Migraine Specialist: Everything You Need To Know

Migraines affect approximately 12%¹ of the U.S. population. While some of them can be treated by your primary doctor or alleviated by changing your lifestyle, some migraines are persistent. If migraines recur after treatment and affect your ability to carry out daily activities, it is best to visit a migraine doctor specializing in this condition.

What is a migraine?

A migraine is a neurological condition that manifests various symptoms, most commonly a throbbing, pulsating pain on one side of your head. While people often use the terms "headache" and "migraine" interchangeably, the two conditions are not the same.

Headaches often result in pain in the head, face, and upper neck. However, while migraines can result in more extreme headaches, not all migraines cause head pain. Migraines also manifest other debilitating symptoms that people with headaches do not experience.

Signs and symptoms of migraine

There are four migraine stages, although you will not always experience all when you have a migraine: prodrome, aura, actual migraine, and postdrome.

Prodrome

Before the onset of a migraine, you may exhibit symptoms that can alert you of its coming. They include:

• Increased urination

• Food craving

• Inexplicable mood changes

• Fluid retention

• Yawning

Aura

This phase entails seeing flashing or bright lights or zigzag lines. You may also experience muscle weakness and pin-like sensations in the arms or legs.

The actual migraine

At this stage, you will experience severe throbbing pain, which typically occurs on one side of the head. While some migraines start as headaches, it is possible to experience a migraine without the headache. 

During this phase, you might also exhibit:

• Increased sensitivity to light

• Nausea and vomiting

• Pain upon coughing or sneezing.

Postdrome

In this last phase, you might contend with fatigue and confusion, lasting up to a day.

Causes of migraines

It is challenging to pinpoint the exact cause of migraines, but genetics and environmental factors play a part.

Migraines can also result from anything that directly or indirectly triggers vasodilation or activates the trigeminal pathway or the brain stem and cortisol, spreading depression.

Some common migraine triggers include:

• Stress

• Inadequate sleep

• Some types of food and drinks (some diets result in the release of norepinephrine and serotonin, which are vasodilators)

• Caffeine withdrawal

• Hormonal changes

• Hunger

• Weather changes

• Sensory stimuli such as bright light, odors, and sounds

• Certain medications

Types of headaches

There are two main types of headaches: primary and secondary.

Primary headaches result when you overexert pain-sensitive structures in your head. They are not indicative of any underlying disease but can be caused by chemical activity in your brain.

Common primary headaches include:

• migraines

• tension-type headache

• trigeminal autonomic cephalalgias

Secondary headaches result from an underlying disease responsible for triggering the pain-sensitive nerves in the head. Some causes of secondary headaches include:

• Concussion

• Meningitis

• Stroke

• Influenza

What doctor specializes in migraines

Neurologists are the doctors best placed to treat migraines. However, other doctors can come to your aid to help determine your migraine triggers and how to treat them. 

For instance, the migraine could stem from a dental issue or a nasal problem. Specialists in these fields could help get down to the root cause of your pain.

Who is a neurologist?

A neurologist² is a doctor who specializes in the diagnosis and treatment of diseases that affect the nervous system. The nervous system is composed of two parts:

• The central nervous system, which entails the brain and spinal cord;

• The peripheral nervous system is composed of the other neural elements such as eyes, ears, skin, and other sensory receptors

Thus, neurologists treat disorders affecting these parts. However, they do not perform surgery but instead, refer such cases to neurosurgeons.

What diseases does a neurologist treat?

A neurologist looks into diseases affecting the brain, spinal cord, and nerves, such as

• Headache disorders

• Alzheimer's disease

• Parkinson's disease

• Amyotrophic lateral sclerosis

• Speech and language disorders

• Seizure disorders

• Cerebrovascular diseases such as stroke

How do neurologists diagnose a migraine?

A neurologist will diagnose a migraine by first looking at your medical history. They will seek information about the onset of the migraine, the frequency, duration, and any known potential triggers. 

They will seek information on the location of the migraine and the accompanying symptoms. Diagnosis or tests done by other doctors could also help reveal the problem.

The neurologist can compare your signs and symptoms to the diagnostic criteria to confirm a diagnosis and determine the subtype of migraine you have. 

Diagnostic aids and screening tools such as a headache diary and headache calendar, which contain information on the pattern and frequency of the migraines, can also help pinpoint your problem or help with a re-evaluation of the diagnosis.

A differential diagnosis is crucial to help determine whether your symptoms result from a migraine or other primary headache disorders. 

The neurologist may examine your symptoms and compare them against the characteristics of primary headache disorders to avoid a misdiagnosis. They could also contrast your symptoms against the red flags associated with secondary headaches to rule out the possibility of potentially life-threatening conditions.

If the neurologist suspects an underlying medical condition to cause the migraine based on their findings in the differential diagnosis, they might recommend neuroimaging³. 

However, it is advisable to avoid neuroimaging methods such as CT scans if there is no suspected case of a secondary headache as it involves exposure to ionizing radiation.

