By: Emily D. Mauser, Dawn C. Buse, PhD, and Noah L. Rosen, MD
Headaches are very common. They are one of the most frequent reasons that people take medicine or see health care providers. There is a range of over the counter and prescription treatments available as well as non-pharmacologic ways to manage headaches and migraines. It can be hard to know when to seek medical treatment and how to find the right providers. If you are wondering if it is time to seek medical treatment for your headaches consider the following questions:
- Are your headaches interfering in your life regarding work, school, family or social activities?
- Have your headaches become more frequent or more severe?
- Are over-the-counter medications no longer effective or do you worry that you might be taking too much?
- Have you gone to the emergency department for a headache?
If you answered “yes” to any of these questions, you should discuss your headaches with a medical professional. You may want to start by talking to your primary care provider (PCP). After talking with their PCP, some people find that their headaches are so severe, incapacitating, or resistant to treatment that they would benefit from seeing a neurologist or headache specialist. A headache specialist is a physician who has expertise in the diagnosis and treatment of head pain disorders.
A headache specialist may be “UCNS certified”; however, that is not always the case. The United Council for Neurologic Subspecialties (UCNS) is an organization that provides accreditation to fellowship programs and certification to individual practitioners in neurologic subspecialties, including headache medicine. “UCNS certified” headache specialists may be neurologists or other type of physicians with expertise in the treatment of headache disorders. Physicians who have taken and passed the UCNS certification exam are legally allowed to call themselves “headache specialists.”
To determine if you should seek care from a neurologist or headache specialist consider the following:
- Have you talked with your primary care provider about your headaches?
- Are you dissatisfied with your current medications or treatment regimen? For example, the medications do not relieve your headaches, you have side effects that you cannot tolerate, or your headaches often return after treatment.
- Are you pregnant, nursing, or trying to get pregnant and experiencing frequent or severe headache?
- Do you experience headache on 15 or more days per month?
- Have you recently experienced a headache that is significantly different than other headaches you have had or that you would describe as the worst headache of your life?
If you answered “yes” to any of these questions, you and your primary care provider may determine that you should follow up with a headache specialist. There are several ways to go about finding one.
- The most common source of referrals to any type of health care provider is usually through word of mouth. You may want to ask your primary care provider if he or she can recommend a headache specialist.
- Your insurance company’s website may have a feature that allows you to search for a headache specialist, or you can call their referral service.
- The American Migraine Foundation website (americanmigrainefoundation.org/find-a-doctortreatment/) contains a page called “Find a Healthcare Professional,” where users can search for a doctor who specializes in headache medicine by name, state, city, zip code, distance from current location, and several other categories.
- The United Council for Neurologic Subspecialties website (www.ucns.org) contains a list of all of their certified headache specialists. Note that the locations (city/state) of some of the physicians on the UCNS list may be outdated because the list was published in the year in which the physician took the certification exam, which in some cases was as long ago as 2006.
Depending on where you live, it may be hard to find a UCNS certified headache specialist. A recent study by Mauser and Rosen (2013) identified all of the UCNS certified headache specialists in the United States and compared that data to state demographics obtained from the U.S. Census.
As of December 2012, there were only 416 UCNS headache specialists currently practicing in the US. The states with the highest number of headache specialists include: New York (56), California (29), Ohio (29), Texas (25), Florida (24), and Pennsylvania (23). Six states do not have any headache specialists: Alaska, Delaware, Montana, North Dakota, South Carolina, and Wyoming. Eight states have only one headache specialist: Arkansas, Idaho, Kansas, Mississippi, New Mexico, Oregon, South Dakota, and Vermont.
Finally, for some patients, headache specialists may recommend that they participate in a headache program or receive inpatient care to treat their headaches. These approaches can be especially helpful in the cases of very severe and treatment refractory headache. They also combine pharmacological treatments (medications) with scientifically proven non-pharmacologic treatments such as biofeedback, relaxation training and cognitive behavioral therapy for headache. For more information on scientifically proven non-pharmacologic treatments and strategies for headache and how to find a provider see:
Emily D. Mauser is a student at Hofstra University. She has conducted headache research at the Pain and Headache Center of the North Shore-Long Island Jewish Health System.
Dawn C. Buse, PhD is the Director of Behavioral Medicine for the Montefiore Headache Center, in New York, NY, an Associate Professor in the Department of Neurology of Albert Einstein College of Medicine and Assistant Professor in the Clinical Health Psychology Doctoral Program of Ferkauf Graduate School of Psychology of Yeshiva University.
Noah L. Rosen, MD is the Director of the Headache Center at the Cushing Neuroscience Institute on Long Island, NY, North Shore-LIJ Medical Group, and an Assistant Professor of Neurology at Albert Einstein College of Medicine.