Partners Award for “ongoing patient education, support, and advocacy,” in 2004 and a Distinguished Service Award from the American Headache Society in 2013. You can find links to Teri’s work on her web site and blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.
Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.