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There are many steps to optimum migraine care. A number of these steps can be performed by the patient even without the input of a physician.

First, it is helpful if patients keep a headache calendar where they write down their headaches, severity, what they take for the headache, and how they respond. I commonly ask my female patients to mark their menstrual cycles.

I ask all of my patients to avoid the most common migraine triggers for a period of time to see the effect. This means going caffeine free and chocolate free. I ask them to try and set a consistent sleep schedule.

For patients with more than 2 headaches a week, prevention before acute medication use is key. While I use many prescription medications for prevention, over the counter products like Coenzyme Q10 can commonly be helpful.

Avoid medication overuse headache. This means limiting all acute headache treatment (both over the counter and prescription) to only 3 days per week. Sorry, but on the other days you just have to suffer. In the long run, the patient is much better off. If they are seeing me, they will be on a preventative to help them. In addition, steroids are commonly used. Less commonly, the patients are admitted if they are unable to stop their daily medication.

Once the best acute migraine therapy is identified and the headaches are usually twice weekly or less, use the best therapy at the start of every headache. This minimizes disability. Unfortunately, many insurance companies work against this by limiting the patients triptan tablets per month. This is despite numerous studies showing that triptan use is actually cost effective.

Patients who are not doing well with their current physician should move on. For whatever reason, some physicians like to treat headache patients and some like to avoid them. Even among neurologists, some are much more likely to take on and treat the more difficult patients. This is human nature and it is unreasonable to fight it. If you are not doing well with your current physician or you feel that your needs are being ignored, go see someone else.