Findings from a recent study indicate that physicians who treat women suffer from substantial unresolved questions, which may jeopardize their ability to provide effective treatment for this painful disorder.
Migraines are notoriously difficult to deal with because of the pounding, throbbing, pulsing pain and confusion they cause. Additionally, discovering that your doctor’s expertise of migraine diagnosis and treatment isn’t as keen as it should be may add to your suffering. It’s possible that this is a frequent occurrence, which is unfortunate. Headache, published online on December 30, 2020, investigated how much information women’s healthcare professionals, such as ob-gyns, had regarding detecting and treating migraine — and discovered that there are substantial knowledge gaps on the subject.
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Despite the fact that migraines are common, research suggests that doctors may not be treating them as well as they might be doing.
In an online survey of 115 women’s health care providers in Connecticut, the researchers discovered that while 83 percent of the doctors said they felt very or somewhat comfortable diagnosing migraine, only 58 percent of the doctors routinely inquired about headaches during their annual visits with their patients.
Only 24 percent of people would request magnetic resonance imaging (MRI) for a novel kind of headache, while 48 percent would want it for headaches that were accompanied with neurologic symptoms such as altered state of consciousness, weakness, numbness, visual abnormalities, or trouble communicating.
Fewer than half of the physicians were aware of popular medicines — such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and triptans — that have been associated to medication overuse (or rebound) headaches if they are taken too frequently for acute episodes, according to the study.
One possible explanation for many of these discrepancies is that just 37 percent of those who answered the survey said they had received instruction regarding headaches or migraines
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Misunderstanding and undertreatment of migraine in women are possible.
A study coauthor, Brian M. Grosberg, MD, director of the Hartford Healthcare Headache Center and a professor of neurology at the University of Connecticut School of Medicine, says that “less than half of the providers reported prescribing migraine-specific medications.” Grosberg is also a coauthor of the study and a professor of neurology at the University of Connecticut School of Medicine. Furthermore, “the majority of physicians did not regularly provide preventative medicines [for migraine], expressing apprehension about doing so.” This is worrisome since prior study indicates that almost 40% of migraine patients may be eligible for preventative therapy, but only 13 percent of those who qualify get it.”
Even more concerning, just a small number of participants reported recommending patients for evidence-based non-pharmaceutical migraine therapies such as biofeedback, cognitive behavioral therapy (CBT), or relaxation methods.
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Considering that migraine is about three times more common in women than in males in the United States, the results of this study are especially concerning, said the study’s researchers. Migraines are common among women, especially before and during their monthly cycles, during the postpartum period or the period after delivery, and during perimenopause, the years-long period before menopause. A large portion of migraine therapy takes place in the main care environment, and about one-third of women seek primary care from their ob-gyns. The majority of research participants agreed that additional education and training in migraine diagnosis and treatment is needed for women’s health practitioners. They also agreed that they would welcome the opportunity to participate in future studies..
Determine whether you get migraines and whether or not you need treatment for them
Talking to your doctor about your migraine headaches and the symptoms that come along with them is the first step in obtaining treatment for migraine sufferers in general. Approximately 40 million Americans suffer from migraine, but only half have been diagnosed or talked to a healthcare professional about it, according to Dawn C. Buse, Ph.D., a clinical professor of neurology at Yeshiva University’s Albert Einstein College of Medicine and a member of the American Headache Society’s board of directors. When you have a headache that is mild to severe and interferes with your ability to function, it is possible that you are experiencing a migraine.
A migraine may be the cause of your nausea and sensitivity to lights and noises, as well as your headache. Consult your doctor about your headaches to ensure that you get an accurate diagnosis and treatment plan.”
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You may discover patterns and triggers by tracking your symptoms.
The keeping of a headache journal is one of the most effective methods to find your way toward migraine treatment. “It provides the individual suffering from migraine, as well as their treating physicians, with a visual representation of the frequency and intensity of their headaches, as well as potential triggers,” Dr. Grosberg explains. According to him, you can also track your use and response to acute analgesic medications, supplements (such as magnesium, coenzyme Q10, and riboflavin) that can help prevent migraine attacks, and lifestyle factors such as diet, hydration, sleep, stress management techniques, and hormonal fluctuations, among other things.
Please keep in mind that, according to Dr. Buse, overusing an over-the-counter pain reliever for migraine may have the opposite effect intended and increase the frequency of migraines. The use of migraine prevention medications as well as non-pharmacological therapy methods may be beneficial in this situation.
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Make sure to inform your doctor if you are suffering from untreated anxiety or depression, advises Dr. Kiran Rajneesh, MBBS, head of the neurological pain section at the Ohio State University in Columbus and assistant professor of neurology and neurosurgery at the same institution. In his opinion, if you have any of these problems and they are left untreated or undertreated, “you may not be getting the full benefit of headache therapies.”.
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Dr. Grosberg recommends that women who suffer from migraine consult with a headache specialist or a neurologist until gynecologists and other women’s healthcare professionals get more training in the assessment and treatment of headaches. A same conclusion may be reached if your migraine episodes substantially impair your daily functioning, if you have attacks more than four times a month, or if acute medicines are ineffective or are being abused.
If you believe you have taken many measures and have not seen any improvement in the management of your migraine headaches, talk with your doctor if a visit with a neurologist is a sensible next step. Dr. Rajneesh concurs:
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Moving on is OK if you are not receiving the attention you need.
I visited six different physicians before landing on my present neurologist.
While I waited in his office for my first visit, he was diligent in his assessment, he listened, and he recognized my problems. For the first time in a long time, I felt understood.
