5 Reasons To Hire a Headache Specialist

Since being diagnosed with chronic migraine over 17 years ago, I cannot tell you the countless doctors I have consulted. Multiple Primary Care Doctors and those in Internal Medicine, an Ophthalmologist, an Optometrist, several regular Neurologists, and Doctors in Functional and Holistic Medicine. The list goes on. There is a place for many of these type of doctors in your headache and migraine care, I know because I utilize several. However, if your headaches or migraines are disrupting your life and work, you have chronic migraines/headaches (15 or more headache days a month), or intractable migraines, I cannot emphasize enough how important it is to find a doctor who specializes in headache medicine. This is not just a regular Neurologist, this is a Neurologist who has had EXTRA, specialized training including certifications in headache medicine.

Headache is one of the top reasons people visit the doctor every year, which is interesting because most regular doctors only get 4-10 hours of training in headache medicine during medical school. I have seen a few of these and trust me, they were not helpful. There are also many self-proclaimed Headache Specialists who just have a special interest in the area of headaches, but have not undergone the specialized training. I have seen two of these in Indianapolis and they did very little for me. 

Here are 5 reasons you should consider hiring a Headache Specialist:

1. Headache specialists go through extra training to become certified in headache medicine. They also usually do an extra year in residency training under some of the top headache specialists in the US at a headache clinic. These people have already seen hundreds of the most chronic headache and migraine patients before finishing residency and they have learned from the best in their field.

2. Headache specialists are always on top of the latest treatments, drugs, and new research. Most of them travel to conferences and seminars on a regular basis to learn what is up and coming for migraine treatment, so they can then offer these treatments to their patients. They will also be the first to get new drugs and treatments, sometimes with free samples.

3. You can get in on a new drug trial if you want because headache specialists always have the latest information on current migraine drug trials.

4. Headache Specialists understand when you have had a debilitating migraine for 7 days and need some acute treatment. They will often try to keep you out of the ER, by pulling you into the office for infusions, trigger points, nerve blocks, etc. When I have seen Neurologists who did not specialize in headaches, I would sometimes wait DAYS for a returned call and would just end up getting sent to the ER anyway. I am so thankful for my doctor who will pull me in on a day or two notice to help me break a bad cycle.

5. Because headache specialists see people just like us everyday, you will never be treated like migraine is a psychological disease, because it isn't.  Headache Specialists are often very understanding and empathetic to the debilitating disease which migraine is. Some of them also struggle with it themselves. Headache Specialists are also very well versed in the fact that everyone responds to treatment differently, and there is not a one treatment fits all.

There are about 500 Headache Specialists in the United States currently which is definitely not a lot

when you consider that 2.5 million people in the US struggle with some type of headache disorder. Several states do not have a Headache Specialist which may mean you are committing to some extensive travel. I drive three hours to see Dr. Kevin Weber at OSU Neurology in Columbus, Ohio who trained and did his fellowship at Cleveland Clinic Headache Center. He is the best doctor I have ever had, and it is 100% worth the drive.

To find a Headache Specialist in your area, please visit the Migraine Research Foundation  or go to the links on my Resource page.

That Darn MTHFR Gene and How It Affects Migraine

Having dealt with chronic migraine the past 14 years, I thought I had literally tried everything there was to treat migraine, unsuccessfully. After struggling with a disease for so many years, it is natural to think we have tried everything. I had failed so many migraine treatments, including botox, I felt like I was completely out of options. Then in 2015 I had some genetic and food sensitivity testing done. 

I have been told over the years my migraines were hereditary and there was just nothing I could do about it. Bad genes, they always said. I do have some bad genes. I inherited some really crappy genes, combined together, making for the perfect storm of poor health. I had heard of the MTHFR gene and started doing some of my own research. I was shocked at how many diseases have been linked to the MTHFR gene. When I got my genetic tests back, I wasn't terribly surprised to learn I had one copy of the MTHFR A1298C and one copy of the MTHFR C677T.

