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Is Seeing a Specialist Always Best?

When people ask me about finding a doctor, I almost invariably tell them to see a headache specialist. Seeing someone with headache-specific knowledge is important because headache disorder education isn’t widespread. But is seeing a specialist always the best idea?

Dr. Aniruddha Malpani of The Patient’s Doctor writes:

Most patients want to go to the doctor who has special expertise in handling their particular problem. They will spend a lot of time and energy tracking down the “biggest name in the field” – and then leave everything up to the doctor. This can often be a short-sighted approach, because specialists are biased, and it’s important to be aware of this bias.

While it’s true that an expert has a lot of experience in dealing with a particular problem, this extensive experience also introduces all sorts of bias in the way he handles this particular problem. There are many reasons for this.

Because he is used to seeing complex cases which have been referred to him, he often cannot deal with simple bread and butter problems ! He also sees life through a distorted lens, and may not be able to see the big picture. Because he cannot afford to make mistakes, he often overtests and overtreats. He often asks for esoteric and expensive (and painful) tests, to differentiate himself from the other ordinary doctors. He also usually bad-mouths alternative options of dealing with the problem – after all, this is his competition! He is reluctant to refer cases which he cannot handle, because this would damage his aura of omnipotence and omniscience.

Often, in the pursuit of narrow goals, he loses objectivity; and is more interested in doing research rather than treating patients. Many experts are so used to seeing only sick patients, that they often cannot recognize a normal variant!

What do you think? Let us know in the comments below or on the online support group and forum.

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Headache NewsBlog By Headache Specialist Alexander Mauskop

Alexander Mauskop, director of the New York Headache Center, regularly posts his thoughts on current headache news on the aptly named Headache NewsBlog. He dispels myths and examines closely media coverage of headache news. Here’s a taste of Mauskop’s blog, but look over Headache NewsBlog to get the full flavor.

Current News

Medications

Botox

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Kerrie’s 2007: A Year to Forget

There was a theme consistently underlying my 2007 posts: My migraines were BAD. The year started with five months of being woken up by a migraine nearly every night and ended with more than two months of horrendous all-the-time migraines. I felt more beaten down than I have in the last three years.

Before you get discouraged by the following review, know that I am more optimistic about treating my migraines than I have been since I got my occipital nerve stimulator in December 2003. (Read more on that following the treatment review.)

Acupuncture
I revisited acupuncture, but my superhero acupuncturist told me that more sessions would be a waste of time and money.

Naturopathy/Homeopathy
Shedding tears in the naturopath’s office the first time was enough to keep me from seeing her again. Against my hard fast rule that I not take anything I can’t identify (which I also broke with the acupuncturist), I took the homeopathic remedy, vitamin D and magnesium supplements she suggested. They did nothing.

Chiropractic
I gave the chiropractor two months, which she said was the maximum time to see results. I went five times one week, four the next, three for a couple weeks and so on. Turns out I hold my adjustments very well. Unfortunately my migraines didn’t changed and having my neck adjusted freaked me out. Once she stopped asking about my headaches, I knew she had given up.

Sleep Specialist
Many people with treatment-resistant headache disorders become much more treatable once they have sleep problems resolved. Although my sleep seemed fine, I saw a sleep specialist with a background in neurology. Sadly, my sleep is practically perfect. I sleep eight hours, wake up rested, nap when I need to without having it interfere with that night’s sleep.

New Headache Specialist
I saw a new Seattle-based headache specialist in May. We hit it off immediately. Too bad we focused on my blog, headache patients in general and clinical trials. I left enrolled in a clinical trial for Lyrica (which I quit) and with a potential advertiser for The Daily Headache, but without having discussed any of my questions or other treatment options.

Food Trigger Diets
Food triggers were my obsession, even though I’ve always thought them to hog the spotlight in headache treatment (only about 25% of people actually have food triggers).

Although wheat and dairy aren’t considered headache triggers in the general sense, they were my target for months. My no-dairy foray lasted six weeks — until I discovered that I’d dropped 12 pounds in that time. Testing wheat lasted three months, yet I had no ill-effects when I reintroduced it.

After a couple years of avoiding them, I’m almost positive that beans, nuts and legumes are triggers for me. But berries, squash, sunflower and soy oil, barley, pineapple, onions. . . are all questionable.

I declared that I was going on a drastic food trigger elimination diet. A couple weeks later came this post: Drastic Elimination Diet for Migraine Triggers: What Was I Thinking? You get the point.

Myofascial Release
Finally some good news. In August I started myofascial release and noticed results quickly. The changes aren’t dramatic, but each treatment usually gives me some relief. The effects have never lasted more than two days — and sometimes only a couple hours — but I’m not complaining.

