Your Migraine Team: you are not alone
Migraine can be a very mild problem for some people. One, two advils, and that’s it (lucky them). But for many people with migraine, there is no quick fix or easy solution.
On your path to improvement and a better life, you may meet different allies with multiple skills. Here is a list of those who can help you on your journey and their role. We did not include friends and families. As everyone has different priorities, we listed them in alphabetical order.
Acupuncture is well studied for migraine, and though the benefits are in good part a placebo response, it is a safe option (including during pregnancy, when most drugs can’t be used). LINKIN 1001
Advocate for patients
The migraine community needs champions, people who spend time improving the situation at a higher level. Politics influence the health care system, and you as a user. Voters change the system, that’s why patient associations like Migraine Canada are important.
The relationship between physicians and chiropractors is not always harmonious, as the theories for each approach are sometimes in conflict. Nevertheless, people with migraine, especially if they suffer from neck pain, will often seek an advice in chiropractic medicine.
Emergency Medicine Doc
If you suffer from severe attacks, you will probably meet many ER docs who will prescribe IV medications. Up to 4% of emergency visits are for headache (not only migraine). Different treatments can be offered, but migraine in the ED remains a difficult situation.
Migraine impacts work significantly and in different ways. It is very important for employers to understand that migraine is a neurological disease that can be disabling. Best case scenario: a migraine friendly workplace and an employee wellness program with a migraine focus. Note: employers may also determine your drug coverage plan.
A key player in your care, they will follow you on the long term. They see the vast majority of people with migraine, but they probably don’t get enough training about headaches. Always remember that family physicians are often forced to work at a fast pace and don’t always have the time to dig deep in explanations and questions. Referring you to a neurologist may be an important step.
Headache Specialists usually see very complex patients, and many headache cases that are not migraine. They are often neurologists, but some family physicians, physiatrists and pain physicians have this expertise. In Canada there is no official training for Headache Medicine subspecialty. Waiting lists to see a specialist are often very long.
Insurance company (drug coverage or disability)
Maybe you don’t perceive your insurance company as an ally (all those forms!), but this is an important part of your migraine situation. Drug coverage is essential to access the best options. Coverage varies from one plan to the other. The disability linked to migraine is not well recognized (a good topic for migraine advocacy).
Exercise is not easy for everyone. The kinesiologist can counsel you on different ways to move, motivate you and provide programs fitted to your needs. What is learned with a kinesiologist can then be practiced on the long term. An underestimated ally to get back in shape, the way that fits you.
Massage therapy is not well studied for migraine. Patient stories suggest a short term relief, but often no lasting effect on migraine frequency. Regular massage is still part of migraine management for some people.
Migraine Canada (founded in 2018) is committed to improving headache care in Canada. We are an alliance of health care providers and patient working together. Our key pillars are Awareness, Advocacy, Education, Support and Research
If your family physician needs advice on your diagnosis and treatment, (s)he may refer you to a neurologist. Prepare for this evaluation by reviewing your stories, making sure that relevant parts of your file are available (imaging results, medication lists) and by filling a headache diary. Expertise in headache medicine may vary from one neurologist to the other.
Some clinics are lucky to work with nurses (another name for angel). The role of the nurse can vary, from gathering information, answering your phone calls and providing advice on headache management. In doubt, the nurse will refer to the physician for advice.
These nurses have trained at a higher level, and they can diagnose and prescribe. They usually work in collaboration with a physician but may also work in independent clinics. Their role in migraine management is to be determined.
Adapting your dietary habits may make a difference in your migraine situation. Many approaches are available, from extremes like the ketogenic diet, to basics like a sufficient water intake. While diets are sometimes overestimated as a migraine treatment, they are an interesting option for many people.
Occupational therapists are well known for things like adjusting desks and stroke rehabilitation to gain back function. In headache management, they can work wonders by helping you find concrete strategies to deal with unpredictable migraines and adapt lifestyle. Examples include sleep routines, pacing, relaxation techniques, and time management.
Osteopathy offers a different non-invasive approach which uses manual manipulations to improve physiological function. It may focus on the structures of the head, neck and shoulders. Scientific evidence for its effectiveness is limited by the fact that manipulations cannot be blinded for research, but positive patient reports are available.
