5 Things you should question your Doctor about your Migraines
Here are 5 things that American Headache Society task force recommends to help physicians and patients make wise decisions about the most appropriate migraine care.
1. There is no need to preform neuroimaging studies when you have stable migraine headaches. This is based on the fact that there is numerous evidence-based guidelines have shown that the risk of intracranial disease is not elevated in people with migraine headaches. A migraine diagnoses however needs to be made based on the International Classification of Headache Disorders criteria to avoid missing patients with more serious headache.
2. If you are going to get neuroimaging, make sure you get a MRI instead of CT scan, except in emergency setting. A MRI is more sensitive than CT scan for the detection of many of the secondary causes of headache. CT scan should only be obtained in the emergency setting when hemorrhage or acute stroke is suspected.
3. Do not get surgical deactivation of migraine trigger points outside of a clinical trial. The value of the form of ‘migraine surgery’ is still under question with limit evidence that it is effective or safe. Long term side effects from these types of procedures are also unknown.
4. Do not take opioids or butalbital containing medications as first line treatment for your migraines. These medications can impair alertness, produce dependence or addiction. They may worsen your headaches by increasing the frequency of your headaches and may make your headaches harder to treat. These medications may also produce heightened sensitivity to pain.
5. Do not use prolonged or frequent use of over the counter medication for your migraines. Over the counter medications (OTC) can be used for occasional headaches if they work reliably without side effects. Frequent use (especially of the caffeine containing medications) can lead to an increase in headache frequency/medication overuse headaches. Overuse of Acetaminophen containing medications can cause liver damage. Overuse of non-steroidal anti-inflammatory drugs can lead to gastrointestinal bleeding. Thus it is recommended that you do not take OTC more than 2 days a week.
Loder E, Weizenbaum E, Frischberg B, Siberstein S. Choosing Wisely in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question. Headache. 2013:53:1651-1659.
Moran, M. From the American Headache Society: ‘Choosing Wisely’ in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question about Migraine. Neurology Today. 2014:14.