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Is Your Doctor a Certified Headache Specialist?

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Wouldn’t it be nice to know that your doctor has at least a little advanced and current training in headache disorders? It would be nice, but it’s actually something that’s very hard to implement.

Would you want a standardized worldwide or countrywide standard, enforced by local governments? Who would decide on the qualifications? Or a standard from a group you trust? That wouldn’t be nearly as widespread, and many excellent specialists would be left out.

Certified Headache DoctorThere are those who are trying to fill the gap. Here are a couple of examples from the United States.

One is the United Council for Neurologic Subspecialties (UCNS). The UCNS is a non-profit organization that awards certification to doctors who meet certain current requirements. Headache medicine is one of their specific subspecialties. You can actually get an idea what their requirements look like by visiting their Headache Medicine Certification page.

The Migraine Research Foundation maintains a list of UCNS certified doctors in the USA, showing who specialized in which age group. Just visit Doctors Certified in Headache Medicine.

The National Headache Foundation also provides certification, called the Certificate in Added Qualification (CAQ) in Headache Medicine. This certification is also based on current knowledge, and is open not only to medical doctors but also advanced practice nurses, dentists, D.O.s, psychologists, and physician’s assistants.

If you fall into any of these categories, you can read more about CAQ here.

The National Headache Foundation has a list that includes both CAQ and UCNS certification. There are some doctors who even have both certifications. The list is maintained here: Healthcare Provider Finder.

Certification is knowledge based, and does not guarantee that you will like the doctor, or even that they will be a good doctor. However, it does help to demonstrate a basic knowledge that, unfortunately, many doctors and even specialists do not have.

Also remember, this type of certification isn’t even available everywhere. There are many excellent doctors who are not, for whatever reason, board certified in this way.

Could You Diagnose This Man?

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He comes into the emergency room, helped along by a friend because he’s having trouble walking. He’s confused, and can’t really understand what the doctors and nurses are saying. He’s having trouble talking.

When you can’t communicate, it’s pretty hard to make a good diagnosis. And problems communicating certainly can be a reality with migraine. Difficulty speaking and/or understanding speech is one of the possible symptoms.

If you had been in the emergency room when this man came in, you might have thought he was drunk. But he wasn’t. You might then realize that he was having trouble with one side of his body. Could it be a stroke? Possibly. He’s in his early 20s, so stroke is possible, though a little more unexpected.

Hemiplegic Migraine EmergencyEventually you find out from his friend that this has happened before, and that the man has a history of migraine. Could it be a migraine attack? It could, but you have to rule out some other things first. And if it is migraine – what kind? And what treatment would be best?

Hopefully you’re not suffering as this man is, and you’re not going to have the frustration the doctor has, because I’m going to tell you his condition. This man is suffering from an attack of hemiplegic migraine.

Hemiplegic migraine is rare, but it’s actually tricky to know just how common it is, because it’s misdiagnosed so often. MS? Epilepsy? A stroke? But in this case, no. One-sided paralysis, confusion, a feeling of “pins-and-needles” – all symptoms of hemiplegic migraine (HM).

This story is based on a real person. 24 years old, he suffered from repeated attacks of migraine since he was 4 years old. His symptoms were temporary, followed by extreme sleepiness. And researchers in Luxembourg and Belgium hope that his case will help others learn how to diagnose HM more quickly.

In a case report published last month, the suggestion was made that doctors consider HM when migraine symptoms are very unusual – that is, there is aura, but not only aura. The key in HM is motor weakness – weakness or paralysis on one side of the body. This might not always be the case, or might not even be noticed or remembered. But with the help of the patient and friends and family, the diagnosis can be helped along.

Another possible symptoms that they mentioned is a temporary encephalopathy, or changed mental state, brought on by mild trauma to the head.

Weakness, trouble thinking/talking, paralysis – these should be signs that the doctor should dig a little deeper. When HM is suspected, genetic testing is helpful. A full family medical history is also critical.

To read the whole article, see Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report. And remember – take migraine seriously, even if it takes some work to understand it.

When Taking a Shower Hurts: Migraine and Depression

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Taking a shower can be pretty painful for some people during a migraine attack. And I’m not necessarily referring to migraine pain. I’m talking about allodynia.

When taking a shower HURTS!Allodynia – in this case, cutaneous allodynia, is a strange discomfort and/or pain on the skin, for no normal reason. The slightest touch can cause this pain – wearing jewellery, even standing outside on a windy day – or taking a shower.

It’s a fairly common symptom of migraine, affecting about 2/3 of us, and more common in women (although I have had the dubious pleasure myself).

