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Who treats migraines?
The number one prescriber to migraine patients are migraine patients. In other words, they self prescribe. This is because the majority of migraine patients never see a physician. In fact even if they consulted a physician at one time or another, only about 50% of patients have even received the diagnosis of migraine headache from any physician. Many are misdiagnosed with tension headache or recurrent sinus headaches. A recent study suggests that patients with moderate to severe recurrent sinus headaches actually suffer from migraine headaches. Neurologists only see a small percentage of overall migraine headache patients. Headache specialists see even fewer patients than the general neurologist.
Urgent care centers and Emergency Room are excellent in ruling out secondary causes of headaches but do very poorly in the acute therapy department. "Migraine cocktails" should avoid opioids. Injectable ketorolac is an excellent backup plan for migraines for patients at home. At $2/dose, it is very inexpensive as well.
In my area, you can find stem cell therapy and PRP (plasma rich protein) therapy that are thousands of dollars and not supported by controlled studies. The placebo arm in recent migraine prevention studies have a response rate (more than 50% fewer headache days) of 40% with 20% of all patients having 75% fewer headache days. While I do send patients for sinus surgery, this is not a cure for migraines (unlike some websites I see in my area). 1-2% of the new patients I see need sinus surgery each year. Nerve decompression surgery has its role but again its use is relatively infrequent. Before doing any expensive procedures or surgery, then please see a Physician who is Boarded in Headache Medicine.
