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But there are other healthcare specialists who can also play an important role in migraine management. That includes healthcare professionals who are in the traditional medical setting, such as physicians specially trained in headaches, as well as those in the complementary-alternative medicine field, such as acupuncturists. According to the American Migraine Foundation, as many as 80 percent of people who experience migraines have tried some sort of alternative treatment to find relief.
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“Our patients oftentimes work with a team of healthcare professionals to help relieve some of their migraine symptoms,” says Timothy Collins, MD, a headache specialist in the department of neurology at Duke University in Durham, North Carolina. “It truly takes a village.”
Here are some common healthcare professionals you may want to consider adding to your chronic migraine management team.
Headache Specialists
What they do: A headache specialist is a neurologist or other type of physician who has taken an active interest in headache, has studied the scientific research available on headache, and treats headache, according to the American Migraine Foundation.
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A headache specialist can be certified by the United Council for Neurologic Subspecialties (UCNS), an organization that provides neurologic fellowship programs, but since this designation is relatively new, not all headache specialists are UCNS certified. A study published in May 2016 in Headache: The Journal of Head and Face Pain found that only about 25 percent of participants with chronic migraines who sought medical care for their headaches received a correct diagnosis. But seeing a physician who specializes in treating headaches may make a difference: According to the study, people who consulted a headache specialist were nearly 1.5 times more likely to receive a diagnosis of chronic migraines than those consulting other healthcare providers.
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“Migraine gets misdiagnosed frequently,” explains Nauman Tariq, MBBS, a headache specialist and director of the Johns Hopkins Headache Center in Baltimore. How they help with chronic migraines: “Our job as a headache specialist is not just to diagnose but to also rule out other things that mimic migraines,” says Dr.
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Tariq. “We’re specially trained to rule out high- and low-pressure headaches. We’re specially trained to differentiate between cluster headaches and other types of rare headaches.” A headache specialist can provide valuable insight to help you understand and manage your chronic migraines.
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“A headache specialist is also much more familiar with the long list of meds available for headache treatment,” adds Dr. Collins.
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“Most primary care doctors are only aware of two to three medications.”
When to consider seeing a headache specialist for your chronic migraines: People who experience unusual or complicated headache symptoms, such as prolonged auras, or migraines that last longer than 72 hours should consider seeing a headache specialist. Seeing a specialist is also recommended for those who have additional medical conditions, experience increasing frequency of headaches, find their treatment is no longer working, or have headaches that are severe enough to interfere with everyday activities, according to the American Migraine Foundation.
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Neurologist
What they do: Neurologists are medical doctors who are trained in diagnosing, treating, and managing disorders of the brain and nervous system, including Alzheimer’s disease, concussion, epilepsy, migraine, multiple sclerosis, and stroke, according to the American Academy of Neurology. But not all neurologists are board-certified headache specialists, says Collins, who is also a neurologist. As such, these physicians often request patients do a variety of things, such as keep a headache and food log, to identify migraine triggers.
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How they help with chronic migraines: Like other headache specialists, neurologists tend to be much more familiar with the medications and treatments that best serve someone who has chronic migraines than a general practitioner does. “Our knowledge of headaches is significantly broader than a primary care physician’s,” explains Collins.
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When to consider seeing a neurologist for your chronic migraines: Seeing a neurologist can be particularly helpful for people with chronic migraines, complex or severe symptoms, or a family history of migraines. A neurologist is specially trained to carry out a detailed history and physical examination — testing of mental status, vision, speech, strength, sensation, coordination, reflexes, and gait — as well as MRI or CT scans, and can help pinpoint the right diagnosis.
Registered Dietitian
What they do: A registered dietitian (RD) is a trained nutrition professional who helps people fine-tune their diets to help achieve and maintain weight loss, manage specific health conditions, and improve overall health.
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“While someone may know what foods trigger their migraines, it can be challenging to apply [that information] to one’s own life,” explains Tanya Zuckerbrot, MS, RD. “Having someone to help guide you and hold you accountable can help you to stick to a plan.”
