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Migraine What Your Doctor Doesn t Know
New findings suggest that doctors who treat women have significant knowledge gaps that could compromise the care of this debilitating condition. By Stacey ColinoJanuary 8, 2021Everyday Health ArchiveFact-CheckedDoes your doctor understand migraine?iStockThere’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. RELATED: 5 Health Conditions Related to Migraine 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. RELATED: Your Everyday Guide to Living Well With Migraine 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. RELATED: June Is Migraine and Headache Awareness Month 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. RELATED: 7 Top Treatments for Menstrual Migraine 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.” RELATED: Dr. Lisa Sanders Diagnoses the Reason Your Condition Has No Name Tracking Symptoms Can Help You Find Patterns Triggers
Keeping a headache diary is one of the best ways to navigate toward relief from migraine attacks. “It allows the person impacted by migraine, as well as their treating providers, a visual picture of the frequency and severity of their headaches as well as possible triggers,” Dr. Grosberg says. You can also track your usage 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, he adds. Keep in mind: Using an over-the-counter pain medication for migraine too often can have the opposite of the desired effect and increase the frequency of migraine, Dr. Buse warns. In that case, you might benefit from preventive medication for migraine and nonmedication treatment options. RELATED: How to Choose Birth Control When You Have Migraine Recognizing Migraine Related Conditions and Co-Occurring Mood Issues
Also, be sure to tell your doctor if you have untreated anxiety or depression, urges Kiran Rajneesh, MBBS, the director of the neurological pain division and an assistant professor of neurology and neurosurgery at the Ohio State University in Columbus. “If you have these conditions and they’re untreated or undertreated,” he says, “you may not be obtaining full relief with headache treatments.” RELATED: Resources for People Living With Migraine and Headache 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.” NEWSLETTERS Sign up for our Healthy Living Newsletter
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