Migraine: What Your Doctor Doesn’t Know

There’s no question that the pounding, throbbing, pulsating pain and disorientation of a migraine is enough to ruin your day. And finding out that your doctor’s knowledge about diagnosing and treating migraine isn’t as sharp as it should be can compound your misery. Unfortunately, this may be a common situation. A study published in the December 30, 2020, issue of the journal Headache examined how much women’s healthcare providers, such as ob-gyns, know about diagnosing and treating migraine — and found some significant knowledge gaps.

While Migraine Is Common, Research Suggests Doctors May Not Treat It Effectively

In an online survey of 115 women’s healthcare providers in Connecticut, the researchers found that while 83 percent of the doctors said they feel very or somewhat comfortable diagnosing migraine, only 58 percent routinely ask their patients about headaches during their annual visits.

Only 24 percent would order magnetic resonance imaging (MRI) for a new type of headache, while 48 percent would order it for headaches with neurologic symptoms such as an altered state of consciousness, weakness, numbness, vision changes, or difficulty with speech.

Fewer than 50 percent of the doctors were knowledgeable about common medications — such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and triptans — that are linked with medication overuse (or rebound) headaches if they’re used too often for acute attacks.

Many of these gaps may be due to the fact that only 37 percent of the respondents reported receiving education about headaches and migraines.

Migraine in Women May Be Misunderstood, Undertreated

"Less than half of the providers reported prescribing migraine-specific medications," says a coauthor of the study, Brian M. Grosberg, MD, the director of the Hartford Healthcare Headache Center and a professor of neurology at the University of Connecticut School of Medicine. And "the majority of providers did not routinely prescribe preventive medications [for migraine], citing discomfort with doing so. This is problematic, as previous research suggests that nearly 40 percent of patients with migraine may be eligible for preventive treatment, yet only 13 percent receive it."

What’s more, very few of the participants reported referring patients for evidence-based non-medication treatments for migraine, such as biofeedback, cognitive behavioral therapy (CBT), or relaxation techniques.

Getting to the Roots of the Migraine Awareness Challenge

The study’s findings are particularly disturbing given that migraine is roughly three times more prevalent in women than in men in the United States, the researchers note. Many women experience migraine attacks before or during their menstrual periods, during the postpartum or the time after childbirth, or during perimenopause, the years-long lead-up to menopause. Much of migraine treatment occurs within the primary care setting, and approximately one-third of women rely on their ob-gyns for primary care. Clearly, women’s healthcare practitioners need more education and training in how to diagnose and treat migraine — and the majority of the study participants indicated that they would welcome these opportunities.

How to Find Out if You Have, and Need Treatment for, Migraine

For women who experience migraine, the first step toward obtaining relief is to talk to your doctor about your headaches and the symptoms that accompany them. "Of the 40 million Americans living with migraine, only half have been diagnosed or talked to a healthcare professional about it," says Dawn C. Buse, PhD, a clinical professor of neurology at the Albert Einstein College of Medicine of Yeshiva University and a member of the board of directors for the American Headache Society. "If you experience headache that is moderate to severe and interferes with your ability to function, it might be migraine. If you have nausea or sensitivity to lights and sounds with your headache, it might be migraine. Talk to your doctor about these headaches to get a proper diagnosis and treatment plan."

Learn Where to Turn for Migraine Care and Treatment

Until gynecologists and women’s healthcare providers receive further training in the evaluation and management of headache, women who are impacted by migraine should consider seeing a headache specialist or neurologist, Grosberg says. The same is true if your migraine attacks significantly interfere with your daily functionality, if you have attacks more than four times a month, or if acute medications are ineffective or being overused.

Dr. Rajneesh agrees: "If you feel that you have tried several steps and not made any progress in the treatment of your migraine headaches, discuss with your physician if a consultation with a neurologist is a reasonable next step."

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