How they help with chronic migraines: “Registered dietitians can help people who get migraines create a routine that is effective in preventing the stressors that can bring on symptoms,” says Zuckerbrot. “We create a meal plan that avoids known triggers and provides important nutrients for migraine prevention.”
People with migraines have reported that some foods may cause their migraines, and an RD may be able to help you identify your possible triggers; if you think a certain food (or foods) may be causing your symptoms, you should keep track of that in your headache diary and share that with your doctor and RD.
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And while some studies have shown that a particular food may not itself be a trigger, according to the American Migraine Foundation, you should not eliminate foods from your diet without consulting an RD specializing in headaches or your doctor. Above all, eating a healthy diet and avoiding skipping meals may be beneficial for managing migraines. “Proper nutrition is important for all people who suffer from migraines,” says Zuckerbrot.
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“Things like dehydration, eating on an irregular schedule or fasting, lack of sleep, and stress are big contributors to the onset of a migraine. Therefore, creating a regular eating schedule with a dietitian is beneficial for migraine sufferers.”
RDs can also help you lose weight, which may be beneficial for managing migraines. In a meta review published in the April-May 2019 issue of the Journal of the Endocrine Society, researchers found that weight loss significantly decreased migraine attacks, including reductions in headache pain, intensity, and duration.
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When to consider seeing a registered dietitian for your chronic migraines: If you think your diet may be related to your chronic migraines or that losing weight may help improve your symptoms, talk to your doctor; if they feel it may be something you should try, you can ask for a referral to a nutritionist who specializes in migraines.
Chiropractor
What they do: After taking a detailed medical history, performing a physical exam, and conducting tests to diagnose patients, chiropractors often focus on problems related to the musculoskeletal system.
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They perform manual spinal adjustments and joint manipulations, use stretching, and apply pressure to improve range of motion and flexibility. Chiropractic care focuses on the body’s ability to heal itself and may also incorporate recommendations for exercise and nutrition. Conditions commonly treated by chiropractors include back and neck pain, arthritis, headaches, sports injuries, and repetitive strains, according to Cedars-Sinai Medical Center.
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“Oftentimes, chiropractic care can be used in a prophylactic way, which will prevent or reduce the frequency of future migraine attacks,” says Joshua Kollmann, a doctor of chiropractic at Carolina Sports Clinic in Charlotte, North Carolina, and nearby Fort Mill, South Carolina. How they help with chronic migraines: Participants in a small study published in March 2019 in the journal Global Advances in Health and Medicine, which looked at how chiropractic care can help migraine symptoms, saw marked improvement in pain, an increase in pain-free days, and a decrease in medication usage.
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Participants also reported a decrease in anxiety after seeking chiropractic care. “Chiropractic care has longer-lasting effects with fewer side effects when compared to the well-known drug treatments that are commonly used for migraines,” explains Kollmann. When to consider seeing a chiropractor for your chronic migraines: If neck or back pain tends to trigger your migraine attacks, seeking chiropractic care can help.
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It can also be helpful if you have a job that requires you to sit for extended periods of time, which can make certain types of headaches worse, according to the American Migraine Foundation.
Acupuncturist
What they do: These specialists use the traditional Chinese method of acupuncture to treat pain by inserting very thin needles into strategic points in the body. “Regular acupuncture treatment can make a big difference with sleep quality and stress management,” says Ashley Paraiso, a licensed acupuncturist at Carolina Sports Clinic in Charlotte, North Carolina, and Fort Mill, South Carolina.
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How they help with chronic migraines: “I look to see what underlying imbalance is causing the migraines and how to shift that imbalance,” says Paraiso. “It’s common for someone who suffers from migraines to start acupuncture treatment with the goal of reducing the occurrence of migraines, and after several treatments not only notice that their migraines have been reduced but also that their sleep, mood, digestion, energy level, and menstrual cycles have improved.” A meta-analysis published in March 2019 in the World Journal of Acupuncture-Moxibustion found that acupuncture is more effective and safer for reducing the frequency of migraine attacks and number of migraine days than medication is. When to consider seeing an acupuncturist for your chronic migraines: If you want to try a complementary practice that may help you better manage migraines, talk to your doctor about adding acupuncture to your migraine treatment plan.