I am not all that special, as this genetic mutation is quite common. Studies have shown, 1 in 2 people, roughly 50% of the population, is a carrier for the MTHFR genetic mutation. Migraine is only a drop in the bucket of conditions the MTHFR gene affects. MTHFR has been linked to so many different health problems and diseases, it is surprising modern medicine isn't testing everyone for this gene. Fortunately, many people who have the gene may never have symptoms of these diseases. But then there are those like me who have several conditions related to MTHFR. Some of these chronic illnesses and diseases include:

• Autism
• Fibromyalgia
• Chronic Fatigue Syndrome
• Irritable Bowel Syndrome
• Coronary Artery Disease
• Parkinson's
• Miscarriage
• Schizophrenia
• Depression
• Anxiety
• Addictions
• Stroke
• Bipolar Disorder
• Blood clots
• Crohn's 
• Epilepsy
• Type 1 Diabetes
• Migraine with aura
• Alzheimer's
• Certain Cancers 
• Rheumatoid Arthritis

And this is in no way a comprehensive list. Dr. Ben Lynch, author of the website mthfr.net, has even gone so far as to claim, "MTHFR is related, directly or indirectly, to basically all human symptoms, conditions, syndromes, diseases and signs."  

What is the MTHFR Gene Mutation?

Never heard of it before? Let me try to explain in simple terms. MTHFR is the abbreviation for a gene called, methylenetetrahydrofolate reductase. MTHFR tells the body to produce an enzyme involved in converting specific B-Vitamins, namely methylfolate, into a form the body can use. Our bodies then take this converted form and turn it into specific proteins and vital compounds. Some of these include the neurotransmitters serotonin, norepinephrine, and dopamine. (2) Having the MTHFR gene with mutations such as C677T and/or A1298C, leads to a reduction in the function of this enzyme, and makes it difficult for the body to convert methylfolate into a form we can use,

specifically folic acid. Folic acid is often added generically to foods (take a look at your kid's cereal box) and is found generically in prenatal vitamins and other supplements. This is not necessarily a problem for people who do not have the MTHFR gene mutation. BUT, if you are a carrier of this gene and have two copies of C677T, or one copy of C677T and a copy of A1298C, you are at a greater risk of developing the diseases and conditions associated with this gene because your body is unable to process folate in the way it is supposed to.(1) I like how Dr. Ben Lynch broke it down on his website. MTHFR function is reduced typically in this way:

• MTHFR A1298C heterozygous (1 copy): 20% reduction in function
• MTHFR A1298C homozygous (2 copies): 40% reduction in function
• MTHFR C677T heterozygous (1 copy): 30-40% reduction in function
• MTHFR C677T homozygous (2 copies) 60-80% reduction in function
• MTHFR A1298C heterozygous and C677T heterozygous (one copy of each): 70% reduction in function. (3)

MTHFR and How It Relates to Migraine
I would love to expound on how MTHFR correlates to Hypothyroidism and the slew of other health conditions,because it is fascinating. But, for the purpose of this blog I am going to hone in on migraine. I love how the human body is complex and intricate, all parts working together to make sure things run smoothly. It is simply amazing to me how one seemingly small thing, can throw our bodies completely off.

In relation to migraine, MTHFR can lead to elevated homocysteine levels, which causes a problem for nerves and blood vessels, contributing to migraines. It can also produce "neurotoxic effects" and "hyperexcitability" in the brain. Studies have found reducing homocysteine levels through the proper supplementation of B-vitamins has helped to reduce migraine. Interestingly, another study found the different mutations on the MTHFR gene correlated to different associated symptoms of migraine. For example, C677T has been associated with physical activity and stress as a major migraine trigger, while the A1298C was found associated in those who suffered from migraine with aura. (1)

So what can we do? First if you do suffer from migraines, it is definitely worth getting tested for the MTHFR gene. I had lots of DNA testing done and it was a simple cheek swab for me.  MTHFR can also be tested for with a simple blood test. Oddly, I found out recently when I was reviewing some old medical records, I was tested for the MTHFR C677T gene back in 2008 when I was living in Amman, Jordan, after suffering two miscarriages. My doctor gave me the results, gave me a prescription for what I assume was a type of folic acid, but never told me anything else about it. Stateside, I have had two different OB's whom I showed this testing to and neither of them knew what to do with it. This is often the case as many doctors are uncomfortable with genetics and don't know how to treat MTHFR, or don't find it necessary. It's like my pediatrician said when I questioned her about having my kids tested for some of these genes, she was more than willing to run the tests, but needed to know what to do with the results. There are many doctors in the states, both conventional and functional, that have a good understanding of the MTHFR gene and know what to do with it.

