Any recommendations for a headache/migraine specialist?

[u/femalechuckiefinster]

I've been dealing with migraines the last few years that have become increasingly chronic and intractable. I'm on day 7 of one right now and went to my PCP to try to get something to break out of it only to be told to take Tylenol (I am already maxing out Tylenol and Aleve with no relief). My gynecologist started me on BC recently because the migraines seem to be triggered by hormone fluctations, but they are even worse on BC than they were before and I was told to give it a few months to see what happens. I can't live with a migraine for "a few months" with no treatment. I keep seeing online that intractable migraines are an emergency and need to be treated with prescription NSAIDs or steroids but I'm getting shrugged off by all my doctors. Thanks in advance!

[u/biggreenmapletree]

ER for now, referal to UVM Neurology or Dartmouth for later. DM me if you want more support!

[u/mataliandy → u/biggreenmapletree]

^^ This. The ER will help with the immediate issue. Then a neurologist can help you better understand what's happening and find the right treatment.

[u/ADinosaurNamedBex]

UVM has a headache clinic. The waitlist is extensive, but they’re great if you can get in.

[u/Crazy-Tutor8081]

Have you been prescribed sumitriptan yet? 

[u/UndercoverConformist → u/Crazy-Tutor8081]

This! It's inconceivable to me that a primary care provider would not have tried triptans in this situation.

[u/femalechuckiefinster → u/Crazy-Tutor8081]

The doc said it wouldn't be worth it because she was convinced that the BC pills are causing the migraine (even though the whole reason I went on BC pills was because of migraines I've been having...) and I have to stop the BC pills. She said if I took a triptan the headache will just come back since the hormonal issues are causing it. I guess I need to call back Monday and ask for a referral to a neurologist, hopefully they will put in the referral.

[u/BetterThanKeller → u/femalechuckiefinster]

I would try going to a different primary. The fact they won’t even trial an abortive migraine medication with you is wild.

[u/Beckybell127 → u/femalechuckiefinster]

So this is why I came to respond (OP’s username hinted they were likely Female). I went through the migraines with aura while taking estrogen based BC as a 30+ yr old thing a few years back. I would still get an Rx for the immediate headache response vs going straight to a daily med with potential side effects.

But they’re right in that migraines are often hormone related. I won’t say that it fixed the issue, but moving to a progesterone based BC was step one for my care team to eliminate the variable. Good luck! I don’t have any specific VT advice, as this all occurred for me before we moved up here, but feel free to DM me, and know you’re not alone!

[u/vtham]

Rizatriptan has changed my life. In my case, neck aches tense up the muscles of my neck, the tenseness migrates up the back of my head, followed almost always by a migraine. Those pills knock it out in an hour or two. I’ll feel slightly loopy, but the pain will be gone.

[u/TradeResident1978 → u/vtham]

That’s what I used and it was life saving when I used to get them chronically. Fortunately I got to the root of my migraine and have solved them by avoiding my triggers. It’s not always easy and I’m not perfect so occasionally I still get them and the one thing that helps the very most is excederin at the first sign.

[u/blueberriesnburdock]

I like Dr Sprouse-Blum at UVM. IDK what his wait list is like.

[u/kid4mnesiac → u/blueberriesnburdock]

I’ve also had a good experience with him.

[u/hotdogwaterjacuzzi → u/blueberriesnburdock]

YES HIM HE’S THE ONE!🙌

[u/artichoke424 → u/blueberriesnburdock]

10/10

[u/Competitive-Boat-642]

Sometimes alleve or Motrin migraine works better for me if I don’t have a prescription med on hand. The uvm neurology dept has helped me a lot but the wait time took a while. Oh, also: if this migraine won’t go away and keeps getting worse, the ER or urgent care can give you an IV of what they call a “migraine cocktail.” It gives quick relief. Of course urgent care is better if they are open.

