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Ask a Headache Specialist: Stanford Headache Clinic Director Taking Your Questions

Have a question for a headache specialist? Robert Cowan, MD, director of the Stanford Headache Clinic and a lifelong migraineur, wants to answer them. Submit your questions by 5 p.m. Pacific time on Friday, March 8, by tweeting with the hashtag #AskSUMed or commenting on the Scope blog post: Ask Stanford Med: Director of Stanford Headache Clinic taking questions on headache disorders.

Stanford Medicine asks that you follow these ground rules when submitting a question:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses

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My Ideal Headache Specialist

Migraine Awareness Month Blogging Challenge #19: “The Match Game” — Describe your perfect doctor to treat your migraines.

My ideal migraine doctor attended Hogwarts and then completed four years at a top-notch magical medical school. After a four-year residency in neurology, she did a two-year fellowship in headache medicine at the world’s best magical headache clinic. She’s kind, compassionate, brilliant and innovative — and she’s never had a patient whose migraine attacks couldn’t be controlled. Chronic migraine is her expertise and her typical patient goes from 25 migraine days a month to five. The treatment is complicated, painful, time-consuming and, of course, expensive, but it works beautifully.

I feel a little snarky writing that I want a magic doctor in response to the blog challenge, but I’m tired and fed up as I begin week four of severely disabling migraine attacks. I have seen so many headache specialists, including some brilliant, well-respected, highly regarded, compassionate, academic superstars and yet I still have a migraine nearly every day. My current headache specialist and the person I saw in Boston are my favorites. I trust them both tremendously and know they have my best interests at heart. And yet I still have a migraine nearly every day. It feels like my migraines are beyond the current understanding and experience of medicine and that only a Hogwarts graduate has the knowledge to get them under control.

National Migraine Awareness Month is initiated by the National Headache Foundation. The Blogger’s Challenge is initiated by Fighting Headache Disorders.

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Terrible Migraines: Is it birth control pills? Allergies? A bad spell?

My brain has had a rough month. I’ve had brief reprieves, but most of my time has been occupied by terrible migraines. I feel better this morning and am taking full advantage of it.

I’m in my fourth week of birth control pills. I’ve been spotting for the last 10 days, which I assume has contributed to the migraines. I plan to give the experiment a couple more months, but am not sure if I can make it that long.

I’m increasingly certain that allergies trigger at least some of my migraines. You may remember last spring was also horrible for me. Magnesium certainly was a factor. I wonder if allergies were also involved. Taking a Zyrtec yesterday appears to have reduced my agony tremendously. I had to reschedule yesterday’s appointment for allergy tests (for the third time) for later this month. (Please note that although allergies don’t cause migraines, they can be a trigger.)

My outlook is surprisingly good. Especially considering a bad appointment with my headache specialist Monday. The gist of the appointment: I have headaches and migraines that haven’t responded to treatment. With time, headache research will uncover more clues. Until then, why not try some more things in case they help? And I should think about medication to “make life bearable,” like morphine. (That’s a can o’ worms I can’t open right now.)

Back to the good outlook: If I have to live with migraines and headaches, at least I can do it the best way possible. I have a comfortable home; supportive, patient friends and family; and an understanding husband. My insurance covers a variety of treatments. I can stream NPR and audiobooks from the library. I eat good food that I don’t have to make. My life is as good as it can be right now.

I’m sad to not post more on the blog. I want to write about news and research. I want to share resources. I want to write about myself less. I want the blog to be like it was two years ago. Change is inevitable, so I’m trying to not worry about it much. Maybe I’ll get there again, maybe not.

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What’s With My Head: New Headache Specialist, Menstrual Migraine, Allergies & Reading

New Headache Specialist
I saw the headache specialist several readers have recommended and really liked him. After more than two hours with me (we had to schedule a second appointment to fit it all in!) he speculated that some of my headaches are actually caused by new daily persistent headache. In the past, my chronic daily headache was always attributed to migraine transforming to everyday.

Although the doctor wants to see me monthly, the next available appointment is in March. Before then I’m supposed to get a lumbar puncture (spinal tap) and more blood work. My last lumbar puncture resulted in a three-week headache and wasn’t responsive to a blood patch. I’m not looking forward to it.

Menstrual Migraine
I got a birth control pill prescription to see if it will manage the two-day migraines I get when my period starts. In typical fashion, I haven’t filled the prescription. The migraine that kept me in bed my first two days of vacation in Mexico should motivate me to to take it to the pharmacy.

Allergies
After always feeling worse after vacation, I finally admitted my headaches and migraines are worse in Seattle than elsewhere. I was in Kansas for a funeral the last weekend of October. I was shocked to wake up two mornings in a row with a barely perceptible headache. Nor was I as congested as I always am at home. I took Zyrtec for a few days and both my congestion and migraines were less. Not a reliable experiment. It unfortunately made me nauseated, so I couldn’t keep taking it. I’m trying Claritin now.

When I was tested for allergies when I was 14, I responded most strongly to mold. That wasn’t an issue in Phoenix — quite the opposite in Seattle. Studies indicate than while allergies don’t cause headache, they can trigger migraines. Thursday I’m seeing an allergist and will probably get tested for allergies. Maybe she can sort something out.

Migraines Triggered By Reading & Working on the Computer
These are still in full-force, hence my infrequent posts. A loved one who is an ophthalmologist gave me a thorough vision and eyestrain exam when I was in Phoenix for Thanksgiving. The diagnosis was convergence insufficiency. That means:

Convergence insufficiency occurs when your eyes don’t turn inward properly when you focus on a nearby object. When you read or look at a nearby object, your eyes should turn inward while you focus, so you can see a single image. But if you have convergence insufficiency, you need to use extra effort to move your eyes inward for focusing. This extra effort results in various symptoms, including eyestrain.

I’m now using an eye patch when I read or am on the computer. So far, I’ve been able to squeak out about an hour on computer with it. I still get a headache if I push it, but it is mild and doesn’t explode into a migraine. If the eye patch continues to be OK, I’ll get prescription reading glasses with a prism, which I can wear over my contacts.

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Seattle Doctors, Neurologists & Headache Specialists

I’ve been asked about Seattle headache specialists and neurologists more times than I can count in the last month. My experience is quite limited, but the online support group and forum has a thread with recommendations for Seattle headache doctors. If you have any to add, please do! You can also check What Do You Think of Your Doctor, an earlier post with lots of good suggestions, some in Seattle, some elsewhere.

Here’s what I know:

I’ve seen Sylvia Lucas at UW and Sheena Aurora at Swedish. They are both kind and caring. We all click with different people, of course, but I found Dr. Lucas to be more patient-oriented and Dr. Aurora to be more research-oriented. Both have at least three-month long waiting lists. It took six months to get into my first appointment with Dr. Lucas and follow-ups are usually scheduled two months out. Dr. Aurora is more like three months for an initial appointment.

A friend sees Patrick Hogan, an osteopathic neurologist, in Tacoma. His number is (253) 284-4488. He requires a doctor’s referral regardless of your insurance and your family/general physician will have to contact his office to get you in.

For other doctors in the Seattle area — or anywhere else in the US, check the National Headache Foundation’s physician finder or the American Headache Society’s health care provider search.

8/14/14: Many readers have lamented Dr. Elena Robinson‘s move to Vancouver. She’s back in Seattle and is in practice with the University of Washington.