Is It Time To Find A New Headache Doctor?
Working with your doctor to manage your migraine disease is a learned skill. Preparing your medical history, documenting symptoms and treatments, and doing your homework are only a few of the steps that can help you and your doctor get the best results. (We have more tips on talking to your doctor here.)
What if you and your provider (doctor, nurse practitioner or other licensed healthcare provider) haven’t reduced the impact of migraine on your life? That’s complicated; migraine disease doesn’t always respond to treatment even if you and your medical team do all the right things. On the other hand, certain clues may suggest it’s time to find a new doctor.
You and Your Provider Don’t Make a Good Team
Finding the right healthcare provider is like dating; someone may be great on paper but not the right fit for you. Maybe you feel like the provider is judging you harshly, or something makes you feel uneasy for a reason you can’t put your finger on. Maybe you simply don’t work together very well. If it feels like you and your provider don’t make a good team, it’s okay to keep looking.1
Your Provider Doesn’t Recommend New Options When Current Treatments Aren’t Working
Maybe your acute treatments aren’t as effective as they used to be. Maybe your preventive treatments don’t work very well, or you find the side effects intolerable. These are both clear signs that you need to try new treatments, combinations of treatments or change dosages.
If your doctor sees these signs but doesn’t recommend new treatments, ask why. Sometimes, there may be a reasonable explanation, such as contraindications with certain medications. Doctors who aren’t headache specialists may be reluctant to prescribe treatments they’re unfamiliar with or those that may increase other medical risks. In that case, your doctor should feel comfortable referring you to a headache specialist.2
But if your provider won’t change your treatment regimen or refer you to a specialist when the signs are clear you need something else, that’s a sign it may be time to consider finding another provider.3 To find a doctor certified in headache medicine, visit the United Council for Neurologic Subspecialities and select your state.
Your Provider Doesn’t Seem Interested in Answering Your Questions or Exploring New Information
Healthcare providers are under more pressure than ever to see more patients and spend less time with them. If you prepared for your appointment with questions and information about migraine but the clinician didn’t seem interested, what do you do?
First, make sure you’re sharing information from reputable sources. There’s a wealth of information out there about migraine, but not all of it is good or safe. Many healthcare professionals have seen the heartbreaking results in patients who were scammed or harmed by disreputable companies peddling fake, untested, unregulated, or dangerous treatments. If your provider knows you’re doing your homework using trustworthy sources, you can avoid misunderstandings.
Reputable sources like our website will name their medical reviewers or professionals who have education and credentials in relevant specialties. Some patient support groups interact with reputable advocacy/educational organizations and have responsible moderators monitoring conversations to ensure information exchanged in the group is credible.
(If, however, a source claims to have a “cure” but can’t show you clinical trial results published in a reputable medical journal, FDA approval histories, or reviews from specialists whose names and credentials you can look up, be skeptical. Migraine disease has no cure, but new migraine-specific treatments are available, and more are in the development pipeline!)
If your doctor is especially busy and doesn’t address questions and new, potentially relevant information in your appointments, try using their online portal. Some providers may be more comfortable addressing your concerns when they have more time to research and digest information.
But if neither of these situations applies in your case, or you can’t resolve the issue, you may want to consider finding a new doctor.4
Your Provider Doesn’t Advocate for Insurance Approval for Newer, More Expensive Treatments When They’re Warranted.
Since 2018, several new migraine-specific medications for acute and preventive treatments have entered the market, but because they are so new they can be expensive. Insurers often won’t cover them until you fulfill “step therapy” requirements (inadequate relief with other, less expensive medications, many of which were not designed to treat migraine). Then, they often require your provider to apply for “prior authorization,” a chance to review how necessary a treatment may be before approving cost coverage of it.
Insurance authorizations and appeals processes can be difficult and time-consuming for healthcare providers. In some cases, it can be dangerous for patients stuck in approval limbo—prompting several states to pass laws restricting them.5 Difficulty with the prior authorization process is not a sufficient reason for a provider to stop advocating for you to have access to new migraine treatments.
Many medical practices now have staff devoted exclusively to navigating the insurance approval process. If your doctor is part of a larger practice or affiliated with a hospital, they may have access to advice or assistance for prior authorizations. We also share a guide for professionals on applying for prior authorizations for their patients with migraine. If you are a good candidate for newer, more expensive treatments and qualify for coverage, but your doctor isn’t fighting for you, that could be a sign it’s time for a new doctor.6