Craniosacral Therapy
Two sessions weren’t enough to judge if craniosacral will be effective. I’ll definitely try again, but it just didn’t work out this time. The woman I saw was wonderful and spent an extra 30 minutes with me each visit. Unfortunately, driving to her practice takes 30 minutes. After spending 20 minutes lost on the way there and another hour on the way home, the negative associations were too strong for me to go back.

What Now?
When the last migraine spell lifted in mid-December I remembered how good I could feel. Thinking about what I love about my life was no longer a reminder of what I couldn’t have, but of how wonderful it truly is. I am happy and getting out of the house more. I even get to see friends!

This year’s list of treatments to try is as long as it was last year. Its like I’ve spent the last 10 years whittling down possibilities and arrived at the most promising therapies. Having had this faith shattered in the past, I am cautious. Nonetheless, I’m positive a brighter path is ahead.

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How to Find a Doctor Who Knows About Headache

Would you trust an editorial about foreign aid policy that was written by the author of bodice-ripper romance novels? How about trusting doctors who calls themselves headache specialists even though they are trained in totally different fields, aren’t certified in headache management, and/or don’t participate in either of the national headache societies?

Some people who appear to be unqualified for a job do have training or experience that you can’t see at first glance. Usually, though, your initial skepticism is proven to be well-founded. The only way to find out is to research the doctor beforehand and devote part of your first visit to interviewing your new doctor. The best credentials in the world mean nothing if the doctor isn’t a good match for you.

To find a headache specialist, start with the American Headache Society or National Headache Foundation. Both have comprehensive lists of specialists who are members of their organizations. Being a member doesn’t guarantee that the doctor is good, but I’d only see someone who was involved in a professional headache organization.

ACHE (part of AHS) has a physician finder on its website. You can call NHF for a list of members in your state (888-643-5552) or check the online database, which includes all headache management certified doctors, whether members or not.

Related posts:

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Update on the Migraine & Chronic Daily Headache Treatments I’ve Tried Since February

I’ve tried a variety of treatments since February, but haven’t kept you updated. It’s like I don’t want to talk about them at the outset because I might jinx it. After a treatment has failed, I push it aside so I don’t have to think about it. Here’s the surprisingly long update.

Naturopath
Shedding tears in the naturopath’s office the first time was enough to keep me from seeing her again. Against my hard fast rule that I not take anything I can’t identify (which I also broke with the acupuncturist), I took the homeopathic remedy, vitamin D and magnesium supplements she suggested. They did nothing.

Chiropractor
I gave the chiropractor two months, which is the maximum time she told me it would take to see results. I went five times one week, four the next, three for a couple weeks and so on. Turns out I hold my adjustments very well. Unfortunately my migraines didn’t changed and having my neck adjusted freaked me out. Once she stopped asking about my headaches and focused on pain in my lower back, I knew she had given up.

By treating me as a challenge for which she was sure she had the solution, the chiropractor made the classic mistake of nearly every “alternative” care provider and many physicians I have seen. That always makes me laugh, but leaves me wary that the overconfident provider is setting him or herself up for a fall. Which is what always happens.

Sleep Specialist
Many people with treatment-resistant headache disorders become much more treatable once they have sleep problems resolved. Although my sleep seemed fine, I saw a sleep specialist with a background in neurology. Sadly, my sleep is practically perfect. I sleep eight hours, wake up rested, nap when I need to without having it interfere with that night’s sleep.

New Headache Specialist
A Seattle-based headache specialist that I’d never seen before was recommended highly, so I saw her in May. We hit it off immediately. Too bad we focused on my blog, headache patients in general and clinical trials. I left enrolled in a clinical trial for Lyrica and with a potential advertiser for The Daily Headache, but without having discussed any of my questions or other treatment options.

I already had Monday’s appointment with my first Seattle headache specialist, so I didn’t make another appointment with specialist #2. Seeing specialist #1 again reminded me that she’s the right doctor for me.

Lyrica Trial
In the spirit of giving back — and possibly finding an effective drug — I enrolled in a clinical trial of Lyrica. Currently I’m keeping a headache diary and am to start the meds (Lyrica or a placebo) at the end of the month. I’m pretty sure I’ll drop out before then.

Six months, the length of the study, is a long time to wait before I can get a prescription and test Lyrica out on my own. I have other treatments in the works and don’t want to confound the equation. Besides my impatience makes waiting more than a year to find out if I took Lyrica or the placebo agonizing. I can’t decide.

Wheat-Free, Dairy-Free Diet
This one needs it’s own post, which I’m working on. In sum, it looked like there could be a connection, then it looked clear there wasn’t. Now I have no clue.

That’s the update. Disappointing, huh? I have another round of ideas percolating. They seem like good ones this time, not acts of desperation. We’ll see.