Migraine is a common neurological disorder, especially in women. However, only about half of those affected seek medical attention for these severe headaches, and most wait before seeking medical help. Fewer leave the doctor’s office with the correct diagnosis and a well-functioning treatment plan. While lack of access to medical care presents a major hurdle in the treatment of migraines, affecting often colored people and other underserved groups, some experts believe that gender bias plays a major role in why migraines are so often misdiagnosed, underdiagnosed, and undertreated.
„It’s unfortunately another example of good old-fashioned sexism,“ says Christopher Gottschalk, MD, neurologist and director of Yale Medicine’s Head & Facial Pain Center. „It must be that women complaining about headaches and not being able to function are lazy or neurotic or trying to get away with something. It can’t possibly be that they have this (medical) problem.“
Regardless of your race, ethnicity, or gender identity, it’s important that a doctor takes your headaches seriously. This is because you may need a prescription for migraine-specific treatments. So, speak to your doctor about migraines. Headaches are never a walk in the park. But the disabling nature of migraines sets these episodes apart from other types of headaches. Experts agree that you should highlight this life-changing aspect to your doctor. „Don’t even use the word headache,“ says Gottschalk. „Talk about, ‚These episodes I’ve been having render me nonfunctional for hours or days on a regular basis.‘ And so I cannot live.“
Here are some ways migraine episodes may affect your life beyond headaches:
– You may feel nauseous or need to vomit.
– Light and sound might bother you.
– You may feel tired or have difficulty thinking clearly.
– Your skin might hurt.
Left untreated, these symptoms can last several hours to several days. Between episodes, there may be brain fog, skin pain, or light sensitivity, especially if you suffer from headaches frequently. During a migraine episode, you may not feel well enough to carry out everyday tasks. And you should inform your doctor about the impact this has on your life. Here are some questions to ask yourself and share the answers with your doctor:
– Do you often leave work early or frequently call in sick?
– Do the symptoms affect school or learning?
– Are you unable to care for your family during an attack?
– Do you struggle to be in a bright office?
– Does the light from your computer screen or phone bother you?
– Do you also have symptoms of depression or anxiety?
Stand up for yourself and inform your doctor. Most doctors are familiar with migraines, but not every doctor specializes in headache medicine. The good news is that there are numerous online resources to help you manage your headaches and get closer to the right treatment. „There’s something called ID Migraine, which is a three-question screener that has been validated millions of times,“ says Gottschalk. „That’s the kind of thing where you find this screener, answer it, and show it to your doctor.“
According to ID Migraine, there’s a very high likelihood that you have migraines if you answer „yes“ to at least two of the following three questions:
– Have you been prevented from doing everyday things for at least one day in the last 3 months due to headaches?
– Do you feel nauseous when you have headaches?
– Are light or sounds bothering you when you have headaches?
You can also discuss the POUND mnemonic with your doctor. Tell them if you experience at least four of the following symptoms during an attack:
– Pulsating headache
– One-day duration of headaches (4 to 72 hours if untreated or treatment doesn’t work)
– Unilateral (one-sided) headache
– Nausea or vomiting
– Distracting headache
Visit trusted websites to learn more about recognizing migraine symptoms. Some examples are the American Headache Society, National Headache Foundation, and American Migraine Foundation. Additionally, groups like Miles for Migraine, Migraine Again, or the Coalition for Headache and Migraine Patients (CHAMP) have quiz questions about headaches and information on how to talk to your doctor.
Ask to try new treatments. There are a variety of medications that target and treat the acute migraine process. These treatments come in the form of pills, injections, nasal sprays, or through a vein in your arm (an infusion). You can also benefit from non-medication therapies. It’s difficult to predict which migraine treatment is best for you. However, there are many ways to stop headaches once they’ve started or reduce the risk of future attacks. In addition to triptans, there are some newer acute and preventive migraine treatments that you can ask your doctor about:
– Gepants (CGRP blockers)
– Dihydroergotamine (DHE)
– CGRP antagonists
– Neuromodulation devices
You can also benefit from:
– Cognitive-behavioral therapy
– Lifestyle changes
The goal of acute migraine treatment is to return to a normal life. Effective acute migraine treatments mean that you have no headaches within a few hours (or almost no headaches). Preventive therapy should reduce the number of future attacks. And those you have should be less intense and shorter. Get a second opinion. Let’s say you’ve already talked to your primary care physician about migraines. And for some reason, you’re not getting the treatment you desire. The next person you want to see is likely a neurologist. A neurologist is a doctor who specializes in diagnosing and treating diseases of the brain and nervous system. They should be familiar with the latest migraine medications and therapies.
Dawn Buse, PhD, is a migraine researcher and clinical professor of neurology at Albert Einstein College of Medicine in New York City. She says that most people are well cared for by their primary care physicians. „But there are people with migraines whose condition may be more complex or severe and for whom a visit to a neurologist would be beneficial,“ she says.
Here are some questions to help you figure out if a neurologist is right for you:
Have you already talked to a primary care physician or gynecologist about your headaches?
Has your primary care physician prescribed migraine medications that don’t work well or cause side effects?
Are you pregnant or planning to become pregnant and have strong headaches?
Do you experience 15 or more headache days a month?
Have you had the „worst headaches of your life“ or a change in your headache pattern?
What if you already see a neurologist but still need more comprehensive or advanced care? „If you want to learn more about the latest cutting-edge therapies or therapy combinations, there are headache specialists and headache centers throughout the country, but there aren’t many and they are mainly in big cities,“ says Buse. Consider consulting a headache specialist once or twice if you want to see one, but they are not covered by your insurance or are far away. Buse says they may be able to create a treatment plan for you that your local neurologist or primary care physician can follow. Visit the National Headache Foundation or American Migraine Foundation to find a headache doctor or specialist near you.