Who Treats Migraines?

The majority of migraine patients are not currently consulting a physician.

There are at least 39 million Americans with Migraines according to the American Migraine Foundation. This is around 12% of our population. Of adults age 16 and over, 18% of females and 6% of males have migraines.  If these patients have consulted a physician at one time or another, only about 50% of patients have even received the diagnosis of migraine headache. Many are misdiagnosed with tension headache or recurrent sinus headaches. A recent study suggests that patients with moderate to severe recurrent sinus headaches actually suffer from migraine headaches. General Neurologists only see a small percentage of patients with migraines and many general neurologists don’t like taking care of migraines. Board Certified Headache Specialists see even fewer of these patients. If you are suffering with migraines or any type of head pain you should start with a neurologist like Dr. Loftus who is boarded in Headache Medicine.

Should I go to an ER or Urgent Care for migraine treatment?

Emergency Rooms and Urgent Care centers are excellent at ruling out secondary causes of headaches (e.g making sure sure the headache is not caused by a brain tumor, concussion, aneurysm, meningitis, etc.)  but many do a poor job in the acute therapy department once any causes are ruled out and it is determined it is a migraine headache. “Migraine cocktails” given in ERs and Urgent Care should avoid opioids. Injectable ketorolac is an excellent backup treatment plan for migraines and patients can be taught how to give ketorolac to themselves intramuscularly at home. At $2/dose, it is very inexpensive as well.  Very few emergency rooms are using dihydroergotamine or haloperidol.  Dihydroergotamine is the a gold standard among headache specialists for prolonged migraine headaches that might drive some patients to an ER.  In a review of acute migraine therapies, IV haloperidol has the highest therapeutic gain (patient response versus placebo) for ER visits. 

Other types of treatments and “migraine cures”.

In my area, you can find stem cell therapy and PRP (plasma rich protein) therapy that are thousands of dollars and not supported by controlled studies.  -Brian Loftus, M.D.

To better understand this, a normal placebo arm in recent migraine prevention studies looks similar to this.  (Keep in mind these are the people who don’t get the treatment.)  Participants  have a response rate (more than 50% fewer headache days) of 40% with 20% of all patients having 75% fewer headache days.

Dr. Loftus does send patients for sinus surgery when it is warranted, but does not claim this is a cure for migraines.  (Although some websites he has seen recently claim it will be). About 1-2% of the new patients he sees each year need sinus surgery.

Nerve decompression surgery has its role but again its use is relatively infrequently. Before doing any expensive procedures or surgery for migraines, please see a Headache Specialist similar to Dr. Loftus who is board certified in Headache Medicine.