Individuals who carry these genes need to be taking daily supplementation of methylated forms of Folate (5-MTHF) and Vitamin B-12 (methylcobalamin).  I take the special forms of these vitamins through Douglas Labs. Many over the counter supplements contain a synthetic form of folic acid, which will actually make things worse as the body cannot process it. Therefore, it is necessary to find the methylated forms with a reputable company. In the case of migraine, it is possible these two forms of methylated supplementation could work together to raise serotonin levels and potentially improve migraine.  And remember, synthetic forms of folic acid is often added to our food, so read labels and avoid. As always, it is better to eat fresh foods that naturally contain folates such as leafy greens.

I have only been on my nutraceuticals for a few months and I have made a lot of changes in my diet and life. Even in this short time, I have seen major progress in not only reduction of my migraine, but also improvement in my IBS, fatigue and Hashimoto's.

  


1. "Effects of MTHFR Gene Polymorphism on the Clinical and Electrophysiological Characteristics of Migraine," BMC Neurology 2013. Online. http://bmcneurol.biomedcentral.com/
2.  "Studies on the Pathophysiological and Genetic Basis of Migraine," U.S. National Library of Medicine National Institutes of Health. Current Genomics, published online 2013.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763681/
3. Lynch, Dr. Ben, "Is MTHFR Related to X Condition? X Disease? X Symptom? X Syndrome?" Online. mthfr.net June 10, 2015

Medical Marijuana For Migraines

One needn't look far to find research pointing to the amazing benefits of medical marijuana for certain medical conditions. And because medical cannabis is being used to treat multiple chronic pain conditions, migraine sufferers are wanting to know if it can help them also. New research may suggest medical cannabis is useful not only for treating migraines acutely, but also for preventing them. While the legalization of marijuana is still highly controversial among individuals and in many states (I live in Indiana where medical marijuana is still not legal), one cannot dismiss the fact there are amazing uses for medical marijuana in the area of pain management. Those who have lived in chronic pain, from either migraines or other diseases, are willing to try almost anything. I know I am, particularly after failing multiple treatments.

Dr. Eric Baron, a top ABPN Board Certified Neurologist and a UCNS Diplomat in Headache Medicine at Cleveland Clinic Neurological Institute in Cleveland, Ohio, spoke specifically on this topic at The Migraine World Summit this year. He gave an excellent history of medical cannabis and the potential benefit for migraine and pain. While it's not surprising cannabis was being used in ancient times by the Greeks and Chinese for pain--who knew as early as the mid-1800's, the Western World was also using it, and specifically in the treatment and prevention of migraines? Dr. Baron discusses this and also gives an in depth summary of why medical cannabis was made illegal in the US.

As a headache doctor that sees chronic patients daily, Dr. Baron discusses why cannabis might also work for migraineurs. Cannabis works through "neurological pathways and electrical channels" in the brain that could also influence the same receptors as modern migraine medication and opioid medications. For example Triptans, a class of abortive migraine medications target the serotonin pathways in the brain. Cannabinoids seem to act in the same way. A problem however, is there have been no clinical trials for medical marijuana and migraine. According to Dr. Baron, we only have case reports and a retrospective study done in 2016. This study looked at 121 patients who used medical cannabis to treat migraines over the course of months. Again as a retrospective study, it showed 85% of patients had a significant decrease in migraines, averaging a decrease from 10.2 migraines a month, down to 4.6. There is definitely a need for more research and clinical trials for the use of medical cannabis and migraines.

You can watch Dr. Baron's fascinating discussion below. You can also follow him on Twitter: 
+Neuralgroover .