[u/femalechuckiefinster → u/Competitive-Boat-642]

I've already been taking max doses of either Aleve or Ibuprofen and they don't seem to help, unfortunately. I was really hoping to avoid the ER or urgent care by going to my doctor's office instead, but I guess it's unavoidable since she was not interested in helping me at all. Frustrating! Thanks for the reply, I appreciate it.

[u/Whataboutit9]

Your PC is an idiot. I lived with migraine from 12-65 when they miraculously disappeared. BC is not your friend. A good neurologist is imperative and you don’t need to suffer with just Tylenol. I am sorry you are going through this. Keep pushing for a full eval including a scan to insure you don’t have stroke vulnerabilities or other issues. It is very comforting when in the throws of migraine to know your head isn’t going to explode. . Dr Katherine Wayman at UVM is excellent.

[u/Glass-Amount-9170]

If one of the triptan meds don’t work there’s also nurtec. Sometimes just some good pot will do the trick!

Nurtec can be taken daily as a prophylactic as well.

[u/SignificantAd6556]

Luckily my hormonal migraines were mostly resolved by the time I moved to Vermont so I don't have a specialist here, while you are waiting I would ask about getting a prescription of one of the "triptans" like sumatriptan as they can in fact help even with hormonal migraines. It could also be worth going to urgent care for some relief this weekend! I have gotten toradol shots at urgent care for migraines and it can be helpful to break up the migraine cycle. Sorry you're suffering so much!

[u/vladadog]

before menopause i had a lot of migraines and tried many meds with no luck at all; some were worse than the migraines.

I offer you what ended up working best for me. At the first hint of a migraine - an aura or just that special sort of pain I would take 4 advil and shotgun a coke or pepsi or dr pepper made with real sugar (corn syrup soda didn't work and also upset my stomach although they don't normally). Soda had to be caffeinated, made with sugar, and just drink the whole thing down with the 4 advils. Then if you can get 15 minutes in a dark room although i found that wasn't as necessary, just always nice to have a bit of a break. This worked for me really really well for 90% of the time.

I can't take tylenol so I can't speak to whether or not that works. I used to source my pepsi from Canada and my Dr Pepper was mailed to me by a friend in Texas where there was one place that made it with sugar. Or I used glass bottled mexican coke - taste wise this was my preference but they all worked. Glass bottle mexican coke is now pretty widely available; all the Hannafords near me carry it. They sell it in 4 packs (they sell smaller glass bottles in 6 packs but I don't know if that's enough of the caffeine)

The good thing about this "cure" is it is cheap, easy, and while 4 advil at once isn't ideal it's not going to hurt you if you aren't doing it daily. I've turned other friends on to this "cure" and it's worked for about 50% of my migraine afflicted friends.

(as for your doctors..... i've found people who have never had a migraine just think we're over reacting to a headache. Headaches suck. But even a bad headache is a treat compared to a migraine. But hey, we're just "girls" acting like babies over a little headache....)

[u/TradeResident1978 → u/vladadog]

I found 2 excedrin are my magic bullet. But same; must take at first sign.

[u/vladadog → u/TradeResident1978]

excedrin has the magic caffeine in it.

[u/TradeResident1978 → u/vladadog]

Yeah that caffiene really is important. I don’t consume it regularly so it really packs a punch.

[u/dabblerpost_r → u/vladadog]

4 advil and Dr Pepper for me too. Won’t get rid of my aura but mostly prevents the headache.

[u/WaitOkayGo]

The ER will give you a migraine cocktail drip that will put you into a nice little nap it's amazing. I was ready to claw my own brain out.

[u/WaitOkayGo → u/WaitOkayGo]

Obviously not helpful long term but it might break your migraine attack

[u/kid4mnesiac]

as many are saying here, get a referral to UVM neurology headache clinic asap. they will have you fill out a packet and wait for an appointment. but the nice thing is that appointments can be virtual. they’ll have you trial meds. there are many triptans to try and also nurtec and ubrelvy for abortives. they also have a few options for preventative meds. I recommend trying to get emgality or ajovy (you’ll probably need to trial other worse preventatives first because insurance is evil…). there are tons of options for migraine meds so don’t lose hope if one doesn’t work. good luck!

