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There are many steps to optimum migraine care. The patient can even perform a number of them without the input of a physician.
- Keep a headache calendar and write down headaches, severity, what you took for the headache, and how you responded to the medication. It is helpful for female patients to mark their menstrual cycles because this is a common migraine trigger. Dr. Loftus has designed the iPhone and iPod touch app iHeadache to do this for you. Most importantly, it prepares reports for you and your physician to use to determine the correct course of therapy.
- Dr. Loftus asks all patients to avoid caffeine and chocolate, the most common migraine triggers for a period of time to see the effect. This means going completely caffeine free and chocolate free.
- Try to set a consistent sleep schedule and get plenty of rest.
What else can I do?
Migraine prevention before acute medication use is key for patients with more than 2 headaches a week.
Limit all acute headache treatments, including both over the counter and prescription, to only three (3) days per week in order to avoid a “medication overuse” headache. Unfortunately, this means you will be in pain the other days but in the long run, you will be much better off. If the patient is seeing Dr. Loftus, they will be on a migraine preventative therapy which will help stop the recurring headaches. In addition, steroids are commonly used. Patients are occasionally admitted to the hospital if they are unable to stop their daily medication but this is uncommon.
Once the headaches have been reduced to twice a week or less through preventative migraine therapy, the patient and physician can work to determine the best acute migraine treatment. Using the acute therapy early at the onset of a headache minimizes disability. Unfortunately, many insurance companies work against this principle by limiting the patient’s triptan tablets per month. This is despite numerous studies showing that triptan use is actually cost effective.
Patients who are not doing well with their current physician should consult another physician. For whatever reason, some physicians like to treat headache patients and some like to avoid them. Even among neurologists, some are much more likely to take on and treat the more difficult patients. This is human nature and it is unreasonable to fight it. If you are not doing well with your current physician or you feel that your needs are being ignored, go see someone else. If you see someone who identifies himself or herself as a headache specialist and you are not making progress, then see a second headache specialist. Being a neurologist, Dr. Loftus is partial to the overwhelming data that migraines are not an allergy, a surgical disease, or some hormonal deficiency. Therefore if you are not doing well with your physician, please see at least one headache specialist who is a neurologist.