These are NOT allies, but you will still meet them on your path. Remember the Golden Rule of Migraine World: no-one-size-fits-all. Any person trying to convince you that migraine can be cured with a «simple trick», «ancient remedy», «miracle procedure» or any other should be considered with a good dose of caution.
Peers with migraine
People with migraine are stigmatized. One very powerful way to break stigmas is to share and realize that you are not alone. Social media allow a lot of communication between people with medical conditions. While this can be hugely supportive, don’t forget that no two people are exactly the same and that anecdotes should never replace science.
Your doctor may not be very available, but your pharmacist usually is. Pharmacists can provide tons of information about medications and supplements. While they can’t prescribe or modify doses, they can answer questions about side effects, and send a fax (yes, fax still exists) to your physician if a medication issue rises.
Migraine often coexists with health problems that can be addressed in physiotherapy. Examples include neck pain, TMJ pain and vestibular migraine. Physios can teach training programs adapted to your specific limitations. Remember that even the best physio cannot do the exercise for you. Your efforts will be rewarded.
Migraine is a real neurological disease, so it is a brain problem. Mental health issues are also brain problems, and they often coexist with migraine. There are actually genetic links between both. Cause or consequence, mental health problems must be addressed in parallel with the migraine situation, and a psychologist can play a life changing role in your story. Interventions can be brief (a few sessions) or long (many years for difficult situations).
Are you surprised to see this role in this list? Secretaries are booking (and rescheduling) appointments. They manage documents from your medical file and insurance forms. They send referral requests. Physicians cannot live without them. They are pivotal allies to ensure that the people involved in your care communicate properly.
There are many situations where a social worker can help a person with migraine. From disability issues to drug coverage support, social workers can do a lot.
This category includes a good dozen of other medical specialists who help your main migraine manager. Common collaborations include:
Allergy specialist: you think you are allergic to NSAIDs…but you’re not really sure? Proper allergy testing can open a whole new list of options.
- Anesthesiology: for nerve blocks, facet blocks etc
- Autonomic System expert: migraine may coexist with something called POTS, and this specialist can diagnose it.
- ENT: for sinus issues and vestibular (dizzy) problems
- Gastro-enterology: childhood migraine equivalents include vomiting and abdominal pain
- Geneticist: some forms of migraine with aura are genetic (hemiplegic migraine, mitochondrial disorders) and may require specialized gene testing.
- Internal Medicine: virtually any rare disease can require the help of internal medicine.
- OBGYN: for contraception advice
- Ophtalmology: migraine can be linked with funky visual symptoms, and sometimes this specialist is required.
- Neurosurgeon: usually not involved for migraine only, but is a frequent collaborator for other headaches (tumors, shunts etc)
- Physiatry: assessment of other muscle and joints issues. Also perform blocks and injections.
- Pneumology: sleep apnea, associated with migraine, is usually diagnosed and treated by this specialist.
- Psychiatry: if mental health issues require more than psychotherapy
- Rheumatology: the Ehlers Danlos syndrome is associated with headaches
- Sleep specialist: severe sleep issues may contribute to migraine and sometimes require high level expertise.
The web is now very rich in information on migraine, but there is the worst and the best out there. Rely on websites run by official associations and major medical institutions. Be careful of any website promoting a unique miracle option or selling a product. Migraine Canada is offering information, share your feedback.
Yoga has multiple benefits on health but should not be tried without supervision. Many yoga postures can lead to injury if performed without guidance, especially in people who are not used to exercise. Be aware that all yoga instructors are not trained to advise people with medical issues. Make sure that your yoga instructor has appropriate training. Other options that may be easier to start with include chi gong, tai chi and Pilates.
Any missing person on this list? Email us at firstname.lastname@example.org
THE MIGRAINE TREE
- ACUTE TREATMENTS
- DEVICES AND NEUROMULATIOIN
- PREVENTIVE TREATMENTS
- PROCEDURES AND INJECTIONS
- SELF-CARE AND LIFESTYLE
- SOCIAL LIFE