A Headache Specialist? Who is that?
Have you ever wondered how Migraine is diagnosed or who makes a Migraine diagnosis? In this post, I am going to explain an overview of how individuals with Migraine go through the process of differential diagnosis, and what physicians may be involved in the process. If you don’t know what Migraine is, then I suggest taking a few minutes to read the post titled “Migraine: Going Beyond The Headache”, it describes my understanding of Migraine from the teachings of doctors such as Peter Goadsby, Joel Saper, Paul Matthew, and Amaal Starling just to name a few. For a quick recap, Migraine disease consists of attacks during which there is an increased presence of Calcitonin Gene Related Peptide.
There is a quote from House, M.D. that fits well here, “Pick your specialist, pick your disease.” It is common for Migraine to get treated like a pain disorder or one which can be treated by a Plastic Surgeon. When I am talking about the later, I am not saying that people are referred to the Plastic Surgeon by a specialist who treats headache disorders specifically, but these individuals are going straight to the Plastic Surgeon or other specialist Otolaryngologist. Why an Otolaryngologist or Plastic Surgeon you might ask.
Is it a Face Lift or Sinus Infection?
First, we will address why going to the Otolaryngologist is not the right approach. Otolaryngologists are also known as Ear, Nose, and Throat specialists, they diagnose and treat diseases of said areas. Migraine can present with symptoms similar to that of a sinus infection and because the Otolaryngologist is focusing on diseases that relate to the Ear, Nose, and Throat that commonly present with headache as a component they miss a lot of what a specialist who focuses on headache would see. As for the Plastic Surgeon, these specialists are trained in the administration of Botcholinumtoxin A (Botox) for cosmetic purposes and aren’t trained in the administration of said treatment for Migraine. So, at this point, you may be asking, who treats headache disorders?
Who treats headache disorders?
There is a subspecialty in Neurology called Headache Medicine. The specialists who practice in this subspecialty are called Headache Specialists. I named a few earlier on in this post but here are a few more, Herbert Markley, Alan Rapaport, and Randall Weeks. These doctors spend their days not only treating patients with headache disorders but also advocating for them and with them because many of these individuals have one sub-type of headache or another and sometimes even multiple sub-types of headache themselves. These doctors also specifically research the medicines and methodologies for the management of Migraine.
Every year there are national and international events that these doctors attend to collaborate and share their findings. One example of an event such as this is the Scottsdale Headache Symposium which is held in November in Scottsdale, Arizona and is happening the week after this article is published. They even attend speaking engagements that aren’t exclusively for the doctors but for the patients as well, one example of this is the Miles for Migraine Walk/Run. There are the opening ceremonies for the walk/run, and in addition to that, there are presentations or talks that are associated these events. I recently attended such an event where there were presentations from doctors Alan Rapaport and Deborah Tepper. There was even a panel format question and answer session at the end of it that included the aforementioned Rapaport and Tepper but doctors Markely and Matthew, the Master of Ceremonies and Moderator of the event was Dr. Randall Weeks. Now that you know the who, you may be wondering, how is Migraine diagnosed. It is a tedious process, so let’s talk about that.
How is Migraine Diagnosed?
Today, diagnosing Migraine isn’t as straightforward as diagnosing some other illnesses. Remember that Migraine is a Primary Headache disorder and the unique thing about these types of headaches is there is no known cause. Given there is no known cause there really is nothing to work forward from. Migraine will not show itself on any type of image, common modalities include Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). There currently aren’t any blood tests available to diagnose Migraine either. In “Migraine: Going Beyond The Headache” I mentioned a quote from Dr. Paul Matthew, “Migraine comes from your mother, not your mother-in-law”. It’s not for certain that you will have Migraine if your mother had it but there is an increased likelihood of it developing at some point in life.
One component of diagnosing Migraine is a complete, accurate, thorough health history. When I say health history I am not just talking about that patients own history but their siblings, parents, and grandparents. The health history combined with diagnostic tools such as previously mentioned imaging studies or brain activity studies such as an Electroencephalogram (EEG) can tell a story that can help a Headache Specialist come to a diagnosis of Migraine. Diagnosing Migraine is done via the process of elimination, I said earlier that there are no tests to directly and definitively diagnose Migraine. As a patient, there is plenty you can do to help get to the diagnosis.
What can I do to help?
One thing you can do before going to see the Headache Specialist is put together a headache diary. A friend of mine took a 3-ring binder and put in the months for the current calendar year. She then marked of which days she had an attack on each calendar and what severity each attack was on a scale of 1-10. At the front of the binder, she includes a summary page that has notes of what symptoms she had and what medications were utilized. You say that you don’t want to deal with papers and binders?
If the physical headache diary isn’t for you there are plenty of digital headache diary apps for Android and iOS. My digital headache diary of choice is Migraine Buddy. This app is great because not only will it allow you to track triggers, reliefs, and symptoms. It will also allow you to export a report of your attacks to share with your Headache Specialist. Regardless of the method you choose the data captured in the diary can be of great help to the doctor in terms of getting an accurate diagnosis.