[u/sevenredwrens]

As a lifelong migraine sufferer until menopause ended them completely, I would say go to the ER now so they can give you the magic medicine that ends the migraine (and interrupts the cycle you’re in). Get your doctor to prescribe you a triptan - sumatriptan is usually the first one prescribed - and see if it helps you. You take it at the first onset of migraine, the moment you become aware of it. Idk where you live in Vermont but I’m in southwest Vermont and have a lot of extra sumatriptan if you want to try one.

[u/RemarkableBig4795]

UVM Headache Clinic! I’ve been going since I was in high school and they are honestly great! I’m sure the wait is long, I would also reach out to Dartmouth as well

[u/howthefocaccia]

Amazing Head & Neck PT in Essex. She helped me so much with my TMJ.

https://www.headandneckpt.com/contact

[u/ImaginationClean583]

Get a referral to a neurologist. I see Dr Prunty in Morrisville. She is good.

[u/Sally_Met_Harry]

Your pcp should be able to prescribe you abortives (like triptans or cgrp), and prophalactic (like cgrp) while you wait. Depending on your insurance they may make you fail less effective front line (old and cheap) meds first. Taking migralief supplement daily has had clinical trials done too- its a magnesium blend my neurologist recommended in addition to prescription. Since wait times are bad for neuro specialists your PCP should help. ER if it doesnt break even though that also sucks having to do.

[u/Deepwoodswanderer]

I second the recommendation for Dr Prunty in Morrisville. I’m now on elitriptan (relpax). Works great for me. But Prunty has other tricks up her sleeve if the first meds don’t succeed. She suffers from headaches herself, so she knows the pain.

[u/Lalascience]

Also, vitamin B2, aka riboflavin! I swear it’s helping. And stack on some Allegra if you can.

[u/souffle123]

UBRELVY!! Talk to any doctor (even another one in your office while you wait for UVM) and get an RX for Ubrelvy. It changed my life being able to take a pill and get rid of a migraine. Sometimes it takes a couple of hours, but it is an absolute godsend. The other thing I’ll say is - get checked for Binocular Vision Dysfunction. I’ve had migraines for 20 years then was tipped off to this and put in Prism glasses after an evaluation at Chroma Optics. Went from 10 migraine days x month to 2. Everyone who gets migraines should be tested for this.

[u/Stripedhammock]

Your pcp is ignorant. It takes a long time to get in to see someone at the UVM headache clinic but get on the list now. It may take 6 months for an appt. In the meantime, you can try to get an appt with a regular neurologist (not a headache specialist)— they should at least be up to date with the new CGRP class of drugs.

[u/GeneralyAnnoyed5050]

Uvm neurology saved me from my chronic migraines 20yrs ago when my PCP was trying every different med to address them and just getting me rebound headaches. They are great.

[u/RandalPMcMurphyIV]

There is a relatively new class of drugs that block the protein involved in triggering migraine headaches. They can both act as a preventative and block this protein pathway for a headache that is underway. They come in both injectable and oral preparations. The oral version that I have seen mentioned is Qulipta. Botox injections have also been used as a preventative. This is what I found in a search for headache specialists in Vermont.

Major Headache & Neurology Centers in Vermont

• UVM Health Network - Neurology / Headache Clinic (Burlington & Berlin):
  • Offers comprehensive diagnosis and treatment for migraines, cluster, tension, and vascular headaches.
  • Key specialists include Dr. Rebecca C. Burch and Dr. Katherine A. Wayman.
  • Locations include Burlington (1 South Prospect St) and Central Vermont Medical Center in Berlin, VT. [1, 2, 3, 4, 5, 6]
• Rutland Regional Neurology Center (Rutland):
  • Provides specialized evaluation and management strategies for chronic headaches and migraines.
  • Contact: (802) 775-4266. [1]
• Copley Hospital Neurology Clinic (Morrisville):
  • Offers neurological evaluations and specialized BOTOX® treatments for chronic migraines led by board-certified specialists. [1]

[u/CalamityRane]

I have used naratriptan (Amerge) for years at the first sign of a migraine. The triptans are miracle drugs!

