For Canadians managing migraine, finding effective healthcare support is essential. Navigating the system, however, requires understanding available options and identifying which providers offer genuine expertise in headache and migraine care. Here, we discuss what you can expect from primary care providers, how to identify specialists and complementary care, and what to look for when choosing a clinic for migraine treatment. 

Current Realities in Migraine Care 

Migraine care in Canada has come a long way yet remains complex due to varying levels of expertise and more treatment options. Without an official certification in headache medicine, expertise may vary among providers, making it essential to understand their backgrounds, training, and specialization. 

What to Expect from Your Primary Care Provider 

Primary care providers (PCPs), including family physicians and nurse practitioners, often serve as the first line of care. Here’s what you can expect: 

1. Diagnosis and Initial Treatment: PCPs typically assess for migraine and may begin treatment with lifestyle recommendations and basic medications to manage acute attacks. 
2. Medication for Acute Relief: PCPs can prescribe medications for managing acute migraine so that you can effectively treat attacks when they arise. Some options include NSAIDs, triptan, or gepants.  
3. Medication for migraine prevention: Preventive treatments should be initiated in primary care if you are experiencing 4+ migraine attacks per month, there is impact on your function, or if you need acute treatment on 8+ days each month. The non-specific migraine preventives are typically started first (click here to learn more). Primary care providers should be able to initiate at least one oral preventive treatment. 
   Some PCPs with a special interest and expertise in migraine may also prescribe advanced preventive treatments, including gepants, CGRP monoclonal antibodies (mAbs), and Botox.  
4. Referral to Specialists: If migraine attacks are unresponsive to initial treatments, or require specialized interventions, PCPs can refer you to a neurologist or headache specialist with expertise in the latest migraine management strategies. 

Screening for Specialized Migraine and Headache Clinics 

As you search for a clinic specializing in headache and migraine treatment, consider the following criteria to ensure you receive comprehensive care: 

1. Availability of Specialty Medications: Look for clinics that offer a full range of treatments, including gepants, CGRP mAbs, and Botox. Clinics that provide these medications are generally more focused on medical migraine treatment and are up to date on the latest advancements. You may need to call around to inquire as the information may not be included on a website. 
2. Avoid Aesthetic-Only Clinics: Be cautious of aesthetic clinics that only offer Botox for migraine prevention. While Botox can be effective for chronic migraine, a comprehensive migraine clinic will typically offer additional preventive and acute medications. Medical clinics specializing in headache treatment are more likely to assess your full medical history and collaborate on a broader treatment plan. 

Types of Providers Specializing in Migraine Care 

If you need specialized care, you may encounter the following types of providers with advanced training in migraine management: 

• Neurologists: Neurologists with expertise in headache medicine can provide comprehensive care, including advanced medications and procedures like Botox, CGRP mAbs, and gepants.  
• Headache Specialists: Neurologists or pain specialists focused exclusively on headaches often practice in academic centers or private clinics dedicated to migraine care. These specialists may provide a higher level of care and offer treatments not typically available in general practice settings. 
• Family Physicians & Nurse Practitioners: There might be some PCPs in your community who have developed a major interest in migraine and who have developed special expertise in migraine care. These often offer a high level of care for those with migraine. Over time we are witnessing an increase in primary care providers becoming more educated on migraine. There are continuing medical education programs now available for primary care providers to advance their knowledge about migraine. 
• Pain Clinics: Pain clinics may offer additional options, such as nerve blocks, infusions, and neuromodulation, although most pain clinics do not focus on treating migraine. It’s best to confirm that the clinic has experience treating headaches specifically. Inquire about their familiarity and use of CGRP mAbs, Botox, and gepants.  

Other Healthcare Professionals Who Can Help with Migraine Management 

Other healthcare providers can offer additional support to those with migraine, addressing lifestyle factors and promoting overall well-being. These healthcare providers commonly* include: 

• Psychologists: Behavioral therapies, such as learning relaxation techniques, biofeedback and cognitive behavioral therapy, can provide tools to manage pain and reduce stress, both of which are critical in migraine management. 
• Physiotherapists and Chiropractors: Skilled in body alignment and musculoskeletal health, these professionals may help reduce neck and back tension, which can be migraine triggers. It is important to understand that neck discomfort and pain may be a part of the migraine attach itself and does not necessarily mean that there is an actual problem with the neck. While neck strengthening, stretching, and postural exercises can be useful, and neck mobilization may be helpful, it is recommended that neck manipulation be avoided. 
• Occupational therapists: Occupational therapists can help those with migraine develop routines for managing their everyday activities without triggering attacks. Many can also help patients learn behavioural skills like relaxation techniques and stress management.  
• Dietitians: For migraine affected by dietary factors, dietitians can help identify triggers and develop a balanced eating plan that may help as part of a migraine management plan.  
• Kinesiologists: Regular exercise can be helpful in reducing migraine attacks, but those with migraine often find it difficult to develop a regular exercise program because attacks may also be triggered. A kinesiologist can help those with migraine gradually improve their fitness without triggering attacks. 

*This list includes examples of professionals commonly engaged. Some patients have also experienced success with other disciplines not included above.  

Building a Multi-Modal Migraine Care Plan 

Effective migraine management often involves combining different treatments and providers. Here’s how to navigate this approach: 

1. Consult Your PCP: Begin with your primary care provider who can make a diagnosis, offer initial treatment and in many cases start preventive therapies if necessary. 
2. Consider Specialized Care: If standard treatments aren’t sufficient, seek out a neurologist or other physicians or nurse practitioners with special expertise and knowledge who can offer advanced migraine treatment options. 
3. Include Other Healthcare Professionals: Other healthcare providers as listed above can enhance your care, help you manage triggers, and support overall well-being. Be sure to discuss these options with your PCP for a coordinated approach. 
4. Stay Informed and Engaged: Proactively monitor your symptoms and follow up with your providers to ensure your treatment plan remains effective. Consider keeping a headache diary, for example The Canadian Migraine Tracker, which is available online.  

Moving Forward with Migraine Care in Canada 

While navigating the Canadian healthcare system can feel challenging, understanding the roles of various providers can help you build a comprehensive, effective care plan. By combining primary, specialized, and complementary care, you can access a range of treatments and resources that will support your journey to improved migraine management and quality of life.