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Physical therapist
What they do: Physical therapists work with patients to help create treatment plans utilizing a variety of techniques and exercises to help promote mobility, reduce pain, and restore function. How they help with chronic migraines: “I work with a lot of migraine patients who suffer from neck and back pain,” says Julie Finocchiaro, a physical therapist with Johns Hopkins Rehabilitation Network in Nottingham, Maryland. Physical therapy starts with an overall assessment.
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“I’m really looking at whether or not a patient is overusing their neck muscles. Are they carrying a lot of tension and stress in their neck? Headaches can often be triggered from postural deficits.
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So I’m looking at what their static posture is like,” says Finocchiaro. Then comes the manual therapy. “After I assess a patient, I can address the issues through manual therapy like trigger point release, dry needling, and manipulations, if appropriate.”
A review published in 2014 in the Journal of The Japanese Physical Therapy Association reported that physical therapy was found to be effective in reducing the pain and frequency of attacks in people with tension headaches.
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And according to the American Migraine Foundation, physical therapy and exercise have also been shown to be particularly helpful in treating cervicogenic headaches, which are secondary headaches felt in the neck that are caused by a disorder of the cervical spine and its component bone, disk, and/or soft tissue. When to consider seeing a physical therapist for your chronic migraines: If your migraines seem to be triggered by neck or back pain, talk to your doctor about adding physical therapy as a complementary treatment.
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Biofeedback specialist
What they do: These specialists help people with migraines incorporate relaxation techniques and exercises into their daily routine to help alleviate chronic pain associated with migraines. “Biofeedback can be one of the most useful therapies for overcoming migraine episodes,” says Merle Diamond, MD, a headache specialist at the Diamond Headache Clinic in Chicago. How they help with chronic migraines: “Biofeedback specialists can give you instant feedback on a migraine patient’s psychological responses,” says Urszula Klich, PhD, a psychologist in Atlanta who is board certified in biofeedback.
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“It measures things such as blood pressure, heart rate, and brain waves.” By measuring those things, the specialist can help you control different body functions, which can prevent migraine attacks. A study published in August 2019 in the Journal of General Internal Medicine showed that biofeedback can effectively reduce headache pain.
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According to the National Headache Foundation, biofeedback has been shown to be effective in soothing the nervous system before it responds with a migraine. Research shows that biofeedback may stabilize the nervous system, reduce the frequency of migraines, and help give a sense of control to people with chronic migraines. When to consider seeing a biofeedback specialist for your chronic migraines: According to the American Migraine Foundation, stress is the most common trigger of headaches.
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Stress has been shown to cause a change in the brain that makes you more susceptible to headaches and may also make headaches last longer and feel more painful. If you regularly experience stress, talk to your doctor about seeing a biofeedback specialist as part of your migraine management routine. You can also try searching the Association for Applied Psychophysiology and Biofeedback, Inc., organization for a list of practitioners who can provide biofeedback services.
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Meditation specialist
What they do: These specialists work with patients on using strategies such as breathing techniques and mindfulness to help calm the body and brain. The benefits of meditation and mindfulness are widespread.
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In a small study published in July 2014 in Headache: The Journal of Head and Face Pain, researchers found that people who participated in an 8‐week stress reduction course that taught mindfulness meditation and yoga experienced 1.4 fewer migraines per month than those who did not participate in this program. How they help with chronic migraines: A meditation specialist can help guide you through a meditation practice that you can incorporate into your daily routine.
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“In addition to making an appointment with ourselves daily for a meditation practice, I recommend setting alarms throughout the day to take at least three deep belly breaths,” says Kelly Keefe, a meditation specialist and founder of Heartspace Academy, an organization based in New York City that promotes mindfulness and practices such as Reiki. “It truly does help relax the body and mind.”
When to consider seeing a meditation specialist for your chronic migraines: If you’re looking for a way to reduce stress, meditation may be a great option for you, regardless of whether it helps you manage your migraines.
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A review of studies on mindful meditation and chronic pain published in September 2016 in Annals of Behavioral Medicine found evidence that this intervention may reduce pain, reduce depression associated with living with chronic pain, and improve quality of life.
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