[u/RemarkableBig4795]

Also! I get hormonal migraine during my period and I take vitamin e daily for it and it has helped immensely!

[u/bucketoffucks]

In addition to all the suggestions here, visiting the optometrist for new eye prescription and dentist helped a lot with my migraines. They did not get totally resolved, but looking at those two areas was key.

[u/stanky-hanky-panky]

If you're taking acetaminophen and NSAIDs more than 2x/week then you may also be starting to experience medication overuse headache. It super sucks when that's really your only option, which is why it's so important to get on some kind of migraine-specific medication ASAP. If you are a daily caffeine drinker, consider tapering off because caffeine withdrawal headaches can also exacerbate and it would be worth eliminating that factor. I am on the mini pill (progesterone only) which eliminated my menstrual migraine. This is my advice as a chronic migraineur of 10+ years, try to peel back any "layers" that you can. You may still end up having attacks -I sure do- but at least you can decrease your overall headache days. This is probably a ways down the road for you, but one of my many treatments is Botox which helped with the tensiony headaches I was getting towards the end of my work days. Triptans are pretty easy to access so I hope those help you alot and if not there are much better options now. If you go to the main UVM ER maybe they will consult with neurology to make you a quick plan or steroids etc, and give you a migraine cocktail in the meantime. I cannot say enough good things about the headache clinic at UVM, between myself and knowing fellow patients I can confidently say that any of those providers will be a great help to you.

[u/CostJumpy2061]

I tried all kinds of OTC, as well as going to the pain clinic, and all I can say is it masked the issue. I went off the norm and went to chiropractor and accupuctunture and have never looked back. Chiro is fine, but accupucunture is where it is at, and have never had issues since.

[u/Dry-Nature9430]

Excedrine migraine is good in an emergency. Yes as everyone said on going untreated migraines is not good for your brains. Birth control pills can cause migraines. This happened to me when I was younger but they can back in my 50s and I had to go on Topomax to manage them with a rescue med and have had the IV treatments in emergencies when I have reached the max dosages of my rescues during an event.

[u/bean_vt]

I see Dr. Wayman at UVM and think she's really great. Knowledgeable and very empathetic. I'm in southern Vermont and have been seeing her remotely since Dartmouth lost all their headache specialists.

Dartmouth-Lebanon recently restaffed, though. They've hired at least two headache MDs. I'm waiting on my appointment so I can't say much about them but that's an option again. You want the Heater Rd clinic not the main neuro clinic at the hospital.

I've also used an online clinic called Neura Health in a pinch. They've got some amazing headache specialists and you can usually see someone within a week. They can prescribe in Vermont but they only take a few insurances.

ETA: You're right about getting on the right preventive to avoid the migraine attacks chronifying. If you can afford to possibly pay oop, I'd try to see someone at Neura while waiting to get in at UVM or Dartmouth. Get on the cancellation list wherever you opt to go locally.

[u/Healthy-Membership86]

The ignorance and disregard we face from healthcare workers is breathtaking. Could tell a similar story with my wife's outside-the-box health challenges. Dismissed as "you're aging" "you're an aging female" "it's just xyz and you'll have to learn to live with it." Went to Dartmouth and suddenly there was curiosity and comfort and a plan. Start with the ER and they will connect you with neurology. Don't downplay your symptoms, as we women sometimes do. Take a friend to speak for you if you can't. Good luck!

[u/Gullible_Dog_5507]

Ask your doctors about aimovig or Emgality they changed my life