When to see a headache specialist for migraine relief

More than 38 million people in the U.S. are affected by migraines, a neurological disorder that causes intense headache episodes. That’s about 12 percent of the country’s population. And despite the availability of effective treatment options, it’s estimated that at least half of people with migraine are undertreated – and most don’t seek help from a doctor.  

"At least half of people with #migraine are undertreated – and most don’t seek help from a doctor.” via @MedStarWHC

Migraine causes a range of symptoms beyond headaches. These symptoms often are debilitating -- more than 90 percent of people with migraine are unable to work or function normally during an episode.

Migraine symptoms can include:

  • Throbbing or pulsating pain
  • Light, smell and sound sensitivity
  • Nausea
  • Blurred vision    

As a headache specialist, people often tell me they’ve tried over-the-counter (OTC) medications and various remedies to find migraine relief, to no avail. I assure them that there are other options, and that they don’t have to accept painful, debilitating migraines as a regular part of their lives. But for every person who seeks treatment from a specialist, there are countless others who choose not to.  

Why is that the case? For one thing, many people aren’t aware they’re having migraines. They’ve never been diagnosed, and they’re hesitant to seek care when they think they “just have a headache.”  

And going to the doctor takes time. It’s faster to stop by the pharmacy and pick up an OTC headache medication. But that time you saved won’t mean much if you’re laid up with migraine symptoms later when the OTC medication doesn’t work. Neurologists like me can prescribe more effective treatments than you’d find at the drug store.    

When to see a headache specialist for migraines

The frequency, length and severity of migraine episodes vary – some people have migraine headaches that last a few hours, while others are cooped up in bed with debilitating symptoms for days at a time.  

With so much variance, it’s difficult to give a broad recommendation on the symptoms that indicate when you should seek migraine treatment. But here’s a good rule of thumb: If your migraines are frequent or severe and proper use of OTC medications isn’t helping, it’s time to seek treatment from a specialist. 

By “proper” use of OTC medications, I mean that you should take the recommended dosage as early as possible during a migraine episode. If you wait to see how bad the migraine will be before you take medication, it’s less likely to work.

Some people with migraines find relief from OTC medications. Yet many people aren’t satisfied with the results or suffer such severe symptoms that OTC drugs don’t help. Additionally, if you rely on migraine medications too heavily, they actually can make migraine symptoms worse.  

This condition – known as rebound headache – occurs when the effects of a medication dose wear off, and people take more medication. If these people take medications too often, they can begin to trigger headaches instead of relieve them. Some people with rebound headaches have near-constant migraines, one melding into the next without relief.

If someone suffers from migraines that last more than four hours at least 15 days per month, we consider them to have chronic daily headaches. Though chronic daily headaches affect a smaller portion of people than migraines – less than five percent of the U.S. population – the condition can be debilitating and damaging to mental health. We can prevent chronic daily headaches by treating migraines before they get worse.    

If medications aren’t helping your migraines, request an appointment with a headache specialist or call 202-877-DOCS.  

Advanced migraine treatments

Migraine treatment falls into two categories: abortive and preventive. Abortive treatments usually are designed to stop migraine symptoms after they start, while preventive treatments aim to reduce the frequency or severity of migraines.  

Typically, we try to treat migraines first with abortive treatment. Any abortive treatments we provide should be taken as soon as you notice migraine symptoms. If severe, frequent and long-lasting migraines persist, we’ll look at preventive treatments.  

My migraine patients have access to a range of abortive and preventive treatments, including:

  • Botox therapy: Botulinum toxin injections are an effective treatment for chronic daily headaches.  
  • External nerve stimulation: An egg-sized device placed on the forehead stimulates the trigeminal nerve, producing a sedative effect that can help reduce the frequency of migraines.
  • Medications: A variety of prescriptions, such as antidepressants, anti-seizure medications and painkillers, can improve migraine symptoms.  
  • Nerve blocks: A medication is injected near the occipital nerve in the back of the head to reduce migraine pain.
  • Surgery:  People with migraines who also have chronic daily headache may benefit from surgery to reduce pressure on certain nerves.  
  • Transcranial magnetic stimulation: A special device held against the back of the head delivers a magnetic pulse to stop migraines as they start.  

With these advanced treatments, we’re able to give many people with severe migraines the relief they’re looking for. And with promising new types of migraine medication on the horizon, people with debilitating migraines soon might have even more options available.  

The top 3 symptoms mistaken for allergies

I see hundreds of people every year who ask for help controlling their allergy symptoms. Allergies can be serious and even life-threatening in some cases. But at least half of the patients I see for ear, nose and throat allergy symptoms don’t have allergies at all.

It’s a common mistake to make. Symptoms like nasal obstruction, “post-nasal drip,” runny nose and cough also may be caused or contributed to by other conditions having nothing to do with allergies.

Good treatment sometimes requires that we determine exactly what’s causing a person’s symptoms. That way, we can prescribe the right treatment for the right problem. Let’s examine the top three problems patients commonly mistake for allergy symptoms or sinus infections and see the impacts they can have on sufferers.