Neuroimaging tests

MRI scan

Magnetic Resonance Imaging (MRI) is a test that provides clear images of the brain without using ionizing radiation.

It gives doctors information about the brain structures and chemicals, using strong magnetic fields and radio waves to produce images projected onto a computer. MRI is not needed to detect primary headaches such as migraines but could be used to rule out secondary headache disorders that mimic migraines.

The neurologist examines the images for any changes in the regular brain structures to seek evidence of an underlying problem.

CT scan

A computed tomography scan uses X-rays to create pictures of the body. Just like the MRI, it is not a diagnostic tool for migraines. Still, it can help rule out more serious medical conditions that result in secondary headaches disguised as migraines.

A CT scan is painless and uses minimal radiation to produce images of body organs.

Sleep study

Also known as polysomnography in medical circles, a sleep study is a test mainly used to diagnose sleep disorders. A sleep study takes place at a sleep center where a technologist monitors brain waves, blood oxygen levels, heart rate, and breathing using sensors placed on your scalp, temples, chest, and legs. 

These sensors have wires connected to a computer that records data while you are sleeping. The data recorded herein can be used to diagnose sleep disorders.

A sleep study can help determine the quality of your sleep, which can, in turn, establish whether your migraines stem from sleeping problems.

Treatment of migraines

Migraines can cause debilitating pain that can make it hard to function normally. Thankfully, you can try the following interventions to treat this disorder and get back to a healthy life.

Lifestyle changes

Adjustment to your way of life can help alleviate migraine symptoms. For instance, exercising regularly releases chemicals that block pain signals in your brain.

Working on your dietary habits can help with your condition. It is advisable not to skip meals, as hunger and malnourishment can trigger migraines. You should also avoid foods and drinks that trigger migraines.

A good night's sleep can also be the difference between a healthy you and the one experiencing migraine episodes. Therefore, establish a proper sleep schedule and avoid distractions that interrupt your sleep.

Given that migraines and stress often complement each other, you can avoid the former by managing the latter. Some effective stress management techniques involve taking breaks when overwhelmed, creating time to relax, and having a positive outlook.

Medication

There are classes of drugs that specifically help prevent or relieve migraine pain. Some types of medications include:

• Painkiller

• Ergotamines

• Triptans

Some medications for prophylaxis migraine treatment include:

• Beta-blockers

• Calcium channel blockers

• Antidepressants

• Anticonvulsants

Injectable medication

Research shows an association between calcitonin gene-related peptide (CGRP) and the development of migraines. Scientists have thus created injectable treatment options that target CGRP to reduce the frequency of migraines. 

Some preventive injectable medications that can also be used for acute or chronic migraines include:

• galcanezumab (Emgality)

• fremanezumab (Ajovy)

• erenumab (Aimovig)

These medications work by blocking CGRP activity or targeting CGRP receptors. However, while the medicines can help prevent migraines, some populations prove unresponsive. Patients can administer these treatment options at home.

Botox is also effective in the treatment of migraines and works by blocking neurotransmitters that carry pain signals to the brain.

There are also injectable options that treat migraines once they have occurred. Unlike the preventive options, injectables for acute migraines are not meant for long-term daily use.

Some available options for treating migraines include sumatriptan and dihydroergotamine (DHE). However, pregnant women should avoid these drugs due to the risk of adverse pregnancy outcomes.

Non-pharmacological therapies

You could pursue this method of treatment as an option, especially if the medicine is contraindicated. Some of the viable interventions include biobehavioral therapy and acupuncture. 

Migraine surgery

Migraine surgery is a controversial method of getting rid of migraine pain by removing tiny sections of bones or tissue pressing on nerves to relieve pressure.

Typical forms of migraine surgery include:

• Neuromodulation

• Septoplasty

• Turbinectomy

• Peripheral neurolysis

Neurologists and health specialists advise against this form of intervention since very few studies exist regarding its effectiveness and the risks involved.

When should I visit a migraine specialist?

Migraines are a common disorder in the U.S. Therefore, it is not uncommon to talk to your primary care doctor upon experiencing the symptoms associated with this neurological condition.

Your doctor can diagnose primary headaches and recommend treatment if required. However, if the migraines become more severe and persist even after treatment, you should visit a migraine doctor.

Possible signs that you need to see a neurologist for your migraines include:

• When the migraine is not responding to the drugs prescribed by your primary doctor

• When you have a migraine and present with other symptoms such as weakness on one side of the body or a seizure

• If the headache begins after you injure your head, this could be a post-traumatic headache.

• Your migraine makes it hard to carry out everyday functions or regularly keeps you off work or other activities.

The lowdown

A migraine is a neurological ailment characterized by pain on one side of the head and can be accompanied by headaches, although this is not always the case. They can result from poor sleeping habits, stress, particular foods, and other causes. 

Your primary physician can treat symptoms of migraines, but if symptoms persist, it is wise to visit a migraine doctor, which is a neurologist, as they specialize in the treatment of neurological issues. A neurologist will examine your medical history and symptoms and determine the best cause of action, including imaging tests if they suspect the migraine to result from an underlying condition.