Headache patient? Think migraine

More than 90% of patients who visit a primary care doctor for headache have migraine, said Jeffrey R. Unger, MD, Medical Director, Chino Medical Group, Chino, Calif.

"We don't see many patients with tension headaches or other secondary headache disorders. People self treat with stress headache," he said.

Should a primary care physician refer migraine patients to a neurologist or other specialist? No, said Dr Unger.

"Family physicians are the best caretakers for patients with headaches, including migraine. We know the patients and their lives," he said.

Migraine will have many different clinical presentations, but a very quick, 3-question ID Migraine test can provide a diagnosis.

• Are the headaches disabling (miss work, etc)?

• Do the headaches cause nausea?

• Do the headaches cause light sensitivity?

Two or 3 affirmative answers indicate migraine.

Migraine is a chronic, progressive disease, said Dr Unger. Patients with migraine often have a history of physical, sexual, or psychological abuse as well as anxiety and other mental health problems.

Migraine tends to start in early adulthood and is more common in women. Headaches starting after age 50 are usually a warning sign of another problem, he said. Also, recurrent headaches are not worrisome and are highly treatable; a single-event headache is more problematic and can indicate a tumor.

Pain relief and a return to a functional life are the goals of migraine therapy.

Ergotamine and the triptans are among the most effective agents for migraine. OTC and combination analgesics are not very helpful; opioids are not recommended.

Behavior modification can reduce migraine attacks. Patients should: eat 3 meals a day; exercise; sleep 8 hours a night uninterrupted; avoid their self-identified triggers; quit smoking; and have no more than 2 cups of coffee per day.