Sometimes, allodynia is a warning sign, coming before the headache phase of the migraine attack. Repeated episodes of allodynia may also signal a future worsening of migraine, from episodic to chronic.

Researchers in Korea studied 332 patients to find out what other issues may be comorbid with allodynia – what did patients with allodynia have in common?

They found that fewer Korean patients seemed to suffer from allodynia than expected, but there was still a large enough group to draw some tentative conclusions.

As with previous studies, they confirmed that the symptom was most common in women. But they also found that allodynia frequently went along with major depressive disorder. Chronic migraine was also present in many patients, as well as sensitivity to light.

Depression continues to be a tricky thing to understand when it comes to migraine. Although certainly migraine symptoms may make you depressed, there seems to be something else going on that makes the depression worse than expected in some people. The commonality of allodynia and depression may give us further clues into the connection.

As we continue to study, be sure to mention as many symptoms as you can to your doctor. Depression, allodynia, and other symptoms and conditions may help her treat you better. Although some medications may better help patients with allodynia, it’s important to treat migraine – and depression – as a whole, in order to get rid of this possibly disabling symptom.

For more on cutaneous allodynia, check out My Hair Hurts! Migraine and Allodynia.

Also see the study abstract here: Cutaneous Allodynia and Its Risk Factors in Korean Patients with Migraine: A Survey of Two Tertiary Care Hospitals. Another in-depth article on allodynia: Cutaneous Allodynia in the Migraine Population

MSG, Migraine, and New Treatments

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A new study is giving us further insight into the migraine-MSG connection, and may be another step to better migraine treatment in the future.

Recently we talked about a non-traditional migraine treatment – ketamine. Ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist, which means that it blocks a certain receptor that plays a part in the migraine chain-reaction. Memantine is another example.

Migraine is actually a complex web of cause and effect. So various treatments attack various parts of the migraine system.

MSG: Why does it trigger migraine attacks?What does all this have to do with MSG? MSG, or monosodium glutamate, is a common additive to foods which seems to trigger migraine symptoms in some people. Researchers in Canada decided to investigate further. In a report published in Neuroscience in October, they explained that MSG given to rats actually activates peripheral NMDA receptors, leading to migraine symptoms.

This may be another bit of evidence telling us to avoid MSG, but it’s actually much more than that.

It further confirms what scientists have suspected for many years – the NMDA receptors can play a key role in migraine disease. And so it may be that NMDA receptor antagonists are worth more serious research.

While older drugs like ketamine may help some patients, the side effects put them a long way down the list for most people. But if we could develop a similar drug with fewer side effects, it could help a lot of people who, up to this point, have not found a good treatment.

For more interesting information about NMDA receptors, and the connection between epilepsy and migraine, see Common Pathophysiologic Mechanisms in Migraine and Epilepsy. For more on how to spot MSG in foods, see The 12 Top MSG Offenders.

CGRP Inhibitor Race

Approaching the Finish line: CGRP Inhibitors

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For the last few years we’ve been watching the race to get CGRP inhibitors on the market for migraine prevention. Well, you could be seeing those drugs approved as early as next year. What’s the latest?

First, if you need to review exactly what CGRP inhibitors are, check out The Secret of CGRP.

CGRP Inhibitor RaceLeading the pack at the moment is erenumab, also known as AMG 334. In September, the report said that 70mg of erenumab, delivered by injection, had almost 3 fewer days of migraine attacks per month. These are episodic migraine sufferers who originally had between 4 and 14 migraine days per month. That means that if you could have about 30% fewer attacks, and side effects seem to be few.

Erenumab now moves into the second part of the trial, testing different dosages over 24 weeks.

Also in Phase III trials is galcanezumab, also known as LY2951742. Galcanezumab also had statistically significant results in previous trials, with a once-a-month injection, and participants are currently being recruited for new trials – those with chronic and episodic migraine, and those with chronic and episodic cluster headache – for more information visit ClinicalTrials.gov.

A little further behind, but possibly the one to watch in 2018, is TEV-48125. A once-monthly injection at various doses was tried, and as early as 3 days into the treatment patients had positive results. Studies continue for both chronic and episodic migraine.

Finally, let’s not leave out ALD403. ALD403 is well on its way for treatment of episodic and chronic migraine, though the episodic migraine trials are further along.

Many patients taking ALD403 in trials actually experienced a complete remission of migraine, and others a significant decrease. Trials continue.

These are just tidbits of information about the trials, and they really can’t be compared at this point, even if we did have all trial data. The point is that these still look like solid options to prevent episodic and chronic migraine, and even cluster. Some if not all of these should roll out over the next 2-3 years, and by that time we’ll know them better.

For more information, see:

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.