Symptom 1: Nasal obstruction

Nasal obstruction, or a blockage of the nasal airway, is a common symptom of allergies and sinus infections. But the anatomy of the nose, or the way the nose is shaped, can have a major effect on a person’s ability to breathe easily.

Deviated septum

The nasal septum is the thin, wall-like structure that separates the right and left nostrils in the nose. Ideally, the septum is straight to divide the nostrils evenly. But birth defects, injuries to the nose or even rapid growth during puberty can cause the septum to become crooked, or deviated.

Most of us have septums that are less than perfectly straight, but it’s usually not noticeable. For some people, though, a deviated septum, depending on its shape, may lead to an obstruction of one or both nostrils.

A nasal steroid may be prescribed, or, in more severe cases, we can correct a deviated septum through a surgical procedure called a septoplasty.

Learn about our minimally invasive ear, nose and throat surgical options.

Swollen turbinates

The turbinates are another structure of the nose. They’re located on either side of the septum inside the nostrils. The turbinates filter, warm and humidify air and keep it from being too dry as you breathe in.

If the turbinates are too large (a condition called turbinate hypertrophy) or misshaped, they can block the airway in the nose. This can lead to a similar type of nasal obstruction as one caused by a deviated septum, and the conditions can also occur together. Someone who has turbinate hypertrophy can feel like they have a stuffy nose or trouble breathing all the time.

A nasal steroid may decrease inflammation (and therefore, the swelling) of the turbinates, or surgery can be performed to decrease their size.

Symptom 2: Chronic cough and sore throat

Allergies or sinus infections can be associated with other inflammatory symptoms, such as:

  • Chronic coughing
  • Hoarseness, or a harsh, strained or raspy voice
  • Sore throat

But these also can be symptoms of other problems, such as chronic acid reflux. Acid reflux occurs when stomach acid backs up, or refluxes, out of the stomach and into the esophagus. The chronic type of acid reflux is called gastroesophageal reflux disease, or GERD. In some cases of GERD, referred to as laryngopharyngeal reflux (LPR), stomach contents can back up and cause symptoms all the way up into the throat, which can damage the soft tissues in that area. LPR can lead to coughing, hoarseness or sore throat, which could be mistaken for allergy symptoms or signs of a sinus infection.

Symptom 3: Headache and facial pain

I frequently see people who come in complaining of “sinus headaches.” They have “congestion” all the time. They have debilitating pain on one or both sides of their head and face and are sensitive to bright lights.

Some of these people actually do have sinus infections or other sinus conditions, but others don’t. Many people who think they have sinus conditions actually are undiagnosed migraine sufferers.

Many people who think they have sinus headaches actually are undiagnosed migraine sufferers.

When I bring this up to patients, some don’t believe me at first. They’ve never considered that their symptoms might be caused by migraine. They say things like, “I’m not seeing sparkly lights or an aura. I didn’t throw up. Aren’t you supposed to throw up if you have a migraine?” That’s not always the case.

I start thinking of migraine whenever I see a patient who complains of sinus headaches but who doesn’t have any other symptoms relating to the sinuses or nasal cavity, such as abnormal nasal drainage or obstruction. If you think you have frequent sinus headaches or infections, but you don’t have nasal symptoms like obstruction, abnormal drainage or other upper respiratory symptoms, ask your doctor if you might actually have migraine.  

Smoking: A major contributor to mistaken allergy symptoms

Symptoms of upper-respiratory conditions are a common thread among people with allergies: runny noses, coughing, sore throats, hoarseness, etc. But those are also symptoms we associate with irritation from first- or second-hand smoke. Smoking contributes to many upper-respiratory conditions patients often think of as allergy symptoms. 

Smoking contributes to many upper-respiratory conditions patients often think of as allergy symptoms.

One of the things we ask during a routine allergy examination is whether the patient smokes or lives with a smoker. It’s surprising how many people don’t know or haven’t accepted that their smoking is the cause of their problems.  

When I see a patient for allergy symptoms, and I learn that the patient smokes, I always begin by recommending that the patient stop smoking. It often can resolve the respiratory problems that brought them to see me in the first place. And even if smoking isn’t the root cause of the problem, it’s often very difficult for us to deal with the issue while the body is under constant respiratory distress from the person’s smoking.

Find the root cause of symptoms to get lasting relief

Allergies are a common condition, and they’re easy to misdiagnose. Most patients don’t need full skin or lab testing for allergies, so doctors often make a diagnosis based on patients’ symptoms, which can be similar to those of other conditions.  

People often assume they have allergies based on a Google search of their symptoms without checking with a doctor. Or they dismiss allergies or sinus problems as something not worth caring about; they just want relief from the symptoms that are interfering with their lives. Talk to your doctor about chronic symptoms, even if you think you know what’s causing them.  

My job as a doctor is to get to the root of what’s harming my patients. If that’s an allergy or a sinus condition, we have treatments available to address those problems. But these symptoms could be signs of more serious issues. If allergy or sinus treatments aren’t giving you relief, talk with your doctor about other potential causes of your symptoms to make sure you’re getting to the root cause—and treating it appropriately.