It’s been 12 years since my first appointment with a headache specialist. Going with Hart when he saw a specialist for the first time a few weeks ago provided an interesting perspective.
Hart had a spike in his migraine frequency significant enough that we were both worried. (We figured out it’s due to an unrelated med change. He stopped the med and his migraine frequency has dropped. Phew!) Seeing my specialist seemed like overkill, but I didn’t want to mess around with unfamiliar providers who could be lacking current knowledge. As a compromise, he saw someone in my specialist’s practice. We have both been impressed with everyone we’ve encountered in the practice and this doc was no exception.
- Oral meds, even the dissolving ones, have to go through the stomach before reaching maximum efficacy. Nasal sprays or injections provide the fastest possible treatment.
- Triptans are most effective when taken before the pain is moderate or severe. All the numerous headache specialists I’ve seen have told me to take triptans as soon as I know a migraine is coming, whether there is pain or not. I recently learned that some people only find them effective if they are taken once the head pain has began. This doc confirmed that when to take triptans is an open debate, but that for most patients he recommends as early as possible, head pain or not. He did say patients can test them at different times in the early migraine (while the pain is still mild) to see when the drug is most effective for them. (The question is whether or not you’re willing to risk a worse migraine now for the potential of less severe migraines in the future.)
- The first preventives the doctor recommended were magnesium (400 mg) twice a day and riboflavin (400 mg) once a day. Amitriptyline was next if those don’t work. I expected the doctor to recommend amitriptyline, but was pleasantly surprised that he said to try magnesium and riboflavin first.
It was a straightforward appointment that went exactly how I expected a first-time visit to a headache specialist to go for someone without chronic migraine. I just wish more people got such care from the start of their migraine treatment.
2 thoughts on “A First Visit to a Headache Specialist”
I’m interested in amitriptyline vs nortriptyline. The 1st neuro I ever saw put me on nortriptyline while I was just episodic & not chronic & it seemed to work for a few months, but then the migraines came back w/ a vengeance. I’ve always wondered if it was a fluke. During those 1st few months I moved, got married & my cousin was in a serious brain injuring accident. I’ve always found adrenaline to help greatly w/ my pain so I’m wondering if it was the nortriptyline or the adrenaline….in any casei didn’t like the side effects–weight gain & low libido. I’ve heard others in the migraine world mention amitriptyline so just wondered if it was better for migraines.
Mindy, amitriptyline has more supporting evidence for its efficacy (http://migraine.com/blog/migraine-preventives-start/), but the other tricyclics are often used. Usually doctors try amitriptyline first, then move to the others if it doesn’t work. Amitriptyline also has weight gain as a side effect.