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When and how to see a headache specialist to treat migraine

Telehealth for Headache

Photo by Elisa Ventur on Unsplash

We are excited to share this guest post by Thomas Berk, MD, Medical Director of Neura Health.

Choosing the right kind of headache care provider can make all the difference in the world, especially if you’ve been struggling with migraine without much success. As a neurologist and headache specialist, I’m here to help you navigate your options.

Many types of doctors treat migraine

Most people’s first step is to talk with their primary care provider about their symptoms. PCPs (and their nurse practitioners and PAs) are familiar with many of the more common subtypes and treatments of migraine, such as triptans and some of the oral preventive medications. PCPs also know how to determine whether a headache could be a sign of something more concerning, such as a brain tumor.

If you experience headache attacks more than once a week, or the treatments given to you by your PCP haven’t been helpful, you will likely need to be evaluated by a neurologist. Neurologists specialize in diagnosing and treating diseases of the brain, spinal cord, and nerves. General neurologists treat many conditions, including epilepsy, multiple sclerosis, Parkinson’s, and Alzheimer’s, for example, in addition to headache disorders.

But there are over 150 different headache disorders (many of which have subtypes, and they need to be treated differently). Specific, unique characteristics differentiate the type of headache you have, and your diagnosis will ultimately dictate how best to treat your headaches and what kind of specialty or generalist care you may need.

Depending on your symptoms and the type of headaches you experience, various types of medical professionals could also be involved in your headache treatment - including physical therapists, dieticians, dentists, and chiropractors.

The difference between a general neurologist and a headache specialist

All headache specialists are neurologists, but not all neurologists are headache specialists. Neurologists often treat headache disorders, but a headache specialist has gone through extra training and is up to date on the latest treatments, medications, and devices. There is a lot of new research to keep up with at the frontier of understanding headache medicine.

Many years ago, there was no formal criteria to be a headache specialist. They were doctors (mostly neurologists) who were particularly interested in headache medicine. Since 2003, there has been a UCNS (United Council for Neurologic Subspecialties) certification for this title. Most headache specialists have completed a headache fellowship (additional years after neurology residency learning about and treating the most challenging and complicated headaches), and are more familiar with rare headache disorders and subtypes than a general neurologist is.

Many patients who struggle with migraine see a general neurologist because they are not aware that there is such a concept as a headache specialist. By the time they realize this is an option, they wish they had been able to get treated by one much sooner.

Who should see a headache specialist?

People with chronic migraine or status migrainosus (an individual attack that lasts more than 72 hours) should certainly consider seeking out sub-specialty care from a fellowship-trained, board-certified headache specialist. And those who have less frequent or less severe migraine could still benefit from a headache specialist of course.

Headache specialists often help patients who have failed multiple medications, who have been through what can seem like every treatment imaginable for 5, 10 or 20+ years. I reassure my patients all the time that they should never lose hope because there’s always something more I can do to help. A good headache specialist must have great compassion and empathy, in addition to a deep knowledge of headache medicine and innovative treatment options. It’s important that patients come away from every appointment feeling optimistic about their treatment plan.

A headache specialist can also offer IV medications when headaches are the most severe, as well as consider off-label and lesser-known ways to manage migraine, and specific symptoms including pain, insomnia, nausea, anxiety, vertigo, light sensitivity, or fatigue. We also know when a patient might require inpatient treatment and can refer them to inpatient headache centers that can help get their condition under control.

Headache specialists know that while prescription medications are often an important part of treatment, there are also many non-medical treatments that can be incredibly helpful toward managing migraine triggers (stress, weather change, poor sleep, certain foods, medication overuse, and more). They think about comprehensive care that is required to help their patient with migraine or other headache disorders. As a result, depending on your individual case, they may recommend that you also see other professionals as part of your treatment plan, such as a dietician, psychotherapist, or even an acupuncturist.

How to get a consultation with a headache specialist

There are only about 700 fellowship-trained headache specialists in the entire United States, most of which are located in major cities. Even general neurologists are difficult to get into - the average wait time to get into a neurologist in the US is 35 days. Every neurologist would have to see 10x the number of patients in a year, in order to adequately meet demand. For patients with long-lasting or frequent migraine, that wait to get treatment can be agonizing.

When people have to wait months to get in to see a neurologist or headache specialist, they get frustrated and often try to find other options - or they make do while they may be in pain. But now telehealth - specifically video visits done at home - can be a great option for those who have trouble getting an appointment in person:

  • Telehealth broadens access to headache specialists
  • Patients avoid the hassle and expense of long drives or travel
  • Patients avoid the migraine triggers they might have encountered in a doctor’s waiting room (lights, sounds, smells)
  • Visits are more quickly expedited and focused, increasing throughput time and reducing waitlists (with Neura Health, you can book a same-day or next-day 45 minute video visit with me or one of our other headache specialists and neurologists.)
  • The neurological exam can be adapted for video visits and a diagnosis can be made virtually
  • The vast majority of serious conditions (where a headache is a symptom of of another medical condition) can be determined quickly and referred ASAP to emergency care
  • Telehealth providers can refer patients to local providers for scans, labs or procedures (injections, infusions, etc) while continuing to oversee their patient’s care overall
  • Technology allows for remote monitoring such as a digital headache tracker seamlessly integrated into the medical record, so the care team can stay up to date on patient progress
  • I encourage you to be aware of your treatment options, including virtual care, to make sure you are getting the expertise, treatment and compassion that you deserve. If you’d like to try Neura Health, I’d be glad to develop a personalized treatment plan for you.

Special Offer: Get a $15 credit toward your first Neura Health membership fee payment by entering promo code ALLAY15. You will be able to book a video visit with Dr. Berk himself!

About the Author:

Thomas Berk, MD is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is an emerging leader of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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