At this point in my migraine adventure, I had been experiencing dizziness, nausea, vertigo episodes, and dissociative symptoms that were plain frightening on a constant basis.
Because I did not have any head pain during my episodes, prior physicians did not associate my symptoms with vestibular migraine.
I was on the verge of losing my job as a watch designer, and I hadn’t been able to drive for months. I was in desperate need of assistance, and I needed it quickly.
Prior to this meeting, physicians had either informed me that there was nothing more they could do and that we had exhausted all other alternatives, or they had told me that my problems were caused by worry and sadness.
In order to get the most out of my visit, I prepared a list of everything I had done so far, as well as a detailed description of the symptoms I was experiencing and the therapies I believed may be beneficial based on my own research.
When we were talking about medicines, I informed my neurologist that it was essential to me to try to have a family as soon as possible and that I was worried about weaning myself off specific prescriptions. None of this was a problem for him, and we adjusted my treatment plan to include items that might either transition into pregnancy or that I would be able to come off of easily when the time came.
I’m fairly sure I heard the “Hallelujah” chorus right there in the clinic.
Due to a variety of reasons, including in-network provider limitations, insurance coverage, and geographic location, visiting seven physicians is not always the norm or an accessible option for the majority of individuals. However, many individuals who suffer from severe migraines find it difficult to locate a migraine specialist that they can trust.
So, how do you know when it’s time to move on or when your doctor may not be the best fit for you? These hints may be of assistance.
They disregard your signs and symptoms.
I was told by some of the most well-known neurologists and otolaryngologists in Dallas that my bouts of vertigo, continuous dizziness, and the sensation that I was falling or walking on marshmallows were all caused by stress and that I needed to relax.
How can someone maintain a calm and collected demeanor when they believe they are losing their health… and their minds?
If your doctor is dismissive of symptoms that are causing you to lose your independence or are having a major impact on your work, you should consider seeking a second opinion.
Other red signs that I have seen that fall into this category include when they refer to your migraine episodes as “headaches” or minimize the severity of your attacks. Migraine is a neurological disease that should be treated as such.
If you find yourself showing up to visits with information that your doctor has never seen before, or if you find yourself spending the majority of your meetings teaching them, it may be time to locate a specialist who shares your enthusiasm for healing.
Your initial visit will be quite brief.
Unless you’re visiting your doctor on a regular basis for follow-ups, your session shouldn’t take less than 10 minutes.
An first session that is so brief would not provide you with enough time to discuss any new symptoms or modifications to your treatment plan, nor would it enable them to pick up on signals that you may be neglecting to mention.
In an ideal situation, a thorough examination should be done at your initial visit, and you and your physician should discuss your symptoms in depth.
When you’re pressed for time, it’s easy to lose track of all the things you want to ask or say.
Bringing a notepad with questions may be helpful, particularly if you have any brain fog, but having a dialogue with your doctor is very essential. You should feel comfortable addressing any adverse affects of prescription medicines, as well as any concerns you may have about beginning a new medication.
They are adamant in their refusal to listen.
With the appropriate migraine expert, a relationship will be established – one in which you and your migraine specialist both listen to each other (yes, this goes both ways).
It’s tough to make any progress in a relationship if you feel like someone is simply talking at you and not paying attention to what you’re saying.
This was a big problem for me in the beginning, and I know many physicians dismissed me as a “dramatic lady.” When my husband was in the room with me, I would discover that they were just talking or listening to what he had to say.
What you’re going through with a migraine condition is real, it’s genuine, and it needs someone’s complete attention.
If your expert isn’t paying attention to you, particularly when you come prepared with research or suggestions, they may be overlooking some important signals that may lead you to the appropriate medicine or therapy.
You had a chance encounter with another individual.
If you go into a meeting with a specialist and leave with more questions than you went in with, you may want to consider finding a specialist who can communicate more effectively or who is more specialized.
Often, this only a little investigation, but some kinds of migraine, such as ocular, vestibular, or hemiplegic migraine, need the use of physicians who are acquainted with the symptoms and therapies associated with those types of migraine.
For example, some of the medicines I may use to treat vestibular migraine are highly unique to that kind of migraine and will not necessarily work for other types of migraine.
If your doctor is accustomed to seeing patients with head pain and isn’t used to dealing with someone who has main symptoms of vertigo or derealization, it’s likely that they won’t have enough expertise in that area to provide you with the best therapy available.
This may make the difference between seeing a neurologist or a headache specialist and seeing a neurotologist.
It’s quite OK to go on and meet someone else, or even seek a second opinion.
They claim that there is nothing more you can do.
I’ll never forget listening to a neurologist, David Dodick, MD, speak at the Migraine World Summit. He said that it would take a lifetime for migraine sufferers to really run out of therapeutic choices.
With the introduction of novel migraine medicines and neuromodulation technologies in recent years, the number of migraine treatment choices is quickly increasing.
If a doctor tells you that you’ve tried everything and there’s nothing more that can be done, what he or she is really saying is that there’s nothing else that they can do for you.
Don’t give up on obtaining the medical attention you need.
In certain areas, it may be difficult to locate the appropriate physician at times, and individuals suffering from migraines used to have to be willing to travel in order to get an appointment.
My husband and I traveled 16 hours to visit a single expert after being advised I shouldn’t fly (it actually was fine for me to do once I saw the right physician).
Now that teleconferences and phone consultations are becoming the norm, it opens the way for many of us to finally get the treatment we need.
