During a recent Facebook Live event with the American Migraine Foundation, Dr. Lawrence Robbins, a neurologist at the Robbins Headache Clinic in Chicago, discussed the clinical pearls that neurologists use to treat patients with migraine and headache disorders.

He also answered questions regarding the most effective treatment options for people living with migraine, how comorbidities affect a patient’s treatment plan, the most common migraine triggers and more. Read on for a overview of his discussion:


There’s No One Approach

Dr. Robbins believes that although medicine can be an effective method of treating migraine, it is not the only answer. “I always want doctors to consider natural alternatives,” says Dr. Robbins. “Whether it’s meditation, physical therapy, psychotherapy, exercise, yoga, massage or acupuncture, we want to do other modalities,” says Dr. Robbins.

If your doctor does decide to go the medical route, Dr. Robbins recommends beginning with a very low dose. “People with headaches often have very sensitive brains and don’t react well to medicine,” says Dr. Robbins. Another important factor to consider when a patient begins treatment is their medical history. “What’s happened in the past with preventives, with as needed abortives, drives where we go with medicine,” says Dr. Robbins.

Address Comorbidities

Comorbidities are two or more conditions that occur in the same person at a higher rate than what would occur by chance. Common comorbidities of migraine include irritable bowel syndrome, fibromyalgia, anxiety, depression and asthma. Knowledge of these conditions should inform a health care provider’s medical advice. In fact, “Medical comorbidities drive where we go,” says Dr. Robbins.

For example, doctors often prescribe antidepressants for migraine management, but these medications are not meant to alleviate anxiety or depression. In fact, they can make them worse. “If somebody does have depression and headaches, they run parallel. They fuel each other. They make each other worse. We need to treat them independently,” says Dr. Robbins.

Factoring in Mental Health

Apart from physical health, Dr. Robbins recognizes the importance of mental health in patients. In Dr. Robbins’ opinion, social support is key to improving mental health. “It may not cure headaches, but it helps quality of life and dealing with everything,” Dr. Robbins says.

Family members and significant others can act as great resources to doctors by providing insights about a person’s emotional state. Regardless if someone has a pre-existing mental health issue, “If it was up to me, maybe everybody would see a psychotherapist. Psychotherapy is a great thing. You see somebody for an hour. They’re nice to you, and they listen to you,” said Dr. Robbins.

For people living with migraine, nothing is clear-cut. Dr. Robbins believes migraine should be viewed as a spectrum. Some days, headaches can be mild, and other days, headaches can be more severe and intense. Ultimately, the same thing is going on inside the brain. “You know, there is an official definition of pain. The definition that I really like is pain is what the patient says it is, and it’s as bad as the patient says it is,” Dr. Robbins says. “We believe the patient 100 percent.”

Tracking Migraine Triggers

Although migraine attacks are unpredictable, Dr. Robbins discusses several common migraine triggers patients may experience. Shifts in altitude, menstruation, exercising, changes in weather, stress and dietary changes can all trigger migraine attacks.

Food is a trigger that is often discussed, however, Dr. Robbins does not believe it to be as common of an issue. “The sad truth is most people avoid all these foods, but it doesn’t matter that much,” he says. Another popular topic when discussing migraine triggers is caffeine. It can either act as a trigger, or as relief from migraine attacks. Caffeine consumption causes varying effects among patients—therefore, Dr. Robbins recommends keeping caffeine at 200 milligrams per day or less, around two cups. Keep in mind, medications like Excedrin contain caffeine, aspirin or for a smaller dose, baby aspirin, may be a better alternative.

To speak with a headache specialist in your area, use our find a doctor tool. Then visit the new American Migraine Foundation website for access to doctor-verified resources, including fact sheets and toolkits.