If you have mild or infrequent migraines, you might be able to manage them on your own with an occasional ibuprofen. However, if migraines start to take over your life, you might need help. When this occurs, you might be stuck wondering, which doctors treat migraines, anyway?
How your primary care physician can help
You also should consider discussing any headaches, particularly if they are new for you, with your primary care specialist. “[If] over-the-counter medication [is] not working for you, that tells you that you've sort of reached the limit, so of course the next step has to be to go to your physician,” says Kaveh Alizadeh, MD, Plastic Surgeon and Headache Specialist at Westchester Medical Center.
It’s the job of your primary care physician (such as an internist or family care physician) to rule out other causes of unmanageable headaches. They may assess your other overall health concerns and vital signs, such as high blood pressure.
“Once you've gone through that step, they're likely to put you in the first regimen of medications that will help with your headaches,” says Dr. Alizadeh. This may include acute migraine medications such as triptans or ergots. Learn more about how to talk to your doctor about migraine treatment.
How a neurologist can help
“If you increasingly notice that you're becoming a victim to your headache — you're constantly… avoiding scenarios, avoiding things that you love to do because of your headaches — I think it's important to seek the next level of treatment,” says Dr. Alizadeh. “That next level of treatment is a neurologist with a special interest in headaches.”
A neurologist is a physician who treats disorders of the central nervous system (the brain, spinal cord, and nerves). Neurologists may specialize in a wide array of conditions — from strokes to multiple sclerosis — so it’s beneficial to find one who specializes in headaches and migraines.
The advantage of seeing a neurologist for frequent or severe migraines is that they can help fine-tune your treatment regimen. They may prescribe an alternative acute treatment, or they may suggest preventative treatments for migraines.
How an interdisciplinary team can help
Beyond a primary care physician and a neurologist, there are actually several fields of medicine that may specialize in migraines. These alternative perspectives may be extremely beneficial for difficult-to-treat migraines.
“If you've been under the care of a neurologist for six months or longer and you're still not seeing any change, I think it's time to go to the next level,” says Dr. Alizadeh. “That next level is for you to go to an academic center where they have an interdisciplinary team of doctors that have come together to manage the most extreme cases of migraines.” You might also consider requesting a telemedicine appointment if in-person is not immediately available.
An interdisciplinary team of doctors to treat migraines might include:
An internist or other primary care physician
A neurologist who specializes in migraines
A pain specialist, such as an anesthesiologist or someone who focuses on headache medicine
A surgeon, such as a plastic surgeon and/or a neurosurgeon
“Hopefully, the consensus of that group will be able to provide a pathway for you,” says Dr. Alizadeh. Learn more here about how to tell if your migraine treatment is working.
Dr. Alizadeh is a board-certified Plastic Surgeon with private practices in New York City and Long Island and formerly served as the Chief of Plastic and Reconstructive Surgery at Westchester Medical Center and New York Medical College.
References
American Academy of Neurology. (n.d.) What is a neurologist?
American Migraine Foundation. (2017). What to expect from a first-time visit to a headache specialist.
Gaul, C., et al. (2011). Team players against headache: multidisciplinary treatment of primary headaches and medication overuse headache. The Journal of Headache and Pain.
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