• So you have a migraine. Your head feels like it's being jackhammered and you see flashing lights. Before you pick up the phone or jump into the car, think. Seeing the right physician can mean fewer headaches and quicker relief when you have them.

    First stop: Primary care

    Call your primary care physician first. If you don't have one, get one. A good primary care internist will be able to distinguish a migraine from other types of headaches (such as tension or cluster). She can develop a treatment plan with you that will reduce the frequency of migraines and give you strategies for treating a migraine when it comes on.

    Referral: Neurology

    If your primary care physician's plan isn't working, she should be happy to refer you to a neurologist. A neurologist can help clarify the diagnosis in difficult cases and add additional expertise to your treatment plan. The neurologist should communicate with your primary care physician to coordinate care and decide how and where treatment should be given when you have a severe headache.

    Migraine emergency

    If your headache is so severe that you're vomiting and can't keep anything down, a visit to the emergency room may or may not be in order. If you have a treatment plan, it will tell you what to do. Some doctors' offices have the capacity to treat quickly and save you hours of waiting in the emergency department. Call your agreed contact person--primary care physician or neurologist--first.

    Follow up

    Whether you've gone several months with only two migraines, or have just returned from an emergency room visit, check up with your primary care physician to follow up on your treatment plan. It may need adjustment, and your doctor will only know if you tell her.

    Second opinion

    If you're still having frequent migraines despite adhering to and adjusting your treatment plan, ask for a second opinion--a referral to a neurologist if you don't have one, or a second neurologist if you already do. Most physicians will be happy to arrange another opinion for you.


    Up To Date clinical community

    American Headache Society

    More Information:

    American Headache Society Committee for Headache Education

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